Skin Picking Test: Do I Have Dermatillomania?

Skin picking disorder, also called dermatillomania or excoriation disorder, is picking at your skin to the point of sores, scabs, or scars, and not being able to stop when you try. It's one of the body-focused repetitive behaviors, or BFRBs, along with hair pulling and nail biting, and the DSM-5 lists it near OCD.

It doesn't work the same way OCD does, though. OCD runs on an intrusive thought and a compulsion that tries to answer it. Skin picking runs on an urge. A bump, a scab, or a rough spot catches your attention, and picking it smooth brings a moment of relief or satisfaction. That relief is what keeps the picking going.

It often starts in the teen years, sometimes around acne, and it tends to come and go, with easier stretches and harder ones. Anxiety, depression, and other BFRBs often show up alongside it.

Picking doesn't look the same for everyone, and it's common to do both depending on the day.

Which style you're in matters for treatment. Automatic picking needs awareness work first, because you can't interrupt something you don't notice. Focused picking needs you to sit with the urge and not go looking.

The marks are the part people see. A lot of the weight is in the urges and in everything you do to hide it.

• Picking at acne, scabs, bumps, or spots that feel rough or "wrong"
• Picking the skin around your nails or cuticles until it bleeds
• Long stretches at the mirror looking for things to pick
• Sores that never get a chance to heal because you go back to them
• Tension before you pick that drops the second you start
• Makeup, long sleeves, or bandages doing cover work
• Skipping the gym, the beach, or bright light because of your skin
• Rules like "only one spot" that last a few days, and then you're back where you started

The face is the most common spot, but picking happens anywhere, including the scalp, arms, back, and fingers.

There's no single cause. BFRBs run in families, which points to genetics, and picking often starts during a stretch of stress or around acne. From there the behavior teaches itself, because the relief is fast and reliable.

Picking is usually doing a job for you. It might take the edge off tension, give your hands something to do when you're bored, or scratch the itch of a spot that doesn't feel right. That's why it tends to show up at the bathroom mirror, in the car, at night, or during work you're avoiding.

Skin picking is treatable, and the work is behavioral. The approaches with the most research behind them:

• Habit reversal training. You learn to catch the urge or the first movement, then use a competing response, something your hands do instead that makes picking awkward, until the urge passes.
• The ComB model. You map your own picking, including the setting, the sensations, the thoughts, and the mood, and then change the pieces that feed it. That might mean dimming the bathroom light, keeping a fidget in the car, or putting bandages on the fingers you pick with.
• Acceptance and commitment therapy. You practice letting an urge be there without acting on it. The urge is uncomfortable, and it isn't an instruction.

Some medications and supplements are being studied for skin picking, with mixed results so far, and none replace the behavioral work. Talk to a prescriber before you start anything.

I'm Nathan Peterson, LCSW, a licensed therapist who works with OCD, anxiety, and BFRBs, and I wrote this free screening. It looks at how strong the urges are, how often you pick and how much damage it's doing, the hiding and shame, and how much of your life the picking is shaping.

It isn't a diagnosis. Only a licensed professional can give you that. What it can do is show you whether what you're dealing with fits the pattern of skin picking disorder, and how heavy it's gotten, so you know what kind of help to look for.