When we experience stress, our brain and body naturally develop coping mechanisms. However, not all techniques are healthy. Some may binge eat and others may turn to alcohol. In rarer cases, you may develop dermatillomania.

Dermatillomania (or excoriation disorder) is a condition marked by compulsive skin-picking as a response to stress and discomfort. This practice can harm the body and lead to: ¹

• Infections
• Scabbing
• Scarring

While it creates physical symptoms, medical professionals agree it’s a mental health condition. That’s because it’s a compulsive action responding to intrusive thoughts.

Symptoms

The act of skin picking is a stress response. Over time, this can cause damage to the body and develop into other health concerns.

To avoid these concerns, it’s important to understand the signs and behaviors of excoriation disorder: ²

• Bruises, bleeding, cuts, or tearing of the skin
• Skin agitation during sleep
• Scratching at acne, scars, moles, and freckles (to “perfect” the skin’s appearance)
• Unconscious poking, prodding, and peeling of the skin, sores, or scabs 

Is Dermatillomania Related to OCD?

Since the act of skin-picking is a response to stressful thoughts, some have argued the condition is linked to obsessive-compulsive disorder (OCD). However, while dermatillomania is an impulse control disorder, those who struggle with it don’t necessarily have OCD.

Excoriation disorder can be seen as a potential physical symptom of OCD. Similarly, those with OCD may show signs of other physical symptoms, such as trichotillomania (pulling out hair). ³

Still, not everyone with OCD will develop these symptoms, nor will everyone with these symptoms meet the diagnosis criteria for OCD.

Causes

In most cases of excoriation disorder, the underlying cause is stress. Stress can be caused by several factors, including:

• Health
• Job pressure or instability
• Lack of leisure time
• Money
• Poor diet
• Relationships

Symptoms of an anxiety disorder may also cause dermatillomania. Simply put, an anxiety attack is a large amount of stress experienced in a single moment. Therefore, a response to this may be to pick at the skin. Such behavior provides control in an uncontrollable situation. ⁴

Still, skin picking may appear through other activities. For example, certain substances can cause these behaviors, such as methamphetamine and cocaine. ⁵

Diagnosis

To come to a dermatillomania diagnosis, a healthcare provider will evaluate the skin and other symptoms. The proper treatment will be authorized if the skin shows signs of breaks, scarring, or infections. ⁶

On top of this, patients will be recommended psychiatric treatment. As mentioned, skin picking is largely the result of stress. Therefore, it’s in your best interest to address the source of this stress.

Treatment

Skin picking is a compulsion. It’s taking control in a situation where you have no control. Therefore, treatment involves showing you ways to maintain control without resulting in such behavior. To get there, doctors will recommend medication, psychotherapy, or a combination of the two.

Medication

Most doctors recommend selective serotonin reuptake inhibitors (SSRIs) for excoriation disorder. The most common include:

• Lexapro
• Prozac
• Zoloft

These are antidepressants that help to increase serotonin levels in the brain. This is important for skin picking as it may help create less agitation. ⁷

Psychotherapy

Since skin picking is a stress response, you need to identify the source of that stress. Psychotherapies are one of the most effective ways to do so. Through cognitive behavioral therapy (CBT), you will identify: ⁸

1. Where your stressors come from.
2. The negative thought patterns it produces.
3. How to properly cope with it.

This process is important as stress can be deeply rooted in our psychology, especially if it’s a product of an underlying trauma.

References

¹ Malayala SV, Rehman H, Vasireddy D. Dermatillomania: A Case Report and Literature Review. Cureus. 2021 Jan 27;13(1):e12932. doi: 10.7759/cureus.12932. PMID: 33654612; PMCID: PMC7910222.

² Grant JE, Chamberlain SR. Characteristics of 262 adults with skin picking disorder. Compr Psychiatry. 2022 Aug;117:152338. doi: 10.1016/j.comppsych.2022.152338. Epub 2022 Jul 14. PMID: 35843137.

³ Lovato L, Ferrão YA, Stein DJ, Shavitt RG, Fontenelle LF, Vivan A, Miguel EC, Cordioli AV. Skin picking and trichotillomania in adults with obsessive-compulsive disorder. Compr Psychiatry. 2012 Jul;53(5):562-8. doi: 10.1016/j.comppsych.2011.06.008. Epub 2011 Oct 19. PMID: 22014580.

⁴ Grant JE, Chamberlain SR. Prevalence of skin picking (excoriation) disorder. J Psychiatr Res. 2020 Nov;130:57-60. doi: 10.1016/j.jpsychires.2020.06.033. Epub 2020 Jul 29. PMID: 32781374; PMCID: PMC7115927.

⁵ Rusyniak DE. Neurologic manifestations of chronic methamphetamine abuse. Neurol Clin. 2011 Aug;29(3):641-55. doi: 10.1016/j.ncl.2011.05.004. Epub 2011 Jun 24. PMID: 21803215; PMCID: PMC3148451.

⁶ Snorrason I, Lee HJ. Assessing Excoriation (Skin-Picking) Disorder: Clinical Recommendations and Preliminary Examination of a Comprehensive Interview. Int J Environ Res Public Health. 2022 May 31;19(11):6717. doi: 10.3390/ijerph19116717. PMID: 35682303; PMCID: PMC9180539.

⁷ Spiegel DR, Finklea L. The recognition and treatment of pathological skin picking: a potential neurobiological underpinning of the efficacy of pharmacotherapy in impulse control disorders. Psychiatry (Edgmont). 2009 Feb;6(2):38-42. PMID: 19724747; PMCID: PMC2719449.

⁸ Xavier ACM, de Souza CMB, Flores LHF, Bermudez MB, Silva RMF, de Oliveira AC, Dreher CB. Skin picking treatment with the Rothbaum cognitive behavioral therapy protocol: a randomized clinical trial. Braz J Psychiatry. 2020 Sep-Oct;42(5):510-518. doi: 10.1590/1516-4446-2019-0636. PMID: 32401873; PMCID: PMC7524420.