Excoriation (Skin-Picking) Disorder

Understanding Skin Picking, Urges, and the Cycle of Tension and Release

Excoriation Disorder (Dermatillomania) is a Body-Focused Repetitive Behavior (BFRB) involving recurring picking of the skin that leads to lesions, scarring, or infection. People may pick at blemishes, bumps, scabs, texture irregularities, or perceived imperfections. Behaviors is sometimes intentional and sometimes automatically.

This condition is not self-harm and not a matter of “just stopping.”
It is a complex, sensory and emotionally driven disorder that deserves skilled, compassionate treatment.

Many individuals pick during stress, boredom, or when they notice an imperfection. Shame often follows, leading to hiding, makeup use, long sleeves, or social avoidance.

You are not alone and recovery is possible.

What Is Excoriation Disorder?

Excoriation Disorder is characterized by:

  • Recurrent skin picking

  • Repeated attempts to stop

  • Skin damage (sores, scabs, scars, infections)

  • Emotional distress or impairment

Picking may be:

  • Focused — intentionally targeting specific spots

  • Automatic — occurring without conscious awareness

Both patterns can coexist and respond well to treatment.

Common Triggers for Skin Picking

Triggers often include:

  • Stress or anxiety

  • Boredom

  • Feeling texture or irregularities

  • Seeing imperfections

  • Perfectionism regarding appearance

  • Emotional overwhelm

  • Fatigue

  • Tactile sensations

  • Using mirrors or bright lights

Common Experiences

People with this condition frequently describe:

  • A rising tension before picking

  • A sense of relief or satisfaction during picking

  • Losing track of time

  • Feeling unable to stop

  • Shame or regret afterward

  • Avoidance of social events or sunlight

  • Covering marks with clothing or makeup

These behaviors are symptoms, not character flaws.

How We Treat Excoriation Disorder

Treatment focuses on awareness, interruption of urges, emotional regulation, and reducing shame.

1. Habit Reversal Training (HRT)

Clients learn to:

  • Identify triggers

  • Build awareness of hand movements

  • Use competing responses (fists, fidgets, barriers)

  • Reduce automatic picking episodes

2. Stimulus Control

Environmental adjustments can significantly reduce picking:

  • Limiting mirror time

  • Changing lighting

  • Wearing clothing that covers high-pick areas

  • Keeping hands occupied

3. Comprehensive Behavioral Treatment (ComB)

We address the sensory, emotional, cognitive, and environmental drivers of picking.

4. ERP-Informed Methods

When picking is tied to anxiety or OCD-like urges, we incorporate:

  • Exposure to sensations or imperfections

  • Reducing avoidance

  • Building distress tolerance5. Nervous System Regulation

Many urges decrease when clients regulate tension, stress, and sensory overload.

Common Questions About Excoriation Disorder

  • No. Skin picking is a BFRB and serves a sensory or emotional function, not self-punishment.

  • Because it temporarily reduces tension or sensory discomfort.

  • Yes. Treatment is highly effective when tailored to individual triggers.

  • Automatic picking is common and treatable with awareness-building skills.

  • Skin often heals well, especially when picking decreases. We also work compassionately with dermatologists when needed.

When to Reach Out for Help

If skin picking feels unmanageable, isolating, or emotionally painful, specialized treatment can help you break the cycle.

At The OCD Relief Clinic, we help individuals:

Reduce picking episodes

Build awareness

Replace behaviors with healthier regulation

Heal shame and rebuild confidence

Improve quality of life


Learn more about Body-Focused Repetitive Behaviors and their treatment.


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