Dermatillomania / Excoriation
Skin-Picking, as well as skin-biting, are Repetitive Body Focused Behaviors (RBFBs), and when meeting diagnostic criteria for severity and level of interference with life functioning, are found under OCD and Related Conditions in DSM-5. Milder forms basically appear like “nervous habits.” In some cases, they are the result of, or precipitated by, a medical condition, such as acne, eczema, or psoriasis. These symptoms are more common in females.
Most pick at their face or cuticles, but any area of the body can become a focus, even gums. People with this issue often find a new area of their skin to pick if their primary area has become too painful or disfiguring. When it heals, they might go right back to it though. Some individuals use their fingers to pick; others use implements like tweezers. Excoriation can reach such a severe level that it requires skin grafts to repair, if this is even possible. Depression and anxiety are common in this population.
Observable, physical problems that the affected individual often attempts to hide or “explain away” often accompany skin-picking and skin-biting. These include sores and scars. They can also result in medical problems, such as serious infections. Unwarranted minimizing, as well as shame and embarrassment, can prevent seeking needed help, or even telling loved ones what is going on.
Stress or feeling bored can trigger or worsen excoriation. This symptom has also been associated with perfectionism. For example, the affected person might notice a “flaw” in their skin and pick at it, or bite it in a backfiring attempt to get it to “look” or “feel” right. Sometimes, this has a sensory component; it can be performed “ritualistically” too. Understanding excoriation can be confusing, as some individuals say picking gives them pain, however, others actually say they find it pleasurable, which makes it resemble an addiction in some respects. Many with excoriation are acutely aware when they pick, but others report little or no awareness.
Cognitive-behavioral therapy (CBT), specifically habit reversal training (HRT) has been shown to help this problem. In this treatment, the person learns to increase awareness of “triggers,” manage his or her “urges,” and how to employ “competing behaviors.” They also learn how to modify self-defeating ideas that could negatively impact their motivation and consistency in using effective strategies. There are certain medications that can also be helpful in helping reduce picking behaviors.