Excoriation disorder—also called dermatillomania or skin-picking disorder—is when skin picking becomes an uncontrollable urge that interferes with well-being and your daily life.
While everyone can feel the need to pick at or scratch their skin from time to time, those with excoriation disorder feel unable to stop, even when skin picking interferes with their daily lives or causes stress and discomfort.
Excoriation disorder affects about 2% to 5% of the population, and about 3 of 4 people living with it are female. Excoriation disorder usually begins during puberty, and it can be triggered by skin conditions like acne and emotional states like stress, boredom, or anxiety. The disorder is most likely to start with picking at facial skin, but skin picking disorder scars can be found anywhere on the body.
This article covers causes, effects, and treatments for excoriation disorder.
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What Is Excoriation Disorder?
Excoriation disorder is a skin-picking disorder marked by an uncontrollable need to pick and scratch at the skin, often to the point of injury. Excoriation disorder can cause feelings of shame, depression, and anxiety at being unable to stop the habit, and it can include losing large amounts of time and energy to obsessively picking at and trying to cover up scars.
Signs and Symptoms of Excoriation Disorder
Signs and symptoms of excoriation disorder include:
- Skin picking that causes bruising, scars, or injury to skin tissue
- Being unable to control or stop skin picking
- Feeling stress, shame, and other negative emotions because of skin picking
- Spending large amounts of time managing the effects of excoriation, like injuries and covering up skin
- Avoiding interactions with others, including medical professionals and intimate partners, because of shame about skin lesions caused by skin picking
What Causes Body-Focused Repetitive Behaviors?
Excoriation is a body-focused repetitive behavior like trichotillomania (hair-pulling disorder) or cheek biting.
Causes of body-focused repetitive behaviors can include:
- Having a family member who also engages in body-focused repetitive behaviors
- Distorted ideas about how the skin is supposed to look
- A bump or scar that is tempting to pick on
- Stressful life situations or living environment
- General temperament, which is the attitude or mood a person is usually prone to
- Age that skin picking begins
The Effects of Excoriation Disorder
Excoriation disorder can have an effect on the physical and mental health of those who live with it.
Social and Emotional Effects
The social and emotional effects of excoriation disorder include:
- Avoiding social interactions that could reveal scars, such as summer outings or intimacy
- Becoming less productive
- Shame and guilt at being unable to stop picking skin
- Depression
- Lost time to obsessing over scars or trying to cover them up
Medical Complications
Excoriation disorder can lead to skin scarring, bruising, and tissue damage. Avoiding medical care because of embarrassment about scars is another effect, and this can make infections or other health conditions worse.
Diagnosis and Comorbid Conditions
There are other disorders that might be present along with excoriation disorder, including:
- Obsessive-compulsive disorder (OCD): A condition where intrusive thoughts lead to ritualistic behavior meant to ease anxiety
- Body dysmorphic disorder (BDD): Fixating on physical flaws to the point of disruption to daily life and well-being
- Mood disorders: Including depression or bipolar disorder
- Anxiety disorders
Treatments for Excoriation Disorder
Only about 20% of those with excoriation disorder seek treatment. This might be because of embarrassment or the belief that the skin picking is simply a bad habit. Some might visit a dermatologist before seeking psychological help with excoriation disorder.
Treatments for excoriation disorder might include:
- Cognitive behavioral therapy (CBT): This is a type of talk therapy that focuses on the thoughts and belief systems that drive behaviors. CBT includes learning techniques to manage emotions.
- Exposure and response prevention (ERP): This is one type of CBT. ERP involves gradually and progressively exposing someone to situations that trigger anxiety as a way to manage that anxiety.
- Medication: Some antidepressants can help with symptoms of excoriation disorder.
Summary
Excoriation disorder—also called dermatillomania or skin picking disorder—is marked by an uncontrollable urge to pick at the skin to the point of harm and disruption to daily life. Causes of excoriation disorder include stress, depression, boredom, wanting to meet certain standards of appearance, and having a family member who also has the disorder.
Skin-picking disorder can lead to bruises and injury, shame, depression, anxiety, and avoidant behaviors to hide one’s body and condition from others. It might also lead to spending excessive amounts of time focusing on skin picking and working to cover up the appearance of scars and lesions.
Treatment for excoriation disorder includes cognitive behavioral therapy (CBT), a type of talk therapy that focuses on the ideas and thoughts behind behavior. A CBT method commonly used to treat dermatillomania is habit reversal training, which involves replacing harmful behaviors with helpful ones.
A Word From Verywell
We can all unconsciously rub our skin from time to time, whether from stress, boredom, or noticing perceived skin flaws. But if you find yourself doing it to ease anxiety and are unable to stop the habit no matter the effect, you might consider seeing a healthcare provider or a trained therapist for an evaluation.
If diagnosis and therapy are inaccessible to you, a support group for obsessive-compulsive behaviors might help, as might researching cognitive behavior therapy and habit reversal techniques. Treatments you can try on your own include mindfulness (letting uncomfortable feelings come and go), wearing gloves, applying lotion to your skin, and being open about your problem to loved ones. Excoriation disorder might seem embarrassing to live with, but facing the emotional causes head on could be a great first step toward healing.
Frequently Asked Questions
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Skin conditions can lead someone to skin picking, but they are not the direct cause of excoriation disorder (dermatillomania). Dermatillomania is a disorder in which the desire to pick at the skin is uncontrollable, and attempts at quitting can be unsuccessful and cause shame. Whereas a skin disorder can be treated with help from a dermatologist, dermatillomania usually needs treatment that addresses the psychological reasons behind it.
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Excoriation disorder is not likely a type of self-harm, considering that those with excoriation disorder are not seeking pain. Self-harm is usually triggered by a need to escape emotional turmoil. On the other hand, excoriation disorder is compulsive and driven by a need to soothe anxiety. According to the TLC Foundation for Body-Focused Repetitive Behaviors, those in a state of skin picking are usually not doing it consciously and wish to stop.
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Cognitive behavioral therapy (CBT) is recommended for skin picking. Habit reversal training is the most common CBT method used. With this method, a therapist will guide a patient toward less harmful behaviors to replace the skin picking. These methods might include wearing gloves, applying lotion to itchy skin, holding back from skin picking in longer and longer increments, and discussing the disorder with loved ones.