OCD Skin Picking: Is It OCD or Skin Picking Disorder?
If you search "OCD skin picking," that makes sense. It feels compulsive, and you can't seem to stop. But picking can come from OCD or from skin picking disorder, and the two are treated a little differently. The difference comes down to what the picking is for.
By Nathan Peterson, LCSW, OCD and BFRB therapistWhat Is OCD Skin Picking?
OCD skin picking usually means repeated picking, scratching, or digging at your skin that leads to sores or damage, along with trying to stop and not being able to. The clinical name for that is skin picking disorder, also called dermatillomania or excoriation disorder.
Skin picking disorder isn't a type of OCD. It's listed in the same family as OCD, and it's a body-focused repetitive behavior, or BFRB, like hair pulling and nail biting. But picking can also be an OCD compulsion, and that changes what you work on in treatment.
OCD Skin Picking vs. Skin Picking Disorder
The biggest difference is what the picking is for.
Skin picking disorder
Picking feels good or calming for a moment. It often happens when you're stressed or not paying attention. A spot feels rough or "wrong," and smoothing it feels better.
Picking driven by OCD
Picking is done to get rid of a feared thing or prevent something bad. For example, picking to remove germs or "contamination" under the skin, or until a spot looks exactly right so the anxiety will settle.
You can have both. They often show up together, and a therapist who treats OCD and BFRBs can help you sort out which is driving what.
Signs of Compulsive Skin Picking
- Picking at acne, scabs, bumps, or spots that feel "wrong"
- Picking at the cuticles or the skin around your nails
- 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
- Picking to get something out of your skin, like germs or dirt
- Feeling like you can't stop until a spot looks or feels "right"
The face is the most common spot, but picking shows up anywhere, including the scalp, the fingers, the arms, and the back.
What Causes Compulsive Skin Picking?
There isn't one known cause. Skin picking often starts in the teen years, sometimes around acne, and it tends to run in families. Stress can make it worse (more on skin picking and anxiety), but picking also happens when you're calm and bored.
What keeps it going is easier to see. Picking brings relief for a moment, and your brain remembers that. So the next time the urge shows up, it shows up faster.
Treatment for OCD Skin Picking
When it's skin picking disorder
The main treatment is a behavioral approach made for BFRBs. You learn when and where you pick, change your setup so picking is harder, and do something else with your hands when the urge shows up. More on excoriation disorder treatment.
When OCD is driving it
The main treatment is ERP. You face the feared thought, like "there's something in my skin," and practice not picking to fix it. I know, leaving it there feels gross, maybe even dangerous. That feeling is exactly what you're practicing with. If contamination fears are behind it, see contamination OCD.
Either way, the urge doesn't have to disappear before you can make progress. Some medications are being studied for skin picking, so that's a question for your doctor.
Next time you reach for a spot, ask yourself, "Am I picking because it feels good, or to fix something I'm afraid of?" Your answer tells you where to start.
Not sure where you land? Take the free skin picking test.
Common questions about OCD skin picking
Is skin picking a form of OCD?
Not exactly. Skin picking disorder (dermatillomania) is in the same family as OCD, but it's its own condition, a body-focused repetitive behavior. Some people with OCD also pick their skin because of an obsession, like a fear of germs under the skin.
How do I know if my skin picking is OCD?
Ask what the picking is for. If you pick to get rid of a feared thing, like contamination, or to make a spot feel "just right" so something bad won't happen, OCD may be involved. If you pick because it feels good or without noticing, it's more likely skin picking disorder.
Can you have OCD and skin picking disorder at the same time?
Yes. They often show up together. A therapist who treats OCD and BFRBs can help you sort out which is driving what.
Is OCD skin picking treated the same way as skin picking disorder?
Not quite. When OCD drives the picking, ERP is the main treatment. Skin picking disorder is treated with a behavioral approach made for BFRBs, focused on noticing the urge and doing something else with your hands.
