What Is Excoriation Disorder and How Is It Treated?

What Is Excoriation Disorder?

Excoriation disorder, also known as skin-picking disorder, is a mental health condition where a person repeatedly picks at their skin, often to the point of causing injury. It goes far beyond occasional picking. People with this condition can spend hours each day trying to remove small imperfections from their skin—sometimes even when there’s nothing there.

Excoriation disorder is classified under Obsessive-Compulsive and Related Disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It affects around 1–5% of the population, and although anyone can develop it, it’s more commonly seen in teenagers and adult women.

Why Do People Pick Their Skin?

This is one of the most misunderstood parts of excoriation disorder. To an outsider, it might seem like a habit or even self-harm. But for many sufferers, it’s not about pain—it’s about relief.

People may pick their skin because of:

• Stress or anxiety relief

• Boredom or restlessness

• Perfectionism—trying to remove perceived flaws

• A sense of satisfaction after picking

Let’s say you have a tiny bump on your arm. Most people would ignore it. But someone with excoriation disorder might obsess over it, feeling intense discomfort until they pick it—sometimes leading to scabs, bleeding, or even infections.

What Are the Common Signs and Symptoms?

Here are some telltale signs someone may have excoriation disorder:

• Visible skin damage (scars, sores, or wounds)

• Frequent use of tools like tweezers or pins to pick

• Spending hours daily picking skin

• Avoiding social situations due to shame about skin appearance

• Unsuccessful attempts to stop despite the harm it causes

Real-life example:
A 27-year-old woman named Rhea described her experience as a “loop she couldn’t break.” She’d start picking while watching TV, thinking she’d just remove one bump. Hours later, she’d realize she had open wounds on her arms and face, followed by waves of guilt and sadness.

Is Excoriation Disorder a Type of OCD?

Yes, it falls under the umbrella of OCD-related disorders. Like OCD, it involves repetitive behaviors and distress when the urge isn’t satisfied. However, skin picking isn’t always driven by obsessive thoughts. Sometimes it’s automatic, almost like being in a trance.

There are two types of picking:

• Focused picking – done intentionally to reduce anxiety or tension

• Automatic picking – happens without awareness, like during screen time or while reading

What Triggers Skin Picking Episodes?

Triggers can vary from person to person, but common ones include:

• Stress and anxiety

• Fatigue

• Skin conditions (like acne or eczema)

• Boredom or idleness

• Emotional upset

Many people describe a “build-up” feeling—an internal tension that only subsides after picking. It’s important to understand that it’s not a choice—it’s a compulsion.

What Are the Effects on Mental and Physical Health?

Excoriation disorder doesn’t just leave physical scars. It can deeply affect a person’s emotional well-being, confidence, and relationships. Here’s how:

Physically:

• Infections

• Permanent scarring

• Delayed wound healing

• Hyperpigmentation

Mentally:

• Low self-esteem

• Feelings of shame or embarrassment

• Social isolation

• Depression and anxiety

One teenager who shared her story on the International OCD Foundation site said she started skipping school because classmates asked about the sores on her arms.

How Is Excoriation Disorder Diagnosed?

A mental health professional will usually:

1. Take a detailed history of your symptoms and behaviors

2. Rule out medical causes like dermatological issues

3. Use criteria from the DSM-5, such as:

   • Recurrent skin picking that results in lesions

   • Repeated attempts to stop

   • Significant distress or interference with daily life

Dermatologists and psychiatrists often work together to make sure both the skin and mental health are addressed.

What Are the Best Treatment Options?

The good news? Excoriation disorder is treatable. Here are the most effective approaches:

1. Cognitive Behavioral Therapy (CBT)

Especially a method called Habit Reversal Training (HRT). It teaches you to:

• Recognize triggers

• Replace picking with alternative actions (like squeezing a stress ball)

• Develop healthier coping strategies

2. Medication

Sometimes SSRIs (Selective Serotonin Reuptake Inhibitors), like fluoxetine or sertraline, can help reduce compulsive urges.

3. Mindfulness and ACT (Acceptance and Commitment Therapy)

These help reduce the emotional pull of the urges by increasing awareness and teaching acceptance of uncomfortable thoughts.

4. Support Groups

Online and in-person support communities (e.g., through The TLC Foundation for Body-Focused Repetitive Behaviors) can be life-changing.

Can Lifestyle Changes Help?

Absolutely. While therapy and medication are important, lifestyle tweaks can make a big difference:

• Keep hands busy (knitting, fidget toys, stress balls)

• Use barriers like gloves or bandages when urges strike

• Set up picking-free zones (no picking in front of mirrors, etc.)

• Journal daily to spot patterns and triggers

• Practice self-compassion instead of shame

Tip: If nighttime is your vulnerable time, try setting up a calming bedtime routine. Soothing music, chamomile tea, and dim lights may help reduce urges.

Is It Possible to Fully Recover?

Recovery looks different for everyone. For some, the picking may completely stop. For others, it might mean fewer episodes and better control.

Progress is not linear—and that’s okay.

The goal isn’t perfection, but awareness, self-kindness, and improvement. With the right help, people can go from feeling trapped to feeling empowered.

What Should You Do If You Think You Have It?

Here’s a step-by-step plan:

1. Track your symptoms for a week.

2. Speak to a therapist or psychiatrist—look for someone with OCD or body-focused repetitive behavior (BFRB) experience.

3. Be honest and open—even if it feels embarrassing.

4. Avoid Googling random fixes. Stick to expert advice.

Final Thoughts: You Are Not Alone

Excoriation disorder might feel isolating, but many people are silently struggling with the same battle. Shame thrives in silence. The more we talk about it, the more we understand—and heal.

Remember: this isn’t about willpower or vanity. It’s a real condition, and you deserve real help.

FAQ – People Also Ask

1. Is excoriation disorder the same as dermatillomania?
Yes, dermatillomania is another term for excoriation disorder.

2. Can skin picking cause permanent damage?
Yes, long-term picking can lead to scars, infections, and skin discoloration.

3. Is skin picking linked to anxiety or trauma?
Often, yes. Many people pick more during stressful periods or after emotional triggers.

4. How do I stop skin picking naturally?
Start by identifying triggers, using substitutes (like stress balls), and creating routines that reduce idle time.

5. Can children have excoriation disorder?
Yes, though it’s more commonly diagnosed in adolescents and adults.