Excoriation Disorder

Excoriation Disorder (also known as dermotillomania), or compulsive skin picking, is a type of obsessive-compulsive disorder, in which individuals experience an overwhelming urge to pick their skin. This urge to pick one’s skin may or may not be triggered by a visible scab or other mark. The most common sites for skin picking are the face, arms, and hands, although others body parts can be picked as well. Episodes of picking can last anywhere between several minutes to several hours. In order to pic skin, individuals may use their fingers, tweezers, pins, or other objects.

As in individuals with trichotillomania, individuals with excoriation also report that their picking behaviour is either focused or automatic. Focused picking typically occurs in a response to an internal state (e.g. anxiety, sadness, stress, shame) or triggered by an stressful external event and is used to relieve tension or distress. Automatic picking occurs out of the individual’s awareness, often while watching television or reading.

Some signs and symptoms of excoriation may include: 

• Compulsive picking of skin 
• Repeated but unsuccessful attempts to reduce or stop picking 
• Increased tension prior to picking or when trying to resist picking 
• Developing skin lesions or scars because of picking 
• Ongoing picking despite obvious signs of damage (e.g. open sores, scars) or infections 
• A sense of pleasure or relief after skin is picked 
• Repeated scratching to eliminate “imperfections” 
• Spending large amounts of time picking 
• Avoiding public events because of their skin 
• Significant impairment or disruption in life functioning 

Picking at scabs or bumps, or popping a pimple from time to time isn’t uncommon. However, for some people skin picking can become chronic. This frequent picking can irritate the skin and cause new sores to form, which can cause scabbing or scarring. Many individuals with excoriation disorder often suffer from obsessive-compulsive disorder (OCD). 

One of the main treatments for excoriation disorder is cognitive behavioral therapy (CBT). CBT can help individuals identify triggers for skin picking, learn ways to cope with these triggers, address impulse control issues, address unhelpful thinking, and find alternative habits to replace skin picking. Additionally, stimulus control has been found to be helpful by making changes to an individual's environment (e.g. wearing gloves or band aids, covering mirrors) in order to help decrease skin picking. 

If you have experienced any of the symptoms above, you may be suffering from excoriation disorder. Contact us for a free 15 minute phone consultation to see how we can help.