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Excoriation Disorder (Skin Picking or Dermatillomania)

Excoriation disorder (also referred to as chronic skin-picking or dermatillomania) is a mental illness related to obsessive-compulsive disorder. It is characterized by repeated picking at one’s own skin which results in skin lesions and causes significant disruption in one’s life. 

Individuals may pick at healthy skin, minor skin irregularities (e.g., pimples or calluses), lesions, or scabs. This disorder is usually chronic, with periods of remission alternating with periods of greater symptom intensity. If untreated, skin-picking behaviors may come and go for weeks, months, or years at a time. It is common for individuals with this disorder to spend significant amounts of time, sometimes even several hours a day, on their picking behavior.

Skin picking is a body-focused repetitive behavior (BFRB) that typically begins during adolescence, commonly coinciding with, or following the onset of, puberty around ages 13-15, but may also occur among children (under 10 years old), or adults (between the ages of 30 and 45). [1] Excoriation disorder affects approximately 1.4% of American adults, and is experienced by women more often than men. [2]

Currently, no specific cause has been identified for excoriation disorder. However, evidence demonstrates that the disorder is more common in individuals with obsessive-compulsive disorder and their parents, siblings or children than in the general population, suggesting that there is a genetic predisposition to the condition. [4]

To be diagnosed with excoriation disorder, a person must show the following signs and symptoms: [3]

  • Recurrent skin picking that results in skin lesions
  • Repeated attempts to stop the behavior
  • The symptoms cause clinically significant distress or impairment
  • The symptoms are not caused by a substance or medical, or dermatological condition
  • The symptoms are not better explained by another psychiatric disorder

Evidence suggests that both medication and cognitive-behavioral therapy (CBT) may effectively reduce symptoms of excoriation disorder.

  • Medication: Successful treatment may include the use of selective serotonin reuptake inhibitors (SSRIs), which are antidepressants that also help reduce obsessive thoughts and compulsive behaviors.
  • Cognitive-behavioral therapy (CBT): Cognitive-behavioral therapy helps individuals understand how their thoughts and behavior patterns are related in order to reduce repetitive behaviors. Individuals learn how to change their thoughts so that they can avoid picking at their skin.

Excoriation disorder often co-occurs with obsessive-compulsive disorder, trichotillomania (hair-pulling), and major depressive disorder. One study indicates that 38% of individuals with excoriation disorder have co-occurring trichotillomania. 

Other body-focused repetitive behaviors (BFRBs), such as nail biting, may also coincide with excoriation. 

Obsessive-Compulsive Foundation
Phone: (203) 401-2070

Picking Me Foundation

Phone: (323) 989-2064

The TLC Foundation for Body-Focused Repetitive Behaviors
Phone: (831) 457-1004

Body Dysmorphic Disorder (BDD)

Body dysmorphic disorder (BDD) is a mental illness characterized by a persistent preoccupation with at least one perceived defect or flaw in a person’s physical appearance 

Obsessive-Compulsive Disorder (OCD) 

Left untreated, obsessions and the need to perform rituals can take over a person's life. OCD is often a chronic, relapsing illness.

Trichotillomania (Hair Pulling)

Trichotillomania is a body-focused repetitive behavior classified as an impulse control disorder which involves pulling out one's hair.