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Skin Picking Disorder (Excoriation)

Many people pick at their skin once in a while, but sometimes it crosses the line into a condition called skin picking disorder (excoriation).

When this happens, picking at the skin -- for example, picking a scab or the skin around your nails -- can become so frequent and intense that it causes bleeding, sores, and scars.

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Some people with this disorder repeatedly scratch to try to remove what they see as some kind of imperfection in their skin.

What Are the Signs of Skin Picking Disorder?

It's hard to say exactly when skin picking changes from a mild, nervous habit to a serious problem that needs treatment. It may help to ask the following questions:

  • Does picking at your skin take up a lot of time during the day?
  • Do you have noticeable scars from skin picking?
  • Do you feel upset when you think about how much you pick your skin?
  • Does picking at your skin get in the way of your social or professional life? For example, do you avoid the beach or the gym because people might see your scars? Or do you spend a lot of time covering up sores before work or social events?

 

How Does Skin Picking Disorder Develop?

Skin picking disorder happens in both children and adults. It can begin at almost any age.

Skin picking disorder often develops in one of two ways:

After some kind of rash, skin infection, or small injury. You may pick at the scab or rash, which causes more injury to the skin and keeps the wound from healing. More itching leads to more picking and more scabbing, and the cycle continues.

During a time of stress. You may absently pick at a scab or the skin around your nails and find that the repetitive action helps to relieve stress. It then becomes a habit.

Skin picking disorder is considered a type of repetitive "self-grooming" behavior called "Body-Focused Repetitive Behavior"(BFRB). Other types of BFRBs include pulling or picking of the hair or nails that damages the body.

It is also sometimes classified as a type of obsessive compulsive disorder because of the compulsive urge to perform repetitive behaviors.

Treatment

Skin picking disorder is treated with therapy and medications.

There are two main kinds of therapy for skin picking:

Habit reversal training. The therapist helps you identify the situations, stresses, and other factors that trigger the skin picking. Then your therapist will help you find other things to do instead of skin picking, such as squeezing a rubber ball. This will help ease stress and occupy your hands.

Stimulus control. This therapy involves making changes to your environment to help curb skin picking. For example, you might try wearing gloves or Band-Aids to help prevent feeling the skin and getting the urge to pick. Or you might cover mirrors if seeing facial blemishes or pimples brings on picking behavior.

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