Updated on 10/22/2021
Some people may 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. 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 Disorder?
Excoriation disorder, commonly known as the “skin picking disorder,” is a psychiatric condition which is characterized by the repetitive and sometimes aggressive picking of one’s own skin. It is a compulsive body-focused repetitive behavior, and people who engage in this skin picking behavior often do not realize that they are doing it. Others find that it’s a habit that is hard to abstain from. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) categorizes excoriation as an obsessive compulsive behavior that is made up of recurrent body-focused repetitive 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
- The compulsive skin picking causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
- The skin picking cannot be attributed to the physiologic effects of a substance (e.g., cocaine) or another medical condition (e.g., scabies)
- The 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 has been described as related to obsessive compulsive disorder (OCD). Obsessive compulsive disorder refers to a mental disorder where a person experiences an uncontrollable need to perform certain compulsions or routines repeatedly (such as hair-pulling or skin picking) and are often overcome by repetitive thoughts, or obsessions. An obsessive compulsive individual often has little control over these thoughts or activities. Similarly, someone suffering from excoriation skin picking disorder often does not have much power of this body-focused repetitive action. Fortunately, research has shown that this condition affects only a small percentage of the population – an estimated 2-5% – the majority being women.
The skin is the body’s largest organ, and this means that any condition that affects it can also affect a person’s general health and well-being. The impact of excoriation disorder on one’s life may be significant, as it causes physical pain and can make an individual feel shame and embarrassment about the appearance of their skin lesions and this compulsive behavior. It can also affect their relationship with themselves and others.
How to Deal With Excoriation Disorder
The exact cause of excoriation disorder, skin picking, remains largely unknown, but there are several ways to deal with the condition. Stimulus control —- a process whereby 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 may be helpful, individuals affected by this condition may find it too easy to remove gloves, or reach for objects like tweezers when the urge to pick at their skin arises. It is as important to deal with the urge for this body-focused repetitive behavior as to adopt habits that can help prevent skin picking.
Here are five ways to deal with excoriation disorder.
1. Identify the triggers
In order to deal with excoriation disorder, the first thing one should do is identify and understand the factors that trigger this compulsive picking behavior. There are a number of biological and environmental factors that contribute to the growth of a persistent pattern of skin-picking and body focused repetitive behavior. It is important for sufferers to be aware of the particular circumstance that affects them, in order to know the type of treatment to pursue for their skin picking disorder.
Some people may pick their skin out of boredom, displeasure at blemishes, and in some cases, as a result of depression. If a person is triggered to pick their skin as a result of 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 is advisable to speak with a mental health expert
2. Get professional help
Many individuals dealing with excoriation skin picking disorder tend to 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.
Additionally, medication that helps ease anxiety and stress may also be prescribed by an in-person or online psychiatrist in order to deal with the triggers that cause repetitive skin picking behaviors. There are several psychotherapeutic approaches and interventions available to reduce the symptoms and repair the skin damage caused by the disorder, such as cognitive behavioral therapy, which helps people understand the relationship between their thoughts, feelings, behaviors, and their mental health. Behavioral therapy for skin picking disorder often involves a level of habit reversal training, which can effectively help put a stop to problematic repetitive behaviors. Additionally, medication that helps ease anxiety and stress may also be prescribed by professionals in order to deal with the triggers that cause repetitive skin picking behaviors.
Since excoriation disorder often occurs simultaneously with other conditions like depression and body dysmorphia, it is equally important to target these conditions as well, so that they don’t trigger the urge to pick while the skin is being treated.
3. Exercise regularly
Chronic skin picking is mostly 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 also help keep the mind occupied, and lessen a person’s urge to do body focused repetitive behavior like hair pulling or skin picking. Aerobic exercises – like biking and swimming – minimize muscle tension and improve the overall mood of a person, reducing their impulse to engage in skin picking behavior.
Apart from physical exercise, practicing mindfulness also helps in dealing with excoriation disorder. Engaging in activities like yoga and meditation can relax the mind and ease stress. Maintaining a calm mind also helps an individual identify obsessive thought patterns that cause them to pick at their skin, and work on controlling those thought patterns. On a general note, exercising the mind and body keeps a person busy and fosters a positive mindset.
4. Develop healthy self-care rituals
Another helpful way to deal with excoriation disorder is by developing healthy rules and rituals to help control anxiety, which often causes the body-focused repetitive behavior. These self-care routines do not have to be life altering —but can be simple activities like listening to soothing music, eating healthy, or adopting a regular skincare routine. These small adjustments can go a long way in curbing stress and reducing the urge to pick the skin. Caring for the body can also help a person develop a more positive mindset.
Even though it may be hard to adopt new habits to replace the habit of compulsive picking, it is important to maintain consistency and slowly incorporate a new, healthy ritual into one’s daily routine.
5. Strengthen your support system
Building a strong support system made up of close friends and family is crucial for anyone who is dealing with excoriation disorder. This condition tends to make people isolate from family gatherings and social events, because they may be ashamed of the scars on their body. If you know someone struggling with excoriation disorder, be mindful that it does not help when they get asked about scars. Many, when struggling with the disorder, find it difficult to speak about.
Even though it can be challenging, it is important for people who are dealing with excoriation disorder to reach out and communicate with family and friends about the condition, surround themselves with people who understand what they are going through, and are willing to provide them with the necessary support and encouragement to deal with the condition.
While dealing with 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 the presence of physical scars stop you from living life fully.