Skin picking itself is not indicative of obsessive-compulsive disorder (OCD). Many people engage in skin picking behavior when they have a scab or a pimple, or just pick at their cuticles. However, compulsive skin picking can be evidence of OCD or another obsessive-compulsive or related disorder. So how can we tell the difference?
When you think of obsessive-compulsive disorders, it’s likely that OCD comes to mind first. However, OCD is not the only disorder of its kind. In fact, there is a wide range of obsessive-compulsive and related disorders in the DSM-V (Diagnostic Statistical Manual). These disorders are categorized together, as they often share many of the same characteristics, and often the diagnosis of one obsessive-compulsive or related disorder is an indication of another.
Several disorders in the obsessive-compulsive and related disorders category may involve skin picking tendencies, most notably excoriation and body dysmorphic disorder. As discussed above, there is a high probability for comorbidity between these disorders, and thus the likelihood of an individual being diagnosed with OCD is much higher for those already diagnosed with excoriation or body dysmorphic disorder. With this in mind, skin picking behavior can point to OCD and therefore it is important to understand these related disorders. While the skin picking behavior of individuals with one of these disorders may appear identical, we can often distinguish them by asking why the individual is engaging in such behavior.
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Excoriation, or skin picking disorder, involves recurrent skin picking despite efforts to stop or decrease the picking behavior. Whereas skin picking may be a component of other disorders in the obsessive-compulsive and other related disorders category, it is the main criteria in excoriation. Individuals with excoriation disorder may spend hours a day engaging in skin picking behavior or thinking about or resisting the desire to pick. The ongoing picking can cause varying degrees of pain and often have serious physical implications, ranging from skin irritation to significant tissue damage, scarring or infection that could, in some instances, necessitate surgery and even be life-threatening.
In addition to the physical effects, excoriation can also impede social and/or occupational functioning. Many individuals report avoidance of social events or say their skin picking interferes with work or school, with the picking often making it difficult to focus. It is also common for individuals to feel embarrassed or shameful about their picking and suffer a sense of loss of control, often resulting in significant distress.
The reasons why individuals with excoriation disorder engage in skin picking behaviors can vary. Often the desire to pick is preceded by feelings of anxiety or boredom. It is also common for individuals to experience growing tension related to the desire to pick, which is followed by a sense of relief and/or pleasure after picking. The individual may also have specific rituals around the skin picking behavior that could involve searching for a certain type of scab to pick or involve playing with or sometimes swallowing the scab following its removal. On the other hand, it is also possible for the picking to be more automatic and out of the individual’s awareness, meaning it occurs without the presence of preceding feelings of tension or anxiety.
Unlike excoriation disorder, individuals with body dysmorphic disorder are primarily occupied with their physical appearance and the perception of such as flawed or defective in one or more ways. Although the focus of these flaws can be on several different areas of the body, it is most commonly on either the skin, hair or nose. It is important to highlight that while others perceive the flaws as minor or may not see them at all, the individual with body dysmorphic disorder can experience a range of concerns from believing they appear unattractive to hideous or even monstrous. The preoccupation with these perceived flaws causes the individual to engage in a wide range of repetitive behaviors such as comparing oneself to others, continuously checking mirrors and excessive grooming or exercising, to name a few. It is also extremely common for these individuals to engage in compulsive skin picking.
While the preoccupation in excoriation disorder is on skin picking itself, and in body dysmorphic disorder it is on physical appearance, many of the effects experienced are the same. The physical and emotional effects, as well as the social/occupational impediments described above, for excoriation disorder exist to the same or similar extent in body dysmorphic disorder. It is also common for individuals with body dysmorphic disorder to experience a great deal of anxiety and social avoidance, as well as depressed mood and low self-esteem due to shame around physical appearance. While the full breadth of emotional and psychological effects associated with body dysmorphic disorder are great, they are beyond the scope of this article.
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Although there are similarities in the physical effects of skin picking in both excoriation and body dysmorphic disorder, the cause is markedly different. While skin picking itself is the obsession in excoriation disorder, skin picking is an effect of the obsession in body dysmorphic disorder. The main focus here is on physical appearance, and individuals engage in skin picking in an attempt to improve or fix perceived defects.
The good news is that help is available. Current research suggests that exposure and response prevention therapy (ERP) can successfully treat individuals with OCD, excoriation disorder or body dysmorphic disorder. ERP is a type of cognitive behavioral therapy (CBT) that aims to reduce compulsive behaviors and decrease avoidance of anxiety inducing situations.
If you or someone you know is suffering from OCD, excoriation disorder or body dysmorphic disorder help is available. You can schedule a free 15-minute call with an NOCD therapist today. All NOCD therapists are trained to provide ERP therapy. NOCD also offers video therapy for those who need it and is available in all 50 states.