Updated on 1/18/2023

Some people find themselves distractedly picking at their skin from time to time. For example, they may randomly pop a pimple or scratch at a particularly worrisome scab or any other skin condition. In some cases, this habit of picking behavior can develop into a more heightened and persistent pattern of compulsive skin picking, a condition known as excoriation disorder.

What Is Excoriation (Skin Picking) Disorder?

Excoriation disorder, commonly known as the “skin picking disorder,” is a psychiatric condition that is characterized by the repetitive and sometimes aggressive picking of one’s own skin. It’s a compulsive body-focused repetitive behavior, and people who engage in it often don’t even realize they’re doing it. Others find it’s a habit that’s hard to abstain from. 

The American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) categorizes excoriation as an obsessive-compulsive behavior that’s made up of recurrent body-focused actions.

The diagnostic criteria for excoriation as laid out by the DSM-5 are:

  • Recurrent skin-picking resulting in skin lesions
  • Repeated attempts to decrease or stop skin picking
  • Compulsive skin picking causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
  • The pathological skin picking cannot be attributed to the physiologic effects of a substance (e.g., cocaine) or another medical condition (e.g., scabies)
  • The pathological skin picking cannot be better explained by the symptoms of another mental disorder (e.g., delusions or tactile hallucinations [psychotic disorder], attempts to improve a perceived defect or flaw in one’s appearance [body dysmorphic disorder], stereotypies [stereotypic movement disorder], or intention to harm oneself (non-suicidal self-injury)

Excoriation disorder is related to obsessive compulsive disorder (OCD). The different types of OCD are characterized by an uncontrollable need to perform certain compulsions or routines repeatedly (like hair-pulling or skin-picking) and is often overcome by repetitive thoughts or obsessions. 

Someone with OCD has little control over their thoughts or actions. Similarly, someone suffering from excoriation skin picking disorder doesn’t have much power over this body-focused repetitive action. Research has shown that this condition affects a small percentage of the population — an estimated 1-5% — the majority being women.

The skin is the body’s largest organ, which means any condition that affects it can also harm general health and well-being. Excoriation disorder can cause significant distress. It can result in physical pain as well as shame and embarrassment about the appearance of skin lesions. It can also affect relationships and self-worth.

Symptoms of Excoriation Disorder

It isn’t always easy to spot the signs of a skin picking disorder. Many people with this condition spend a significant amount of time trying to camouflage excoriation disorder symptoms, making the condition difficult for others to detect. That said, there are some recognizable symptoms, such as:

  • Devoting large amounts of time to skin picking 
  • Skin lesions 
  • Attempting to hide lesions via makeup, clothing, or other means 
  • Social withdrawal
  • Rituals surrounding skin picking 
  • Engaging in other repetitive, body-focused behaviors, such as hair-pulling 
  • Significant impairment or distress due to these symptoms

Causes of Excoriation Disorder

What causes people to compulsively pick at their skin? While skin picking disorder hasn’t been linked to a specific cause, several factors make people more likely to develop it. 

Skin conditions, such as acne or eczema, are potential triggers for the onset of excoriation disorder symptoms. It’s not unusual for people to begin picking at their skin because there’s a blemish they want to get rid of, such as a pimple or a mole. 

“Excoriation disorder is related to the compulsive behavior of picking at your skin. There are several theories of what can cause this diagnosis. I have often seen clients whose anxiety was the biggest contributing factor to their compulsive behaviors. Identifying your specific triggers is an important goal of therapy.”

Talkspace therapist Ashley Ertel, LCSW, BCD

People may begin picking at their skin in response to various emotions, such as anxiety, anger, or boredom. Guilt and shame are also common triggers for skin picking. In many cases, people turn to skin picking because they don’t have other coping mechanisms. 

Research shows a link between excoriation disorder occurring comorbidly with other mental health conditions. Many people pick at their skin to cope with: 

As we’ve already noted, skin picking is significantly more common in people with obsessive-compulsive disorder, and it’s also been linked to body dysmorphic disorder. 

How to Deal with Excoriation Disorder

Stimulus control — a process where people struggling with this condition adopt preventive measures like keeping sharp objects used to pick at their skin out of reach or wearing protective clothing like gloves to prevent them from picking their skin — has been recommended as a means to break the habit.

While these tips can be helpful for some, others affected by this condition find it too easy to remove gloves or reach for objects like tweezers when the urge to pick at their skin arises. It’s as important to deal with the urge for this body-focused repetitive behavior as it is to adopt coping strategies that can help prevent skin picking. 

Multiple techniques can be effective. Here are 7 ways to deal with excoriation disorder.

1. Identify the triggers

To deal with excoriation disorder, the first thing one should do is identify and understand the factors that might trigger a compulsive picking behavior. There are several biological and environmental factors that can contribute to the growth of a persistent pattern of skin-picking and body-focused repetitive behavior. It’s important to be aware of any circumstances or triggers affecting someone to know the type of treatment to pursue.

