Dermatillomania: The compulsive urge to pick at your skin
You find a bump, and you can't leave it alone. Twenty minutes later you're still at the mirror, and you're not sure how you got there. Dermatillomania, also called skin picking disorder, is what it looks like when that keeps happening and you can't stop on your own.
By Nathan Peterson, LCSW, OCD and BFRB therapistWhat is dermatillomania?
Dermatillomania is repeated picking, scratching, or digging at your skin that leads to sores or damage, along with trying to cut back and not being able to. Its clinical name is excoriation disorder. You'll also see it called compulsive skin picking.
It's one of the body-focused repetitive behaviors, or BFRBs, along with hair pulling (trichotillomania) and nail biting. The DSM-5 lists it with OCD and related disorders. Older articles call it an impulse control disorder, but that's out of date.
Picking often brings a moment of relief or satisfaction. Then comes the part nobody posts about: the marks, the covering up, and the shame of "why can't I stop?"
Signs of skin picking disorder
- Picking at acne, scabs, bumps, or spots that feel "wrong"
- Picking at the cuticles or the skin around your nails
- Using tweezers, pins, or your nails to dig at skin
- Spending a long time at the mirror looking for things to pick
- Sores, scars, or infections from picking
- Covering marks with makeup, long sleeves, or bandages
- Trying to stop over and over without it lasting
- Avoiding the beach, the gym, or close contact because of your skin
The face is the most common spot, but arms, legs, the back, and the chest are common too.
Dermatillomania on the scalp
Scalp picking is easy to hide, which is part of why it can go on for years. It often looks like running your fingers through your hair looking for bumps or scabs, picking them off, and then checking the spot again. Some people also pull hair while they're at it, so it can overlap with trichotillomania. More on dermatillomania on the scalp.
Dermatillomania on the fingers
Picking the cuticles and the skin around the nails is one of the most common versions. It's quick and easy to do without noticing, like in meetings, in the car, or while you're on your phone. Over time the skin can stay raw, split, or infected. More on dermatillomania on the fingers.
If this sounds familiar, it could possibly be dermatillomania. A therapist who treats BFRBs can tell you for sure, and you can start with the free skin picking test.
Focused vs. automatic picking
Picking tends to show up in two ways, and it's common to do some of both.
Focused picking
You know you're doing it. Something feels rough or uneven and you need it smooth, or you're stressed and picking takes the edge off. It feels like you have to get it "right" before you can stop.
Automatic picking
You don't notice until after. You're scrolling, driving, watching TV, or reading, and your hand has been at your face the whole time.
Knowing which one you do matters, because they call for different fixes. Common triggers include boredom, stress, being tired, bad lighting in front of a mirror, and sitting still.
What causes dermatillomania?
There isn't one known cause. It often starts in the teen years, sometimes around acne, and it tends to run in families. Skin picking and anxiety often go together, since picking can take the edge off stress for a moment. But picking also happens when you're calm and bored.
What keeps it going is easier to see. Picking brings relief or satisfaction for a moment, and your brain remembers that. So the next time you're stressed, bored, or feel a rough spot, the urge shows up faster.
Dermatillomania and excoriation disorder treatment
The main treatment for skin picking is a behavioral therapy called habit reversal training, or HRT. It's often combined into a bigger plan called the ComB model.
How habit reversal training works
- Awareness. You learn when, where, and how you pick, including the moment right before.
- A competing response. When the urge shows up, you do something with your hands that makes picking hard, like making a fist or holding an object, until the urge passes.
- Changing the setup. Dimmer bathroom lights, a timer at the mirror, fidget toys where you scroll, bandages or gloves on the fingers you pick with.
I know, "hold a stress ball" sounds way too simple for something that's been going on for years. The simple part is the point. The work is doing it every time, especially the times you don't want to.
For the full breakdown, including how it's diagnosed, see excoriation disorder treatment explained.
Why willpower doesn't work
"Stop it" treats picking like a choice you're making badly. Most of the time the urge shows up before you've decided anything. HRT doesn't wait for you to feel like stopping. It gives your hands a plan for the urge, and lets the urge be there until it fades.
Medication
No medication is approved specifically for skin picking. Some doctors prescribe medication to help, so that's a conversation to have with your doctor or psychiatrist.
For the next three days, jot down every time you catch yourself picking: where you were, what you were doing, and what you felt right before. No fixing yet. (Yes, you'll forget to write some down. Write down that you forgot.)
That list tells you where to start. If you want help turning it into a plan, that's what the course below is for.
Common questions about skin picking
Is skin picking a form of OCD?
They're related but not the same. The DSM-5 puts excoriation disorder in the same group as OCD, obsessive-compulsive and related disorders. With OCD, a ritual is usually about stopping a feared outcome. Skin picking is usually about an urge, a tension, or a feeling in the skin that picking settles for a moment. Some people have both.
Is skin picking self-harm?
Usually not. Picking isn't usually an attempt to hurt yourself, and a lot of the time you don't notice you're doing it. If you are hurting yourself on purpose, that's worth talking about with a professional, and it gets its own kind of support.
How do I stop picking my skin?
Telling yourself to stop hasn't worked, and that's not a willpower problem. What helps is learning when and where you pick, making it harder to pick in those moments, and giving your hands something else to do while the urge passes. A therapist who treats BFRBs can walk you through it, or you can start with the course below.
Should I see a doctor about my skin?
If a spot looks infected (red, hot, swollen, or oozing) or won't heal, yes, see a doctor. A dermatologist can treat the skin while you work on the picking.
