Picking your skin is not a sure-fire sign of a mental health condition. Many people engage in skin picking behavior from time to time, such as when they have a scab or a pimple, or the tendency to pick at their cuticles when they’re bored. However, compulsive skin picking can be evidence that something deeper is at play.
The compulsive urge to pick your skin may qualify as an obsessive-compulsive behavior but it does not, in isolation, mean that you have obsessive-compulsive disorder (OCD). If this sounds a bit confusing to you, you’re not alone. To understand things better, it’s important to know that there is actually a wide range of what’s called “obsessive-compulsive and related disorders,” according to the DSM-V (Diagnostic Statistical Manual). These disorders often share many of the same characteristics but there are also key differences.
These disorders can also occur at the same time. For instance, people with another root cause for their skin picking — such as excoriation (aka skin picking disorder), which we’ll get into below — are more likely to have OCD or another condition that falls into the category of an “obsessive-compulsive or related disorder” (such as body dysmorphic disorder).
Let’s get into some key differences:
Understanding excoriation disorder
Excoriation, or skin picking disorder, involves recurrent skin picking despite efforts to stop or decrease the picking behavior. Whereas skin picking may be one component of other disorders, 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, require surgery and even be life-threatening.
In addition to the physical effects, excoriation can also get in the way of one’s social and/or work life. Many people report avoidance of social events or say their skin picking makes it difficult to focus. It is also common to feel embarrassed about the skin picking behavior and feel out of control, which often results in significant distress.
Why do people with excoriation disorder pick their skin?
The reasons why people 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. There may also be specific rituals around the skin picking behavior that could involve searching for a certain type of scab to pick or 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 outside of the person’s realm of awareness, meaning it occurs without the presence of tension or anxiety.
Understanding Body Dysmorphic Disorder
Unlike excoriation disorder, individuals with body dysmorphic disorder are primarily occupied with their physical appearance and the perception of how they look. They may fixate on a perceived bodily “flaw”. Although the focus of these flaws can be any area of the body, it is commonly centered on the skin, hair or nose. While others perceive these flaws as minor or may not notice them at all, it’s a different story altogether for the person who is suffering with body dysmorphic disorder. They may believe they appear unattractive, 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 people with body dysmorphic disorder (or BDD) 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, the behavior of skin picking can have a similar impact on people regardless of the root disorder that’s behind it. For example, just as is the case for those with excoriation disorder, it’s common for individuals with BDD to experience a great deal of anxiety and social avoidance. They may also feel depressed and encounter low self-esteem issues due to shame around their physical appearance.
Why might people with Body Dysmorphic Disorder pick their skin?
Skin picking is an effect of the obsession with how they look in people with body dysmorphic disorder. In other words, people with BDD often pick their skin in an attempt to improve the appearance of perceived skin flaws. They may do this by attempting to remove or minimize nonexistent or slight imperfections in appearance (like pimples or bumps, for example).
OCD is characterized by obsessive and unwanted thoughts or urges followed by repetitive physical or mental compulsions performed in an attempt to reduce the resulting anxiety or distress. People who suffer from OCD spend a lot of time wondering what their thoughts mean about them, and worry about what might happen (typically something bad) if they don’t engage in compulsive behaviors. Unfortunately, compulsions only provide short-term relief, if that.
The good news is that whether you have skin-picking disorder, body dysmorphic disorder, or OCD — or more than one of these disorder at the same time — there is effective help available.
You can conquer your skin picking habit
If you feel you may be suffering from excoriation disorder, it’s time to seek a proper diagnosis and get on the road to recovery with one of the most effective therapies for skin-picking disorder and all other BFRBs: habit reversal training (HRT).
In HRT, the various circumstances in a person’s life that contribute to the pulling or picking episodes are taken into consideration. It is typically a short-term treatment, lasting around 12 therapy sessions or sometimes fewer, and has shown to be highly effective when people follow the therapist’s guidance.
For the other conditions we’ve discussed, decades of research show that that exposure and response prevention therapy (ERP) can successfully treat individuals with OCD or body dysmorphic disorder. ERP is a type of behavioral therapy that aims to reduce compulsive behaviors and decrease avoidance of anxiety-inducing situations.
By doing ERP with a trained therapist, you won’t be riddled with distress from your thoughts – like “Everyone is looking at this pimple on my face and I must get rid of it by any means.” And you’ll no longer spend hours each day performing compulsions such as looking for your “flaws” in a magnifying mirror and trying to correct any blemishes. And the things that matter the most to you — like your social life, self-esteem, and work life — won’t be at risk of slipping away.
A lot of people think that ERP will be too overwhelming, so they avoid it. But that’s not the case at all. A trained therapist who specializes in ERP will take the time to understand your symptoms and create a custom ERP therapy plan specifically for you — no matter what the root cause.
Here at NOCD, our licensed therapists receive specialized training in both ERP and HRT therapy, and have experience treating the various conditions that might be related to your skin picking. I encourage you to learn more about getting on the path to recovery with NOCD Therapy.