Some people may pick their skin out of boredom, displeasure at blemishes, or in some cases, as a result of depression. If a person is triggered to pick their skin due to physical conditions like acne, consulting a dermatologist may be the best option. However, if the obsessive-compulsive habit is triggered by depression or anxiety, it’s important to speak with a mental health expert.

2. Get professional help

Many people dealing with excoriation skin picking disorder avoid seeking help from an expert because they feel shame about their condition and skin lesions. At the same time, others may not see skin picking as being serious enough to warrant seeking medical help.

Medication that helps ease anxiety and stress might be prescribed by an in-person or online psychiatrist to deal with the triggers that cause repetitive skin picking behaviors. There are several psychotherapeutic approaches and interventions available to reduce the symptoms, like cognitive behavioral therapy (CBT), which helps people understand the relationship between their thoughts, feelings, behaviors, and their mental health. Behavioral therapy for skin picking disorder can involve a level of habit reversal training, effectively helping to stop problematic repetitive behaviors. 

Since excoriation disorder often occurs simultaneously with other conditions like depression and body dysmorphia, it’s important to target these conditions with a therapist as well, so they don’t trigger the urge to pick up while the skin is being treated.

3. Exercise regularly

Chronic skin picking can be triggered by stress, anxiety, and negative moods. Adopting a consistent exercise routine is one effective way to reduce stress. Engaging in regular physical activity can help keep the mind occupied and lessen the urge to do body-focused repetitive behavior like hair pulling or skin picking. Aerobic exercises — like biking and swimming — minimize muscle tension and improve overall mood, reducing the impulse to engage in skin picking behavior.

Apart from physical exercise, practicing mindfulness can also help in dealing with excoriation disorder. Engaging in activities like yoga and mindfulness meditation can relax the mind and ease stress. Maintaining a calm mind and controlling harmful thought patterns can help identify obsessive thoughts that cause someone to pick at their skin. On a general note, exercising the mind and body keeps us busy and fosters a positive mindset.

4. Develop healthy self care rituals

Another effective way to deal with excoriation disorder is by developing healthy rules and rituals to control anxiety, which often contributes to body-focused repetitive behavior. 

These self-care routines don’t have to be life-altering or complicated. They can be simple activities like listening to soothing music, journaling for mental health, eating healthy, or adopting a regular skincare routine. Small adjustments like these can go a long way in curbing stress and reducing the urge to pick skin since self care helps develop a more positive mindset.

Even though it may be hard to adopt new habits to replace compulsive picking, it’s important to maintain consistency and slowly incorporate new, healthy rituals into daily routines.

5. Strengthen your support system

Building a strong support system made up of close friends and family is crucial for anyone dealing with excoriation disorder. This condition tends to isolate people from family gatherings and social events because they may be ashamed of the scars on their bodies. If you know someone struggling with excoriation disorder, be mindful that it doesn’t help when they get asked about scars. Many, when struggling with the disorder, find it difficult to speak about.

6. Try breathing exercises

Deep breathing can be an excellent way to calm down and relax when feeling overwhelmed. When some people feel the urge to pick at scabs, moles, or freckles, they can distract themselves by focusing on their breath instead. Taking deep breaths can also encourage the brain to release endorphins, a feel-good chemical. 

While there are many different breathing exercises, even something as simple as taking deep, slow breaths can be effective. Ideally, deep breathing should be done for at least 5 minutes. Many people find it easier to complete breathing exercises in a quiet area, but this coping strategy really can be done anywhere without others noticing.  

7. Learn more    

It can be difficult to cope with conditions someone doesn’t know much about. When people are still asking themselves questions like what is excoriation disorder, it can be hard for them to understand their symptoms. Learning more about skin picking can make people more aware of their condition and how it impacts their life. 

From books to podcasts to support groups, there are a wide range of resources available to people who have questions about excoriation disorder. Either in-person or online therapy can also be an excellent place to speak up and ask questions about why someone might pick at their skin and what they can do to stop. 

“With a diagnosis such as excoriation disorder, it’s important to find a therapist with whom you can build strong rapport. There’s often a lot of self-judgment associated with this diagnosis, and finding a therapist who helps you to feel safe is key.”

Talkspace therapist Ashley Ertel, LCSW, BCD

It can be challenging, but it’s important for people dealing with excoriation disorder to reach out and communicate with family and friends about their condition. Surrounding themselves with people who understand what they’re going through can ensure they get the necessary support and encouragement to deal with their condition.

When confronting excoriation disorder, the most important thing to remember is that everyone has the right to feel confident. Always. The skin positivity movement is one of the most progressive trends of the decade, and it highlights the need for people to feel free in their skin, regardless of conditions that cause them to have physical scars or blemishes. Don’t let excoriation disorder stop you from living life fully.