Stopping skin picking
Skin picking disorder - NHS
Also called dermatillomania or excoriation disorder, skin picking disorder is where you cannot stop picking at your skin. There are things you can try to help yourself, but some people may need professional treatment.
Check if you have skin picking disorder
Most people pick at their skin from time to time, but you may have skin picking disorder if you:
- cannot stop picking your skin
- cause cuts, bleeding or bruising by picking your skin
- pick moles, freckles, spots or scars to try to "smooth" or "perfect" them
- do not always realise you're picking your skin or do it when you're asleep
- pick your skin when you feel anxious or stressed
You may pick your skin with your fingers, fingernails, teeth or with tools like tweezers, pins or scissors.
Things you can try if you have skin picking disorder
Do
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keep your hands busy – try squeezing a soft ball or putting on gloves
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identify when and where you most commonly pick your skin and try to avoid these triggers
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try to resist for longer and longer each time you feel the urge to pick
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care for your skin when you get the urge to pick it – for example, by applying moisturiser
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tell other people – they can help you recognise when you're picking
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keep your skin clean to avoid infection
Non-urgent advice: See a GP if:
- you cannot stop picking your skin
- you're causing serious damage to your skin by picking it, like cuts that do not heal within a few days
- picking your skin is causing you emotional distress or affecting your daily life
What happens at your appointment
A GP will ask you about your skin picking behaviour and look at your skin.
If they think you have skin picking disorder, they may refer you to a specialist for diagnosis and possible treatment.
This could be with a type of talking therapy or medicine.
They may also refer you to a skin specialist (dermatologist) if your skin is badly damaged or you have any underlying skin conditions that may be triggering your skin picking, like acne or eczema.
Treatment for skin picking disorder
Talking therapy for skin picking disorder
Talking therapy is currently thought to be an effective treatment to help change skin picking behaviour.
If you're offered this, it'll usually be given through community mental health services.
The most common type of talking therapy offered for skin picking disorder is cognitive behavioural therapy, and may include a technique called habit reversal training.
Habit reversal training works by helping you:
- recognise and be more aware of your skin picking and what's triggering it
- replace skin picking with a less harmful behaviour
Medicines for skin picking disorder
Your doctors may recommend some types of medicine to help you control your skin picking behaviour.
This may be prescribed by a GP, but more often it'll be prescribed by a specialist (psychiatrist).
Causes of skin picking disorder
Skin picking disorder is related to obsessive compulsive disorder, where the person cannot stop themselves carrying out a particular action.
It can be triggered by:
- boredom
- stress or anxiety
- negative emotions, such as guilt or shame
- skin conditions, such as acne or eczema
- other blemishes that the person wants to get rid of (these may not be noticeable to other people)
It's sometimes called a body-focused repetitive behaviour and is similar to repetitive hair pulling disorder (trichotillomania).
It's also related to other obsessive compulsive disorders, such as body dysmorphic disorder, where the person is excessively preoccupied with their appearance.
People with skin picking disorder often also have other obsessive compulsive disorders. These may require their own assessment and treatment.
Page last reviewed: 24 March 2021
Next review due: 24 March 2024
Picking your skin? Learn four tips to break the habit
If you can’t stop picking your skin, you may have a very common condition called skin picking disorder (SPD). We all pick at a scab or a bump from time to time, but for those with SPD, it can be nearly impossible to control those urges. Apart from the cosmetic impact of recurrent skin lesions and scarring, SPD can lead to serious infections, shame, depression, and anxiety.
You may be feeling alone or embarrassed, but you should know that this condition affects at least five million Americans.
A diagnosis of SPD, also known as excoriation disorder, is made when there are repeated attempts to stop picking, and the skin picking is either distressing or interfering with social or work functioning. SPD is one of a group of disorders that is related to obsessive-compulsive disorder (OCD).
You already know that it is not a matter of will — trying to stop is the equivalent of telling one not to have high blood pressure. The good news is that therapy, medication, and dermatologic treatments can help. For most, though, no one treatment will be curative, and you will experience remission and recurrence.
Having realistic expectations and arming yourself with a variety of skills for skin picking flares will make this condition much more manageable. Here are four tips that can help you tackle your picking.
1. Know your triggers
You may be tempted to pick for a variety of reasons, from boredom, itch, or negative emotions, to blemishes or simply looking at or feeling your skin.
