Skin Picking Dermatillomania, Is It a Disorder?

skin picking

Dermatillomania, also known as skin picking disorder, is classified as an impulse control disorder and pertains to continuous and compulsive picking of the skin.  Dermatillomania is classified in the DSM-5 under the category of Obsessive-Compulsive and Related disorders and is a body-focused repetitive behavior.  Skin picking disorder tends to have an onset in adolescence, but can also have an earlier or later onset in life. Skin picking disorder is more prevalent in females than males and is a relatively chronic condition.  Skin picking disorder may result in medical issues or significant tissue damage and causes marked distress and impairment in a person’s daily functioning.

People who engage in repetitive skin picking usually focus on their face, hands, arms, and legs and may use their fingers or objects like tweezers or pins to engage in the behavior.  People may pick at skin that is healthy, pimples or calluses, or scabs.  People with this disorder spend an excessive amount of time thinking about picking their skin and trying to resist the temptation.  Individuals may spend several hours a day thinking about or engaging in picking behaviors.  Skin picking disorder can last anywhere from several months to several years and symptoms may intensify or decrease periodically depending on circumstances and stressors. 

Skin picking disorder can cause extensive damage to the skin and can result in discoloration, scars, infections, and wounds.  Individuals experience significant distress from the condition and tend to experience a significant amount of fear and shame.  People may go to excessive lengths to cover their skin for fear that someone will notice and expose their condition.  People may attempt to hide their skin with clothing or makeup, or may withdraw from relationships or social opportunities all together.  Isolation from family and friends can cause deterioration in important relationships, which can result in further feelings of anxiety and depression. 

Skin picking disorder is not diagnosed when the skin picking is prompted by another medical or psychological condition, such as autoimmune disorders, withdrawal, developmental disorders, or other skin conditions.  Skin picking disorder is only diagnosed when diagnostic criteria is met.  The diagnostic criteria for skin picking disorder includes continuous picking of the skin resulting in skin lesions, frequent attempts to reduce or eliminate the skin picking, and clinically significant impairment and distress caused by the skin picking behaviors. 

At present time, the cause of skin picking disorder is unknown.  It is believed that a combination of heredity and genetics along with other environmental factors may be a cause for skin picking disorder.  Skin picking behavior tends to develop in conjunction with puberty or with other problems of the skin, such as acne.  Skin picking disorder is often linked with perfectionism or as a way to cope with stressful events.  Some individuals may engage in skin picking behaviors to release tension and negative emotions.

People with skin picking disorder usually attempt to stop the behaviors themselves, as they are often embarrassed and ashamed to seek professional treatment.  Most people are unsuccessful in their efforts to treat themselves and require clinical intervention.  Professional, therapeutic intervention can assist people to reduce the symptoms of skin picking disorder.  Treatment often includes a combination of cognitive behavior therapy and medication.  Cognitive behavior therapy helps people to identify how thoughts and feelings impact their behaviors and attempts to help them to alter their thinking.  Antidepressants may also be used in conjunction with therapy to help a person to decrease obsessive thoughts and compulsive behaviors.  In some cases, antibiotics, medical intervention, or even surgery may be required to help people with severe cases.