Compulsive Skin Picking

Compulsive skin picking goes by many different names. It’ commonly diagnosed as “Impulse Control Disorder Not Otherwise Specified.” It’s also called “dermatillomania” and “excoriation disorder.”

Compulsive skin picking is an anxiety disorder in which people compulsively pick pimples, scabs, and other imperfections on their skin. Depending on severity, skin picking results in red marks, scab, scars, and disfigurement. It’s a mental illness in which the person compulsively picks or digs into the skin with fingers, pins, tweezers, or other items to remove small irregularities such as moles or freckles.

It’s worth noting that many people with this disorder report that the behavior is often done. Skin picking are usually preceded by an emotional feeling of tension or anxiety. During episodes of skin picking, feelings of relief, relaxation, or even dissociation (zoning out) usually occur.

After the episodes of skin picking are over, feelings of guilt, shame, and depression are common. Skin picking frequently result in disruptions to one’s life such as lateness or avoidance of social interactions. There are many different triggers of pulling and skin picking and the specific triggers vary from person to person.

Common Triggers of Skin Picking

Common triggers include:

  • Being in a location in which skin picking commonly occur (e.g., the bathroom, bedroom, or car)
  • Being around utensils used to pick (e.g., tweezers, mirrors)
  • Noticing an imperfection in the appearance of one’s skin (e.g., noticing pimples or scabs on one’s skin)
  • Feeling an imperfection on one’s skin (e.g., a pimple can be felt)
  • Feeling anxious, depressed, angry, excited, or bored
  • Desiring to fidget with one’s skin
  • Desiring to feel a certain physical feeling from skin picking (e.g., a pop when a pimple is popped)
  • Finding oneself skin picking after a significant amount of time (minutes to hours) during which the person was not aware of the picking.

Compulsive skin picking is defined as an impulse control disorder, however, it frequently co-occurs with obsessive compulsive disorder (OCD), and is informally considered OC spectrum disorders. In addition, although compulsive skin picking is not addictions, it functions very much like an addiction.

The urge to pick increases as the frequency of picking increases. Picking feels pleasurable despite the fact that the behavior later causes depression, shame, guilt, scarring, bald patches, and other negative consequences.

Treatment of Compulsive Skin Picking

Treatment of compulsive skin picking needs to be designed to treat the specific triggers and emotional responses of the individual. Treatment includes education about compulsive skin picking, awareness of triggers of picking, and strategies to reduce the occurrence of picking.

Once the occurrence of picking is reduced, the urge to pick is reduced accordingly. For some people, antidepressant medications can reduce the urge to pull in some individuals so that clients can better use the strategies they are learning in treatment. However, medication should always be done in conjunction with therapy and should only be short term.


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