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Why do I pick at my scabs? A therapist explains

By Elle Warren

Nov 28, 20235 min read minute read

Reviewed byApril Kilduff, MA, LCPC

Habits are, by definition, hard to break. They are especially hard to break if they bring us a sense of satisfaction or pleasure. 

For some, picking at scabs does just that. If you’re feeling lost about why you can’t seem to stop doing this, this article should help answer your questions. It’s scary to be confused by our own behavior, but we all do things we don’t understand. As you read, I hope this can be a source of comfort: it’s a profound act of self-compassion to try to gain a deeper knowledge of your brain and your behaviors. 

If you spend an excessive amount of time picking at your scabs, rest assured that there are answers for you. Let’s take a look at this particular habit, and what you can do if it’s interfering with your life.

Why do you pick at your scabs?

We all probably do this from time to time. When you have a scab on your body, it’s completely normal to want to touch it and even pick at it. It’s not necessarily something you need to worry about.

However, says April Kilduff, MA, LCPC, LMHC, a specialist in OCD and related disorders, “If it’s happening so much that you’re causing additional damage to your skin, like wounds that are getting infected, scarring, or getting bigger—or if you actually creating new scabs—these are signs that you might want to seek professional help.” 

If you find yourself in the latter category, you could have something called a body-focused repetitive behavior (BFRB). When a BFRB is focused specifically on skin picking, it’s also referred to as skin picking disorder, dermatillomania, or—most often these days—excoriation disorder. It’s estimated to affect between 1.4% and 5.4% of American adults.

What is a BFRB?

A body-focused repetitive behavior is a chronic, recurring self-grooming behavior. Behaviors can include picking, pulling, biting, or scraping, and usually focus on one’s hair, skin, lips, cheeks, and nails. They cause physical damage, but people who struggle with them feel unable to stop their habit.

They are characterized by being “highly repetitive and time-consuming”, says Kilduff. Moreover, “They typically result in skin or hair being damaged.”

Though picking at scabs naturally results in them becoming larger, bloody, or even infected, Kilduff says those with BFRBs may feel “a refusal to have any marks on them. They may want their skin to be perfect—even if their behaviors don’t actually help and could make things worse.” 

Diagnostic criteria for BFRBs in the DSM-5, the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, include:

  • Recurrent skin picking that results in skin lesions
  • Repeated attempts to stop the behavior
  • The symptoms cause clinically significant distress or impairment
  • The symptoms are not caused by a substance, medical, or dermatological condition 

The motivation to pick at one’s skin often stems from an attempt to regulate one’s sensory system. “If you’re bored, for example,” says Kilduff, “you might do this to stimulate yourself. If you’re anxious, you might do it to try to soothe yourself.” It typically feels very satisfying to engage in the behavior, and again, you may also have the desire to make your skin smooth or remove unsightly scabs.

While you may not feel frustrated or distressed while you’re picking at your scabs, the habit tends to bring shame, frustration, or embarrassment afterward, particularly when others can see the results of your picking. People struggling with excoriation disorder might try to cover their scabs when they’re around others, or try to keep their picking habit out of sight.

Get your life back from OCD

Could it be something besides a BFRB?

BFRBs can be easily confused with compulsions in obsessive-compulsive disorder (OCD). While BFRBs are a type of compulsive behavior, they’re not the same as compulsions in the context of OCD. 

Compulsions are triggered by intrusive triggers, meaning that they’re performed “to immediately relieve distress and anxiety caused by a thought, to try to get some certainty or reassurance, or to try to prevent a bad thing from happening,” Kilduff explains.

“Those are not typical motivators for pulling and picking,” Kilduff continues, “which is usually about sensory regulation and/or perfectionism.”

If you find that your picking does tend to happen after you have a distressing thought, and the picking is a direct response to it, you could be experiencing OCD. Learn more about the disorder here

Note that you can also experience OCD and BFRBs simultaneously. It’s common for those with BFRBs to have a co-occurring condition, especially OCD or an anxiety disorder.

How can you get help?

As overwhelming as all this information may be, there’s good news: there are evidence-based treatments for BFRBs. The condition is highly treatable. Even if your behavior is currently habitual and ingrained in your day-to-day life, it doesn’t have to stay that way.

The primary evidence-based form of treatment for BFRBs is called habit reversal training (HRT). It’s the oldest and most well-researched treatment method for BFRBs, and it works to develop the sufferer’s awareness of where, when, and why they pick at their scabs. As with addressing any problem, gaining awareness is a key first step.

Awareness also leads to the next critical component of HRT treatment, which is developing competing responses. These are behaviors that one can do in place of the picking. For example, whenever you have the urge to pick at a scab, you might learn to gently ball up your fists, physically preventing your habit.

Social support is the third component of HRT—and it can sometimes be just as important as the first two. Involving loved ones in your treatment plan helps ease the shame you may have around it. They can also help you to notice when you’re engaging in the BFRB. And if you’re utilizing your competing response instead, they can offer you positive feedback. 

You can access effective treatment

No matter how long and to what severity you’ve been engaging in picking, there is hope for you. HRT therapy is highly effective, and it’s more accessible than ever.

Licensed therapists at NOCD receive intensive, specialized training in treating BFRBs—including excoriation disorder—with HRT. If you think you or someone you care about may be struggling with a scab-picking habit, I strongly encourage you to learn more about NOCD’s evidence-based, accessible approach to treating BFRBs.

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