What Is Excoriation Disorder? Stop Compulsive Skin Picking!

Man with skin picking disorder

If you have an annoying rash or a scab, you may have this urge to start scratching or picking it every now and then, which is totally normal. The same could be for annoying strands of baby hair—it’s tempting to pull them out so the rest of your hair looks neat. However, if this skin picking or hair pulling starts to become repetitive and becomes an impulse you can’t get rid of, you may have unknowingly developed excoriation disorder.

So what is excoriation disorder, and how do you overcome it? Before you run into any medical complications, seek help right away. Here at Counseling Now, our professional counselors are dedicated to improving a wide variety of mental health conditions, including excoriation disorder. Read on to learn more about it and what can be done to address it.

Man with excoriation disorder
Image from PxHere by An Min

What Is Skin Picking Disorder or Excoriation Disorder?

Excoriation disorder is also referred to as chronic skin picking disorder or dermatillomania. Under the DSM-5 or the Diagnostic and Statistical Manual of Mental Disorders, excoriation disorder is categorized as a mental illness under obsessive-compulsive disorders and body-focused repetitive behaviors. 

Individuals diagnosed with excoriation disorder may have a compulsive habit of skin picking. Others are prone to nail biting or hair pulling as well. The disorder involves repetitive, persistent, and heightened skin picking or hair pulling that eventually leads to skin damage or even disruption of one’s life. It might come to the point that the person spends so many hours a day picking on their skin that they end up not ignoring their daily responsibilities.

People with excoriation disorder have an uncontrollable urge to scratch skin irregularities like pimples, scabs, calluses, or lesions. For some, the need to pick their hair or lashes is unbearable. When this disorder is left untreated, it may go on for months or years and lead to skin damage.

What Causes Excoriation Disorder?

Unfortunately, there’s no known cause of the condition. However, there are some biological and environmental factors that prompt individuals to start picking at their skin or pulling their hair. Here are a few of them:

  • The symptoms of the condition, particularly nail biting, could be the result of significant stress, anxiety, or emotional distress.
  • People with existing body-focused repetitive behavior like hair pulling, nose picking, or lip biting are more likely to develop dermatillomania.
  • Some may start out being extremely conscious of their appearance or a classic example of a person with body dysmorphic disorder. They might have the tendency to pop their pimples or remove unwanted minor skin irregularities.
  • Other people could begin the acts of picking and pulling out of boredom. Over time, they become repetitive and turn into destructive habits. The person then does it whenever they have free time on their hands. 
  • Some evidence shows that excoriation disorder, like any form of obsessive-compulsive disorder, may be linked to genetics. Alternatively, it might be related to one’s upbringing at home. For instance, growing up in a household where nail biting is tolerated, kids may deem the behavior normal and adopt it as they grow up.

In certain cases, yes, skin picking has something to do with anxiety. Chronic skin picking may be related to emotional components such as anxiety, tension, and boredom. People with excoriation disorder feel a sense of gratification, relief, and pleasure after doing compulsive picking. In other words, it’s their stress reliever.

Some individuals who have dermatillomania may not even notice that they have harmful habits. They might not realize they’ve been picking at their skin for a long time. They only become aware of it when they see open sores or scabs, which lead to more skin picking. In addition, seeing visible marks could make the person more self-conscious, one consequence of which is anxiety.

What Are the Symptoms of Excoriation Disorder?

How can you determine the possibility that you have excoriation disorder? How can you differentiate it from the usual picking behavior when you’re nervous, or how do you know if it’s become a significant problem? If you have the following signs and symptoms, consider seeing a therapist right away:

  • Recurrent and repetitive skin picking that results in wounds, skin conditions, or skin lesions
  • Repeated attempts to stop such habits but fail to do so
  • Your recurrent skin picking takes several hours of your day. You end up spending more time picking your skin than attending to more important matters such as your job and household chores.
  • You pick at your skin even though you have no skin conditions that cause itchiness or discomfort.
  • Your skin picking has led to clinically significant distress in your social life, relationships, and school or work.

Have you noticed these signs in yourself? Or have you seen a loved one displaying these symptoms? If so, don’t wait any longer and find a therapist to work with. Keep in mind that this compulsive behavior may lead to severe skin damage should intervention not come early or quick enough. Looking for and getting the right solution is an absolute must.

How Is Excoriation Disorder Treated?