You may even find the experience of picking itself pleasurable. Understanding your triggers can be a first step in deciding which treatments to pursue. For example, if your picking is triggered by a skin condition such as acne or itch, you might be best served by first seeing a dermatologist. If, however, your picking is triggered by depression, anxiety, or more of an urge, you should consult with a mental health professional with expertise in skin picking.
2. Make it harder to pick
One simple strategy to reduce picking, called stimulus control, involves changing your environment to make it harder to pick. Examples of this technique include keeping your nails short, wearing gloves at times when you are most likely to pick, and making the skin more difficult to access by wearing tight-fitting clothing or long-sleeve shirts. You can also try distracting your hands with any number of items including silly putty, stress balls, fidgets, and tangle toys.
Once you have found an item that works for you, make sure to have one everywhere you spend time such as work, home, and your bag, so you are fully covered.
3. Get therapy
Cognitive behavioral therapy (CBT) is a structured type of psychotherapy that aims to produce healthier behaviors and beliefs by identifying unhelpful thoughts and behaviors. A specialized type of CBT has been developed for SPD. This type of CBT includes more of the stimulus control techniques described above, as well as habit reversal training, in which individuals are taught to engage in a harmless motor behavior (like clenching one’s fists) for one minute when triggered to pick. Clinical trials have demonstrated that skin-picking for CBT can be extremely effective. But because it is different than other types of CBT, it will be important to work with a therapist who is trained in treating SPD. You can find skin-picking experts at the TLC Foundation for Body-Focused Repetitive Behaviors.
4. Consider medication with your providers
While no medication has been formally approved by the FDA to treat excoriation disorder, there is evidence to suggest that selective serotonin reuptake inhibitor (SSRI) antidepressants and N-acetylcysteine (NAC), an antioxidant supplement, can be helpful.
Please be aware that even over-the-counter, well-tolerated supplements like NAC should always be taken under the supervision of a medical professional for guidance on dosing, duration of treatment, drug interactions, and side effects.
For more on overcoming SPD, visit the TLC Foundation for Body-Focused Repetitive Behaviors and the International OCD Foundation.
Dermatillomania: what to do with the obsessive desire to pick acne?
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29/10/2021
author Maria Chernitsova
In a recent article on the fight against post-acne, we casually mentioned lovers of pimple crushing.
And it is not at all accidental: the elimination of inflammation with one's own hand is the most common cause of scars and spots.
And if in the previous material it was important for us to highlight specific ways to eliminate existing acne spots, today we decided that it is worth considering this problem from a different angle.
After all, the best way to get rid of hated post-acne is to prevent their appearance!
Why do we like to squeeze pimples and blackheads so much?
The reason for this is dermatillomania.
Dermatillomania is a desire to damage one's skin, which has an obsessive character. Often this desire is not realized by a person and is performed "on the machine".
How does it manifest itself?
- you have a habit of biting your lips until they bleed;
- you pick at pimples, often quite unconsciously;
- you like to press blackheads;
- you aggressively scratch your skin until it hurts;
- you have an irresistible desire to peel off the crust from a fresh wound;
- burrs are haunting you: they need to be torn off immediately.
In general, dermatillomania is not only the desire to crush pimples. The spectrum of its manifestations is much wider!
Why can't you just stop picking at leather?
There are a number of reasons for this:
1. Most likely, you are in a state of stress, experiencing background anxiety, thus trying to calm yourself.
Picking the skin or tearing the lips to shreds in this case is a habitual "grounding" ritual that distracts from anxiety.
2. You are in a negative cycle.
There is some kind of trigger emotion that a person is sometimes not even able to realize (let alone "digest" and live it correctly). Each time faced with this emotion, a person resorts to this form of self-ham.
The sequence of the negative cycle is as follows: painful trigger emotion → desire to calm oneself and distract oneself from unpleasant emotions → act of self-harm → feeling of guilt → repetition of the situation.
What to do with these?
1. Recognize that you have a problem and tune in to solve it. If you have tracked these obsessive compulsions in yourself, this is already half the battle!
2. And, perhaps, the most important thing is to try to get rid of the feeling of guilt if you suddenly pick up acne again. Remember: shame and guilt only exacerbate all bad habits. Those who have ever tried to get rid of nicotine addiction probably know what I'm talking about.
3. If you often do not even realize how it happened that the face is again like after the bombing, bring it into the area of awareness. So it will be easier to catch yourself in these episodes. By regularly fixing your desire to commit self-harm, you will gradually learn to control these manifestations.
