Excoriation Disorder (Skin Picking Disorder)

Excoriation Disorder (Skin Picking Disorder)

As the name suggests, skin picking disorder (SPD) occurs when individuals habitually engage in EXCESS picking, rubbing, scratching or digging into the skin on various areas of their body in an attempt to remove or “fix” various perceived flaws or irregularities that appear on their skins surface. While it is common for many people to have the occasional ‘pick’ at the odd bump or lump on their skin, the consequences of excoriation disorder can have severe implications on the individual’s quality of life, ability to perform daily tasks such as work or school, and their motivation to engage in various social activities.

Individuals with SPD may go to great lengths to avoid various public areas (such as gyms, swimming pools, or beaches) or close contact with others where their skin damage caused by their SPD behaviours may be noticeable (eg: bleeding, raw, scabbed, and other damages to skin). Often, the skin picking behaviour have debilitating effects on the individual’s ability to perform daily tasks due to the time consuming, isolating, and distressing nature of the disorder. Skin picking disorder is thought to affect around 5% of the general public, and falls under the category of body-focused repetitive behaviour (BFRB) disorders, as it shares similar characteristics to those demonstrated in Trichotillomania (TTM) (otherwise known as hair pulling disorder), excessive nail biting, and cheek biting.

What are the symptoms?

  • Repetitive nail biting and skin picking, rubbing, scratching or digging behaviours on various areas of the skin where the individual believes they have a perceived flaw, resulting in significant damage to the skin.
  • Individual may associate the skin picking behaviour with pleasure or as a method of soothing tension or relieving boredom, however these emotions are followed by intense feelings of regret, distress, and guilt.
  • Skin picking behaviour interferes with the individual’s quality of life and ability to engage in routine tasks due to the amount of time it takes out of their day and the accompanying level of shame, distress and embarrassment that their behaviour invokes.

Why does it happen?

There are a number of reasons to suggest why some individuals develop SPD and others don’t, with some suggesting its origins lie in genetic or biological predispositions – however, a singular cause for skin picking disorder has yet to be discovered. For most individuals with excoriation disorder, their behaviour is often a habitual response to feeling common emotions such as anxiety, fear, excitement, or even just boredom. Many individuals report that their picking behaviour gives them a sense of momentary pleasure, satisfaction, and has soothing elements. However, much of the positive effects one associates with their skin picking behaviours are short-lived, and are soon replaced with deep pangs of guilt, shame, and distress. Habitual skin picking behaviour often starts out as a coping mechanism response to a stressful life event – while other cases may develop from a prior skin lesion where the individual has felt the need to itch their healing wound, resulting in cyclical scabbing, itching and picking behaviours whereby the skin never completely heals.

How is it treated?

There are multiple approaches to treating excoriation disorder, some of which may incorporate the use of various medications used in conjunction with psychotherapeutic options, however, the effectiveness of these will vary across each individual case. The most effective form of treatment providing long lasting results for SPD is a form of Cognitive Behavioural Therapy (CBT) known as Habit Reversal Training (HRT). HRT involves identifying the individuals underlying emotional, behavioural and environmental triggers that are associated with their behaviour, and once these are identified, they are then taught various alternative methods and strategies to deal with their emotions in order to respond to their identified triggers in a more constructive manner.

Another effective psychotherapeutic treatment for SPD is called Stimulus Control (SC), whereby the individual attempts to prevent their destructive behaviours by modifying various stimuli in their everyday environment that they have identified as trigger points for their skin picking behaviours – for some this may be setting an alarm on their phone to remind them not to spend too long ‘zoning out’ in front of the TV or computer where their skin picking behaviour often occurs automatically, or for others they may find it helpful to wear gloves, band-aids or other props that cover their fingers that may prevent them from feeling the same sensation that would otherwise result from bare skin contact.