What is Excoriation Disorder? Skin-Picking Compulsion Explained

Excoriation disorder (skin-picking) is a type of body-focused repetitive behavior. This disorder is defined by frequent skin picking that results in skin sores.

Patients with this disorder constantly pick at or scrape their skin but not out of concern for their appearance or health (eg, to remove a lesion that they perceive as unattractive or possibly cancerous). Others pick at smaller lesions like calluses, pimples, or scabs. Some patients may also pick at healthy skin.

Some of us pick at our skin not fully aware of what we are doing, while others are more aware of it. No obsessions or concerns about appearance lead to the picking (which may be a symptom of body dysmorphic disorder). Skin picking, which is frequently followed by a sense of satisfaction, might, however, be preceded by a sensation of tension or anxiety that is relieved.

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How Can You Identify Excoriation Disorder?

Excoriation disorder is different from just picking on your skin. (Image via Freepik/Freepik)

Most likely all of us have witnessed someone picking at their skin in the past, whether it's a pimple, scab, or dry, flaky skin.

Not everyone who picks at their skin, though, has a serious issue. What distinguishes healthy skin picking from aberrant skin picking, then? Here are some identifying features of excoriation disorder:

1) Continuation

Like other disorders, skin picking is continuous and repetitive. (Image via Freepik/Freepik)

Individuals with excoriation disorder frequently pick at their skin for long periods. That may also become automatic for many. For instance, a person can unknowingly be picking at their skin while speaking on the phone.

If a person is conscious that they're picking at their skin, they may also be more focused. However, the individual gets scabs and wounds as a result of the skin picking. Many individuals remain undiagnosed after trying to cover it with makeup or clothing.

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2) Failure to Quit

The individual makes an effort to quit picking at their skin. Individuals must have frequently tried to quit picking at their skin without success to meet the criteria.

They might have asked for assistance from others to quit as well. It's possible that the fact that they feel relieved and satisfied after picking at their skin makes it tough for them to stop. In other words, they find it difficult to stop if it makes them feel good.

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3) Significant Distress

Often people with excoriation disorder hide their scars and wounds. (Image via Freepik/Freepik)

Excoriation disorder produces clinically substantial distress in other areas of life. It affects a person's ability to concentrate at work or in school, among other things that matter to them. A person's actions may cause them to experience guilt, embarrassment, or humiliation.

Examples of clinically significant distress include refraining from all social interaction due to self-consciousness, picking at their skin in public, and avoiding all types of social interaction altogether. Or they skip lessons out of concern that they won't be able to control the impulse to pick their nose in front of others.

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4) Differentiation From Other Disorders

It's important to distinguish between excoriation disorder and other illnesses. A standard requirement for diagnosing additional diseases listed in the DSM is that they must be clearly differentiated from other disorders.

Excoriation disorder also needs to be distinguished from other behaviors, such as delusions, attempts to improve appearance in body dysmorphic disorder, stereotypes in stereotypic movement disorder, obsessions and compulsions in OCD, or attempts to improve appearance in obsessional compulsive disorder (OCD).

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Is Treatment Available?

Excoriation can have a long-lasting effect on your mental health. (Image via Freepik/Freepik)

It's believed that talking therapy can help people stop picking at their skin. Cognitive behavioral therapy, which may also use a method known as habit reversal training, is the most popular kind of talking treatment for skin picking condition. The process of habit reversal training assists you to recognize and pay closer attention to skin picking, as well as the triggers.

Skin plucking should be replaced with a less hazardous habit. To assist you in controlling your skin picking behavior, your doctor may prescribe certain medications. Again, medications can only be prescribed by a psychiatrist.

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Skin-picking conditions, if left untreated, can result in open wounds, scarring, and severe emotional distress. Due to self-image issues, individuals with this disorder may often experience social withdrawal and avoid engaging with friends and family.

Excoriation disorder treatments concentrate on locating triggers, dealing with the activity, and treating any underlying physical or psychological issues that may be present.

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Janvi Kapur is a counselor with a Master's degree in applied psychology with a specialization in clinical psychology.

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