4. If you can track the moment when the hands reach for the face, visualize the result of this "event". No, really. give free rein to your imagination and have a good idea of how long it will take to heal wounds, how much money will be spent on the purchase of appropriate care.
And it’s also good to imagine the craters and ruts that can remain after picking acne.
5. Get anti-stress toys. They are very relaxing and relaxing. Even my colleagues and I have, and not even one! We highly recommend.
6. Contact a specialist (psychologist, psychotherapist). Usually, repressed emotions / unresolved issues of a personal nature are behind the manifestations of dermatillomania.
5 ways to deal with the urge to touch and pick your skin - HEROINE
Picking a crust from a healed wound, squeezing a minor pimple to get rid of it, biting your nails or the skin around them are bad habits that are not very common to talk about. Almost everyone has such weaknesses to one degree or another, but sometimes obsessive attention to one's skin can become a symptom of mental illness and seriously ruin one's life. We tell you how to understand that you need help, and share simple tips to help take your mind off the desire to dig up your body.
When attention to one's skin becomes a disease
In psychiatry for people suffering from an obsessive desire to do something with their skin, there is a diagnosis of "neurotic excoriation", or "dermatillomania".
These are compulsive, that is, obsessive, actions that lead to self-damage of the skin: combing, squeezing, and other manipulations.
The American Psychiatric Association classifies dermatillomania as a form of obsessive-compulsive disorder (OCD).
The fact that you sometimes, contrary to the advice of dermatologists, give in to the desire to squeeze out a pimple does not mean at all that you have a mental disorder. Everyone's own skin imperfections cause irritation, especially when you live in a world of glossy faces, thanks to a photo editor or Instagram mask. You can talk about dermatillomania only in cases where attention to your skin takes an obsessive form and causes serious discomfort. For example, many wounds and scars remain on the body, which makes a person embarrassed to wear open clothes, begins to avoid social situations and experience complexes.
Like all people with OCD, the person with dermatillomania is well aware that they are harming themselves with their actions, but cannot resist the urge to do them over and over again.
His mind is guided by a well-known chain: "anxiety - a familiar ritual (combing the skin, biting off burrs, etc.) - relief." Post-ritual calm does not last long: soon another wave of anxiety sets in, and the cycle starts again.
Due to the inability to cope with an obsessive desire and because the consequences of his actions affect his appearance, a person with dermatillomania often experiences feelings of guilt, self-loathing, which only increases the anxiety state.
Read on: What you need to know about agoraphobia and how to distinguish it from anxiety
How to deal with the urge to touch the skin
With dermatillomania, you can’t just stop yourself from engaging in self-harm - this will inevitably lead to a new breakdown and aggravation of the situation. It is difficult to cope with this condition on your own, most often the help of a psychotherapist is needed here. Treatment is the same as for other OCD patients—cognitive behavioral therapy, sometimes combined with anti-anxiety medications and antidepressants.
However, there are things a person with dermatillomania can do for himself. These tips are also suitable for people with a mild degree of disorder and in general for anyone who wants to wean themselves from harmful skin manipulations.
Know that squeezing pimples will not get rid of them
Inflamed pimples look unattractive, but by squeezing them, you destroy the skin barrier and create a wound where there was none. As a result, instead of disappearing without a trace, the pimple leaves behind a scar and heals much longer than it could. In addition, squeezing increases the risk of infection and aggravates the problem. Understanding this fact can help you resist the urge to touch your skin.
Spend less time in front of a mirror
When it comes to the habit of picking your face, the absence of a mirror can at least slightly reduce the temptation. Try not to keep it on hand. When you're in front of a mirror when you need to, like after washing your face or before applying makeup, it's important to stay mindful and not let yourself drift off.
Often people who are prone to dermatillomania forget themselves in their impulse and come to their senses when the skin is already hopelessly damaged.
Wash your hands often and disinfect your skin
If you can't completely stop the bouts of "self-digging", at least try to make them as safe as possible. Touch your face only with clean hands, disinfect the skin, treat wounds with antiseptic and healing agents to reduce the likelihood of infection.
Find something to do with your hands
The main rule of getting rid of a bad habit is to replace it with something else. For example, put an elastic band on your hand and click it when you reach for the skin. Or find an interesting distracting anti-stress toy.
Pay attention to the triggers that make you do it
An important step in the fight against dermatillomania is to become aware of the triggers that make you resort to a bad habit. These can be certain emotions (anxiety, fear), specific thoughts (fear of doing your job poorly, dislike for your body), social situations (communication with strangers, being in a big company).
