Excoriation (Skin Picking) Disorder
If you find yourself repeatedly picking at your skin, whether it's acne, scabs, or even healthy skin, you're not alone.
Skin picking can feel like an uncontrollable urge, and for some, it’s a way of dealing with emotions like stress or anxiety.
However, when these behaviors become persistent and lead to visible damage, scarring, and emotional distress, it may indicate Excoriation Disorder (also known as Skin Picking Disorder).
While this condition can be distressing, the good news is that there are effective treatment options, particularly Cognitive Behavioral Therapy (CBT), that can help reduce the behavior and its associated distress.
What is Excoriation (Skin Picking) Disorder?
Excoriation Disorder is characterized by the repeated picking of one’s skin, often causing noticeable damage, scarring, or infections.
This disorder falls under the category of obsessive-compulsive and related disorders in the DSM-5 (American Psychiatric Association, 2013).
Unlike occasional skin picking, Excoriation Disorder is a chronic condition that can significantly interfere with a person’s daily life.
The picking is usually a compulsive behavior, often linked to feelings of tension or anxiety, and a sense of relief or satisfaction once the behavior is performed.
Common symptoms of Excoriation Disorder include:
Repeated skin picking: Picking at scabs, acne, or healthy skin, leading to sores, scars, and potential infections.
Inability to stop: Despite attempts to reduce or stop the behavior, individuals feel compelled to continue picking.
Significant distress: Feelings of shame or embarrassment, especially when the damage is visible.
Physical damage: Open sores, scabs, scars, and risk of infection.
Avoidance of social situations: People may avoid social interactions to conceal skin damage or due to fear of judgment.
Temporary relief: A feeling of relief or satisfaction during or after skin picking, followed by regret or guilt.
Diagnosis
According to the DSM-5 criteria, Excoriation Disorder is diagnosed when skin picking leads to visible damage and causes significant distress.
The diagnostic criteria are:
Recurrent skin picking results in physical damage, such as sores or scars.
Multiple unsuccessful attempts to stop or reduce the behavior.
The behavior causes significant distress or impairment in social, occupational, or other important areas of functioning.
The behavior is not better explained by another medical or mental health condition (American Psychiatric Association, 2013).
In the ICD-10, it is classified as an “Obsessive-Compulsive Disorder” (F42.8) related condition due to the compulsive nature of the behavior (World Health Organization, 2019).
How Excoriation Disorder Affects Daily Life
Excoriation Disorder can have profound consequences on an individual’s physical, emotional, and social well-being.
Visible skin damage can lead to feelings of embarrassment, shame, and low self-esteem.
Individuals often avoid social situations, making the disorder even more isolating. The compulsive nature of the behavior can also interfere with daily activities, work, and school.
As the condition worsens, emotional distress such as anxiety and depression can develop, further exacerbating the symptoms.
Treatment Options for Excoriation Disorder
Excoriation Disorder is treatable, and there are several evidence-based treatments available that can significantly reduce skin-picking behavior and address the emotional distress associated with the disorder.
The NICE (National Institute for Health and Care Excellence) guidelines recommend several treatment approaches, focusing primarily on Cognitive Behavioral Therapy (CBT) and Habit Reversal Training (HRT), with additional support from medications when necessary.
Effective Treatment Options Include:
According to the NICE guidelines, the first-line treatment for Excoriation Disorder is CBT combined with HRT. Medication, such as SSRIs, is recommended for individuals who do not respond to psychotherapy alone (National Institute for Health and Care Excellence, 2013).
It focuses on identifying and altering the negative thought patterns and emotions that trigger compulsive skin picking. By helping individuals become more aware of the behaviors and the underlying triggers, CBT empowers them to develop healthier coping mechanisms.
CBT and HRT have been shown to be effective in a range of studies, with individuals demonstrating significant reductions in skin-picking behavior and improvements in emotional well-being (Diefenbach & Tolin, 2009).
Mindfulness-Based Cognitive Therapy (MBCT): MBCT is a form of therapy that combines traditional CBT techniques with mindfulness practices.
This therapy helps individuals become more aware of their bodily sensations and emotions without acting on them.
By fostering greater self-awareness and emotional regulation, MBCT can help individuals break the cycle of compulsive skin picking and respond to urges with more calmness and acceptance.
Support Groups: Support groups or group therapy can also be a valuable part of treatment.
Connecting with others who struggle with similar behaviors can reduce isolation and provide emotional support.
Group therapy offers a safe space to discuss challenges, share strategies, and gain encouragement.
How Shenwise Can Help
At Shenwise, we understand how challenging it can be to live with Excoriation Disorder.
That’s why we offer compassionate, evidence-based treatment options, including Cognitive Behavioral Therapy (CBT) and Habit Reversal Training (HRT), to help you break the cycle of skin picking and manage the emotional distress it causes.
We work closely with you to understand your unique triggers and develop personalized strategies to improve your self-image and coping skills.
Together, we can work to transform your relationship with your skin and foster a healthier, more positive self-image.
If you're ready to take the first step toward healing, contact us today for a free 15-minute consultation.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Diefenbach, G. J., & Tolin, D. F. (2009). Cognitive-behavioral therapy for excoriation (skin picking) disorder: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 77(5), 862–868. https://doi.org/10.1037/a0016237
Flessner, C. A., Frankel, A. M., & Woods, D. W. (2008). Cognitive-behavioral therapy for excoriation (skin picking) disorder: A review and treatment considerations. Journal of Contemporary Psychotherapy, 38(4), 161-168. https://doi.org/10.1007/s10879-008-9097-7
Keuthen, N. J., Woods, D. W., & Flessner, C. A. (2013). Cognitive-behavioral therapy for skin picking disorder. Journal of Anxiety Disorders, 27(1), 78-82. https://doi.org/10.1016/j.janxdis.2012.10.007
National Institute for Health and Care Excellence. (2013). Obsessive-compulsive disorder and body dysmorphic disorder: Treatment in adults and children. NICE Guidelines. Retrieved from https://www.nice.org.uk/guidance/cg31
World Health Organization. (2019). International Classification of Diseases (ICD-10). Retrieved from https://www.who.int/classifications/icd/en/