What Is Dermatillomania (Skin Picking Disorder)?

Dermatillomania — also called excoriation disorder or skin picking disorder — is a body-focused repetitive behavior (BFRB) characterized by the compulsive, repetitive urge to pick at skin, scabs, blemishes, cuticles, or perceived imperfections. The picking often causes wounds, scarring, or infection — and most people feel intense shame and go to great lengths to hide the damage.

Skin picking disorder is classified as an obsessive-compulsive and related disorder in the DSM-5. It is one of the most common BFRBs, estimated to affect 2–5% of the population — though many people never seek help because of shame, stigma, or the belief that it's "just a habit."

Skin picking frequently co-occurs with hair pulling disorder (trichotillomania), nail biting, and other BFRBs — as well as anxiety, depression, and OCD. Many people experience more than one BFRB simultaneously.

Automatic vs. Focused Picking

Like trichotillomania, skin picking disorder occurs in two distinct styles — and many people experience both:

Common Skin Picking Disorder Symptoms

Skin picking disorder is more than occasional picking at a blemish. The condition involves a persistent cycle of urges, behavior, physical consequences, and emotional aftermath that can consume significant time and significantly impact quality of life.

• Recurrent urges to pick at skin, scabs, blemishes, cuticles, or perceived imperfections
• Picking skin without being fully aware it's happening
• Tension, discomfort, or a "need" before picking that is relieved by the act of picking
• A sense of satisfaction, pleasure, or calm during or immediately after picking
• Wounds, sores, scarring, or infections caused by picking
• Shame, guilt, and embarrassment about picking and its physical results
• Concealing wounds or skin damage with makeup, clothing, or bandages
• Avoiding situations — swimming, sleeveless clothing, intimacy — where skin damage might be noticed
• Spending significant time examining skin for spots to pick — mirrors, magnifying mirrors, bright lighting
• Repeated attempts to stop that haven't been fully successful

What Triggers Skin Picking?

Skin picking can be triggered by a wide range of internal and external factors. Understanding your personal triggers is an important part of treatment — because different triggers respond to different interventions.

• Sensory triggers — the feel of a bump, rough patch, scab, or perceived imperfection on the skin that creates an urge to smooth it out or remove it
• Emotional triggers — anxiety, stress, boredom, frustration, or emotional numbness that picking temporarily relieves
• Situational triggers — specific environments where picking is more likely, such as the bathroom mirror, the car, in bed, or in front of a screen
• Cognitive triggers — thoughts like "I just need to get this one spot" or "my skin needs to be smooth"

How Is Skin Picking Disorder Treated?

Skin picking disorder is treatable. The most evidence-supported treatments fall under the umbrella of cognitive behavioral therapy (CBT):

• Habit Reversal Training (HRT) — Builds awareness of picking triggers, urges, and behaviors, then trains a competing response — a physical substitute action that makes picking impossible — whenever the urge arises.
• Comprehensive Behavioral Treatment (ComB) — A more individualized approach that identifies the sensory, cognitive, emotional, and situational drivers of each person's picking and tailors specific interventions to those drivers.
• Acceptance and Commitment Therapy (ACT) — Helps develop a different relationship with picking urges — noticing and accepting them without acting on them, while staying committed to values-based living.

Medication has not been found to be a reliable standalone treatment for skin picking disorder. Some supplements like N-acetylcysteine (NAC) have shown limited promise in research. For picking that causes wounds requiring medical attention, coordination between a therapist and a dermatologist or physician may be helpful.

What Does This Skin Picking Test Measure?

This free skin picking screening was created by Nathan Peterson, LCSW — a licensed therapist specializing in OCD, anxiety, and body-focused repetitive behaviors. The test assesses the presence and severity of skin picking disorder symptoms including picking urges, frequency, physical damage, emotional impact, and daily functioning.

This is not a clinical diagnosis. Only a licensed mental health professional can formally diagnose excoriation disorder. But it gives you a clear picture of whether what you're experiencing matches the pattern of skin picking disorder — and how significant your symptoms are.

Frequently Asked Questions About Skin Picking Disorder