Excoriation disorder, dermatillomania, or skin picking, is a chronic condition involving repeatedly picking at one’s own skin that often results in swollen or broken skin, open sores or wounds, and can lead to injury or scarring. It is sometimes accompanied by a feeling of tension, “wrongness”, or sense of imperfection, or alternatively a sense of relief or stress reduction while picking. It is sometimes comorbid with Obsessive-compulsive disorder.

Skin picking is categorized as a body focused repetitive behavior, often called “BFRBs” by researchers, clinicians, and others in the BFRB community. Skin picking can cause significant stress, anxiety, and self-esteem issues. This issue often initially presents around puberty, but it can effect an individual at any age. Skin picking sometimes is exacerbated by skin conditions like eczema or acne. Though facial skin is one of the most common areas where skin picking occurs, other areas of the body can also be effected, such as arms, legs, back, scalp, and pubic areas. Someone suffering with a BFRB like skin picking can try very hard to “stop” picking, but it is often extremely difficult to reduce or resist the “urge” to pick. Sometimes spending excessive amounts of time performing checking behaviors in the mirror can occur. It is not uncommon for individuals to spend large amounts of time on picking behaviors, as well as attempt to conceal or hide skin issues. Sometime these avoidant strategies by themselves cause impairment and additional stress.

Skin picking is a condition that can be treated with an adapted version of Habit Reversal Training. This is a behavioral treatment that focuses on 1) awareness, 2) environmental triggers, 3) competing responses, 4) education about skin picking, and 5) self-esteem building and identity development.

It is not only important to build self-efficacy in managing picking, but also building self-esteem and identity in areas outside of this, such as hobbies, interpersonal skills, personal passions, academic performance, and roles in family and community. Patients are not just someone who struggles with skin picking, but also a great sister, grandson, friend, soccer player, artist, mathematician, etc.!

It is important to know that a “cure” for body focused repetitive behaviors, such as skin picking, does not exist; HRT is system that adds ‘tools to your toolbelt’ to better manage unwanted behaviors/habits and improve quality of life.

Dr. Lazaroe trained in HRT for skin picking at both the University of Florida and University of South Florida Rothman Center. Contact her today to set up a consult.

Please view our Treatment Programs page to learn more about the treatment programs offered at our clinic, including our Intensive Outpatient Program (IOP), as well as our Team page to learn more about our background, practice, and core therapy values.