Since dermatillomania is categorized as an obsessive-compulsive disorder, medication and therapy can certainly help in the management of the symptoms and treatment of the condition. It’s best to consult a doctor regarding the best treatment options for you. Here’s what you can expect to encounter once you begin the journey of recovering from excoriation disorder:


After you’ve been diagnosed with excoriation disorder, your psychiatrist may prescribe some medication depending on your circumstances. For example, your doctor might ask you to take anti-anxiety medicine if your anxiety triggers your recurrent skin picking behavior. Other examples of medication are selective serotonin reuptake inhibitors and antidepressants.

If the skin damage has become painful or infected, you may be prescribed topical options like cortisone agents or antibacterial cream.


Cognitive behavioral therapy (CBT) can help individuals with excoriation disorder control their urge and explore the roots of their repeated picking behavior. CBT sessions will allow you to understand the reasons you’re engaging in such acts as well as your thought patterns. With the guidance of your therapist, you’ll learn various ways to change your behavior and mindset so you can leave your skin and hair alone.

Habit Reversal Training

Other than counseling sessions, your therapist may use habit reversal training. This focuses on undoing a bad habit. It involves different forms of training so you can learn self-control and quit harmful behavioral patterns, so it’s ideal for managing the symptoms of and treating excoriation disorder.

How to Deal With Excoriation Disorder

In addition to getting medical treatment and talking to a therapist, there are several other ways you can manage excoriation disorder. Yes, professional help plays a significant role in overcoming the condition, but you also have to make changes within yourself in order to maximize your success.

Regardless of how many therapy sessions you attend or how long you’ve been on your medication, it won’t matter if you continue the lifestyle and routines that triggered your condition in the first place. These are some of the things you have to remember if you want to recover from dermatillomania for good:

Stimulus Control

To start off, you have to adopt preventive measures to better resist the urge to pick at your skin or hair. For instance, if you can’t help but scratch your skin, wear a long-sleeved top or protective clothing. If you bite your nails too often, put on a pair of gloves. It’s also recommended to throw away tweezers or sharp objects that you use on yourself whenever you exhibit symptoms.

By controlling the stimuli around you, it’s less likely that you’ll continue engaging in repetitive behaviors.

Identify Your Triggers and Do Something About Them

During CBT sessions with your therapist, you’ll discover what triggers your skin picking habits or body-focused repetitive behavior. If your repetitive behaviors are caused by emotional distress, be aware of it and, as much as possible, avoid what makes you stressed.

If you pick at your skin due to acne or blemishes, it’s best to see a dermatologist as well to avoid breakouts. Meanwhile, if the reason for your skin picking is boredom, then find some hobbies to make yourself productive and not entertain obsessive thoughts about scratching and similar habits.

Develop a Healthy Self-Care Routine

It doesn’t matter whether you have a dermatological condition or not—developing a healthy self-care routine may shift your mindset away from skin picking.

Taking care of your skin isn’t superficial; it’s a form of self-love. Developing a healthy routine for the largest organ in your body increases your appreciation for it along with your self-esteem. Though replacing your bad habits with good ones can be hard at first, consistency is the key. What’s more, perhaps in no time at all, you’ll have glowing skin that you’d always want to care for.

Have a Healthy Support System

Share what you’re experiencing with your trusted family members and friends. This way, they’ll fully understand your condition and help you avoid triggers and repetitive behaviors. You’ll also be more motivated to keep going with your treatment if you have the right support system in place.

Get Professional Help

A lot of people may feel embarrassed to do this, but if you don’t see a doctor or therapist, your condition might only get worse. Some individuals with excoriation disorder may have deep wounds or lesions due to months of picking at the same spot or wound. Others could have thinning hair and bald spots due to obsessive hair picking. In such cases, DIY treatments won’t give you any results.

Also, if excoriation disorder is caused by an anxiety disorder or any form of depression, a mental health professional’s knowledge and expertise are invaluable to your recovery.

Talk to a Counselor at Counseling Now

Can excoriation disorder be treated? Yes, it can. With the help of your doctor and a therapist at Counseling Now, you’ll be able to overcome excoriation disorder. Like any condition related to compulsive urge such as obsessive-compulsive disorder, it can be controlled and managed using the right approach. Talk to a counselor at Counseling Now today to get the treatment you deserve.

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