Excoriation Disorder (Skin Picking / Dermatillomania)

Written By Stacey Steiner

What is Excoriation Disorder?

Excoriation disorder, also known as skin picking disorder or dermatillomania, is a mental health condition where a person repeatedly picks at their skin. This behavior causes tissue damage, wounds, or scarring and often becomes difficult to control. Many people experience cycles of urges, picking episodes, and feelings of distress afterward.

Despite being a newly-classified DSM disorder, excoriation disorder is relatively common and affects between 1.4 and 5.4% of the general population

TPC: The Professional Counselor [source]

Excoriation Disorder Patterns

  • Intentionally picking at blemishes or perceived imperfections.

  • Picking without awareness, such as while watching TV.

  • Alternating between focused and automatic picking.

 

WHAT ARE SOME COMMON SYMPTOMS?

  • Repetitive picking that causes wounds, scabs, or scars

  • Strong urges or tension before picking, followed by relief afterward

  • Repeated attempts to stop without success

  • Significant distress or interference in daily life

  • Picking from multiple body areas such as the face, arms, hands, or scalp

Excoriation disorder often occurs alongside conditions like depression, anxiety, OCD, ADHD, and trichotillomania.

Causes and Risk Factors

The exact cause is not fully understood, but contributing factors may include:

  • Genetic vulnerability — family history of OCD or related disorders

  • Emotional stress — anxiety, boredom, or negative emotions triggering urges

  • Skin conditions — acne or eczema can act as initial triggers

  • Biological overlap — related to OCD and other body-focused repetitive behaviors

  • Reinforcement — the temporary relief or satisfaction from picking strengthens the habit

Treatment Options

Therapy Approaches

  • Cognitive Behavioral Therapy (CBT) — addresses thoughts and behaviors related to picking

  • Habit Reversal Training (HRT) — builds awareness of urges and teaches competing behaviors

  • Acceptance and Commitment Therapy (ACT) — teaches acceptance of urges without acting on them

  • Comprehensive Behavioral (ComB) strategies — identify and change triggers across emotional, sensory, and environmental areas

  • Support groups — peer connection for encouragement and accountability

Medications

  • SSRIs (antidepressants) to reduce urges and co-occurring anxiety/depression

  • Clomipramine — a tricyclic antidepressant sometimes used

  • N-acetylcysteine (NAC) or memantine — studied for reducing compulsive behaviors

Self-Management Strategies

Practical steps that may help include:

  • Keeping a trigger journal to identify situations that lead to picking

  • Using barrier methods like gloves, bandages, or clothing to cover areas

  • Replacing picking with fidget tools or stress balls

  • Practicing mindfulness and stress management (deep breathing, meditation)

  • Reducing exposure to mirrors or tools that encourage picking

  • Maintaining good skin care routines to support healing

  • Seeking support and accountability from trusted friends or groups

    HOW DO I GET HELP?

If you or someone you know is struggling with excoriation disorder:

  • Talk to your doctor or dermatologist — they can address skin health and refer to mental health care

  • Find a therapist trained in OCD and body-focused repetitive behaviors (BFRBs)

  • Consider combined care — therapy plus dermatologic support can be most effective

Reach out to crisis resources if you feel overwhelmed or unsafe.

Stacey Steiner
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