Skin picking disorder, also known as dermatillomania, is a mental health condition whereby a person feels compelled to pick at or manipulate their skin regularly. They may pick at moles, spots, scars or scabs. Repeated skin-picking can cause scarring, injuries and infections. Both the compulsion to pick at the skin and the impact it has on the skin's surface and daily life over time can cause stress and anxiety. Skin picking disorder may also co-occur with other mental health conditions such as body dysmorphic disorder and obsessive-compulsive disorder.
What are the signs and symptoms of skin picking disorder?
Skin picking disorder is known as a body-focused repetitive behaviour, when someone uncontrollably picks, rubs, squeezes or scratches their skin intensely.1 This may be done using fingernails or other tools such as tweezers, pins, needles or their teeth.2 Most commonly, individuals pick at the skin on their face, arms, scalp and legs, with the time spent picking each day ranging from a few minutes to multiple hours.2,3,4
There are two main types of skin-picking: focused and automatic. Automatic skin-picking happens without a person thinking about it. They may start to run their fingers across their skin to find an uneven surface, pimple, scab or scar, which they will begin picking. Automatic picking is a kind of scanning, with the person’s fingers acting like a radar. Focused picking is when a person chooses to begin picking at a particular area of the skin, which may go on for a long time. It’s this type of picking that can be most damaging to both the person’s skin and their well-being, as they may believe that picking their skin will make it appear smooth or better looking.
Who is affected by skin picking disorder?
1-5% of the population lives with skin picking disorder, making it a fairly common condition.5,6 Skin picking disorder may be diagnosed at any age, but most often when an individual starts puberty.7 Skin picking disorder is more common in those assigned female at birth (AFAB) than those assigned male at birth (AMAB).8 Those with pre-existing skin conditions such as acne or eczema are more likely to be diagnosed, as well as those with mental health conditions such as anxiety.9
What are the causes and risk factors for skin picking disorder?
Some of the main causes and risk factors for skin picking disorder are shown in the infographic below:
Image source: Parr-Reid S. Canva.
Common triggers for skin picking are boredom, anger, anxiety and being away from planned activities.10 This might be whilst sitting on the sofa or lying in bed.
How is skin picking disorder diagnosed?
There are some key tests and questions that can be used by a healthcare provider for the accurate diagnosis of skin picking disorder. Firstly, your healthcare provider will start by doing a physical examination of your body to identify any areas that may show evidence of skin picking. They will then ask you some questions about your previous medical history and any current conditions or behaviours that may relate to the condition.
Laboratory tests are rarely used to identify skin picking disorder, as it is mostly behavioural and psychological. To be given a diagnosis of skin picking disorder, you will need to meet all five of the criteria below:
- You experience skin picking regularly
- You have tried on several occasions to stop picking or pick less
- Picking your skin is badly impacting your daily life, for example, your work or social life
- Your skin picking is not directly related to another skin condition such as scabies or because of a medication you are taking
- The skin picking is not happening as a result of a different mental health condition such as body dysmorphic disorder, where you pick your skin because you do not like the way that it looks
If you think you may be living with skin picking disorder, speak to your healthcare provider to get the most appropriate support for you. It can be a daunting and anxiety-provoking experience visiting a healthcare provider, so if you have any worries or concerns, it can be helpful to take a loved one with you for support.
How is skin picking disorder treated?
Skin picking disorder is very treatable and gets better with time. Most commonly, talking therapies are given to those with skin picking disorder, to understand why they are picking their skin and how it makes them feel. Examples of this are cognitive behavioural therapy (CBT) and habit reversal training, which look at ways to prevent skin picking and replace it with healthier behaviours.
Medications can be given to help manage the symptoms of skin picking disorder. For example, if an individual is picking their skin due to anxiety or depression, they may be prescribed antidepressant medications to help lift their mood.
Coping strategies for those living with skin picking disorder
There are lots of great ways to manage skin picking that can be done at home or on the go at a low cost. The infographic below shows some examples:
Image source: Parr-Reid S. Canva.
The Picking Me Foundation has a wonderful page all about talking to others if you have skin picking disorder, sharing lived experiences of the condition. Skin picking deserves to be understood and not stigmatised, so the more conversations people start about it and try to understand it, the better the outlook will be for people living with skin picking disorder.
