Skin picking disorder (dermatillomania): symptoms, causes and treatment

The NHS describes skin picking disorder as a condition, also called dermatillomania or excoriation disorder, where you cannot stop picking at your skin. Most people pick at their skin from time to time, but with this disorder the picking is repeated, hard to resist and can damage the skin. OCD-UK says it is listed in diagnostic manuals under the heading of obsessive compulsive and related disorders, and as a body-focused repetitive behaviour.

You may pick your skin with your fingers, fingernails, teeth or with tools like tweezers, pins or scissors, according to the NHS. OCD-UK adds that the face and arms are the most commonly picked areas, and that there may also be skin rubbing, squeezing or biting.

The NHS says you may have skin picking disorder if you:

• cannot stop picking your skin

• cause cuts, bleeding or bruising by picking your skin

• pick moles, freckles, spots or scars to try to "smooth" or "perfect" them

• do not always realise you are picking your skin

• pick your skin when you feel anxious or stressed

OCD-UK says people with skin picking problems often spend significant amounts of time on picking rituals, sometimes several hours per day, and the pattern may last for months or years, causing significant distress or impairment. It can hinder social interaction, which may be avoided if scars are visible.

The NHS says skin picking disorder is related to obsessive compulsive disorder, where the person cannot stop themselves carrying out a particular action. It can be triggered by boredom, stress or anxiety, negative emotions such as guilt or shame, skin conditions such as acne or eczema, and other blemishes the person wants to get rid of, which may not be noticeable to other people.

People with skin picking disorder often also have other obsessive compulsive disorders, such as body dysmorphic disorder, which may need their own assessment and treatment, the NHS says.

OCD-UK explains there are similarities but important differences. In OCD, the compulsions are driven by unwanted intrusive thoughts (obsessions), usually carried out to prevent something bad happening. In skin picking there are not always obsessions, and the picking is primarily to reduce tension or stress, sometimes to reduce or prevent blemishes, or because of guilt.

The NHS says there are things you can try that may help.

• Keep your hands busy, for example by squeezing a soft ball or putting on gloves.

• Identify when and where you most commonly pick your skin and try to avoid those triggers.

• Try to resist for longer and longer each time you feel the urge to pick.

• Care for your skin when you get the urge to pick it, for example by applying moisturiser.

• Tell other people, who can help you recognise when you are picking.

• Keep your skin clean to avoid infection.

• Keep your nails trimmed, and do not keep things like tweezers and pins where you can easily get at them.

The NHS says a GP will ask about your skin picking behaviour and look at your skin. If they think you have skin picking disorder, they may refer you to a specialist for diagnosis and possible treatment, with a type of talking therapy or medicine. They may also refer you to a dermatologist if your skin is badly damaged or you have any underlying skin conditions, like acne or eczema, that may be triggering your skin picking.

The NHS says talking therapy is currently thought to be an effective treatment to help change skin picking behaviour. It is usually given through community mental health services. The most common type is cognitive behavioural therapy (CBT), and may include a technique called habit reversal training, which works by helping you recognise and be more aware of your skin picking and what is triggering it, and replace skin picking with a less harmful behaviour.

Your doctors may recommend some types of medicine to help you control your skin picking, which the NHS says may be prescribed by a GP but more often by a specialist (psychiatrist). OCD-UK says some people need the extra support of an SSRI antidepressant to help them through therapy.

The NHS says to see a GP if you cannot stop picking your skin, you are causing serious damage to your skin by picking it, like cuts that do not heal within a few days, or picking your skin is causing you emotional distress or affecting your daily life.

On the NHS, the GP can refer you to community mental health services for talking therapy, and to dermatology for skin damage. Some people also choose a private therapist trained in CBT and habit reversal training. Whichever route you use, it is reasonable to ask about the therapist's experience of body-focused repetitive behaviours.