Lucy Mellor, who is 23 and lives with skin picking disorder says this about coping with the condition:
“For me, skin picking is something that happens when I am worried or stressed. So it is really helpful when I can let a friend know and they can point out if I am doing it and help support me to feel better. I also find that I just need to use my hands, so doing my hair in plaits or drawing can really help to keep my hands busy whilst being creative.
I now feel less self-conscious about skin picking, as it’s something I can talk to my friends and loved ones about and they want to listen, which makes such a difference.”
Support for loved ones of someone with skin picking disorder
If your loved one is experiencing skin picking disorder, there are some ways that you can support them. For example, asking non-judgemental questions about their condition such as what might help them to manage it. Also, if you notice they are doing it without realising, providing distraction can help rather than just pointing it out. Any way of showing that you want to understand what they are going through and are there to help them makes a big difference.
Since skin picking often comes with difficult feelings, try to support your loved one through those feelings instead of focusing on the picking itself.
Skin picking disorder is a mental health condition where someone continually and uncontrollably picks at their skin. It is fairly common, affecting those who are AFAB more than those who are AMAB. The condition can cause stress and anxiety and affect daily life. It is typically diagnosed alongside other mental health conditions such as anxiety, body dysmorphic disorder and obsessive-compulsive disorder, as well as in those who have acne or eczema.
The condition is highly treatable and can be managed with talking therapies, medications, support from loved ones and alternative ways to keep a person’s hands busy that don’t involve skin picking.
If you think that you or someone you love may be living with skin picking disorder, it is a good idea to speak to your healthcare provider and find support to ensure that the condition is managed.
- Gallinat C, Stürmlinger LL, Schaber S and Bauer S. Pathological Skin Picking: Phenomenology and Associations With Emotions, Self-Esteem, Body Image, and Subjective Physical Well-being. Front Psychiatry 2021;(12)732717. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8549828/
- Tucker BT, Woods DW, Flessner CA, Franklin SA and Franklin ME. The skin picking impact project: Phenomenology, interference, and treatment utilization of pathological skin picking in a population based sample. J Anxiety Disord 2011;25: 88–95. https://pubmed.ncbi.nlm.nih.gov/20810239/
- Bohne A, Wilhelm S, Keuthen NJ, Baer L and Jenike MA. Skin picking in German students: prevalence, phenomenology, and associated characteristics. Behav Modif 2002;26:320–329. https://pubmed.ncbi.nlm.nih.gov/12080904/
- Flessner CA and Woods DW. Phenomenological characteristics, social problems, and the economic impact associated with chronic skin picking. Behav Modif 2006;30: 644–963. https://pubmed.ncbi.nlm.nih.gov/17050772/
- Hayes SL, Storch EA and Berlanga L. Skin picking behaviours: an examination of the prevalence and severity in a community sample. J Anxiety Disord 2009;23(3): 314–319. https://pubmed.ncbi.nlm.nih.gov/19223150/
- Keuthen NJ, Koran LM, Aboujaoude E, Large MD and Serpe RT. The prevalence of pathologic skin picking in US adults. Compr Psychiatry 2010;51(2): 183–186. https://pubmed.ncbi.nlm.nih.gov/20152300/
- Odlaug BL and Grant JE. Phenomenology and epidemiology of pathological skin picking. In: Grant JE, Potenza MN (Eds). The Oxford Library of Psychology: Oxford Handbook of Impulse Control Disorder. New York, USA: Oxford University Press; 2011: 186–195.
- Bohne A, Keuthen N and Wilhelm S. Pathologic hairpulling, skin picking, and nail biting. Ann Clin Psychiatry 2005;17(4): 227–232. https://pubmed.ncbi.nlm.nih.gov/16402755/
- Lochner C, Roos A and Stein DJ. Excoriation (skin-picking) disorder: a systematic review of treatment options. Neuropsychiatr Dis Treat 2017;13: 1867–1872.
- Grant JE, Odlaug BL, Chamberlain SR, Keuthen NJ, Lochner C and Stein DJ. Skin Picking Disorder. Amer J Psych 2012;169(11): 1143–1149. https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2012.12040508