Skin Picking Disorder (SPD), also known as excoriation, is a mental health condition marked by the repetitive and compulsive picking of one’s skin, which causes significant tissue damage and emotional distress. Although some may consider skin picking to be a harmless habit, those who engage in it can suffer serious physical and psychological consequences. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) classifies the condition as Obsessive-Compulsive and Related Disorders.
Individuals with SPD frequently experience an overwhelming urge to pick at their skin, which they may find difficult or impossible to resist. This behavior can result in open wounds, scarring, and infections, causing significant impairment in daily functioning. The condition is similar to other body-focused repetitive behaviors (BFRBs) like trichotillomania (hair pulling) and onychophagia (nail biting). SPD can affect people of all ages, but it typically begins in adolescence and is more common in females than males.
Define Skin Picking Disorder (Excoriation)
Skin Picking Disorder is defined as recurrent skin picking that causes skin lesions, followed by repeated attempts to reduce or stop the behavior. The behavior is not caused by the effects of a substance (e.g., cocaine) or another medical condition (e.g., scabies) and results in clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Key Features of Skin Picking Disorder:
- Recurrent Skin Picking: People with SPD frequently pick at their skin, often focusing on specific areas of the body such as the face, arms, hands, scalp, and legs. The picking may be limited to healthy skin, minor skin irregularities, scabs, or lesions caused by previous picking episodes.
- Inability to Stop: Regardless of the negative consequences, people with SPD frequently struggle to stop or control their picking behavior. This lack of control is a central feature of the disorder, distinguishing it from occasional skin picking, which many people do without much distress.
- Emotional Triggers: Negative emotions such as anxiety, stress, boredom, or frustration frequently initiate or exacerbate skin picking behavior. Some people may pick their skin in response to perceived imperfections or to relieve stress or boredom.
- Time-consuming Behavior: Skin picking can take up a significant amount of time, with some people engaging in the behavior for several hours per day. This can disrupt daily activities, including work, school, and social interactions.
- Physical Consequences: SPD can cause severe skin infections, tissue damage, and permanent scarring. The visible signs of skin picking can cause embarrassment, shame, and social withdrawal.
- Psychological Impact: The psychological impact of SPD is significant, with many people experiencing feelings of guilt, shame, and low self-esteem. The condition is frequently associated with other mental health disorders, such as depression, anxiety, and obsessive-compulsive disorder (OCD).
Prevalence of Skin Picking Disorder (Excoriation
Skin Picking Disorder’s prevalence varies according to the population studied and the diagnostic criteria used. However, research indicates that SPD is more common than previously believed, affecting millions of people worldwide. Despite its prevalence, the condition is frequently underreported and underdiagnosed, owing to the stigma associated with the behavior and people’s proclivity to conceal their symptoms.
Global perspective
Globally, Skin Picking Disorder is thought to affect 1.4% to 5.4% of the population. The condition occurs in a variety of cultures and age groups, but it is most commonly reported in Western countries. The stigma associated with skin picking behaviors, combined with a lack of awareness among healthcare providers, frequently results in underreporting and misdiagnosis, especially in areas where mental health resources are scarce.
United States
SPD is considered a major public health concern in the United States. A 2023 study published in the Journal of Obsessive-Compulsive and Related Disorders found that 2% to 3% of the U.S. population meets the diagnostic criteria for Skin Picking Disorder. The study also discovered that SPD is more common in women, with a female-to-male ratio of roughly 3:1. The condition usually appears in adolescence, with a median age of onset between 13 and 15 years.
SPD has received more attention in recent years as social media and online platforms have grown in popularity. Online communities and forums dedicated to BFRBs, such as skin picking, have given people a place to share their stories and seek help. However, the increased visibility of the condition online has resulted in the spread of misinformation and the possibility of triggering content, which can aggravate symptoms in some people.
United Kingdom
Skin Picking Disorder is becoming more well-known in the United Kingdom, particularly among mental health professionals. According to the British Skin Foundation’s 2022 survey, approximately 1.7% of the UK population reported engaging in skin picking behaviors that met SPD criteria. The survey revealed the condition’s significant emotional and psychological impact, with many respondents expressing feelings of shame, guilt, and social isolation.
The UK government has acknowledged the need for improved mental health services and support for people living with SPD and other BFRBs. However, access to specialized treatment is still limited, and many people continue to suffer in silence due to the stigma associated with the condition.
Australia
SPD is becoming more widely recognized in Australia as a serious mental health issue, particularly among adolescents and young adults. According to a 2023 study conducted by the Australian Psychological Society (APS), 2.5% of Australians exhibit symptoms consistent with Skin Picking Disorder. The study also discovered that the condition was frequently associated with other mental health disorders, including anxiety, depression, and OCD.
Australia has attempted to raise awareness of SPD through public health campaigns and educational initiatives. However, there are still challenges in ensuring that people with SPD have access to appropriate treatment and support services, especially in rural and remote areas where mental health resources are limited.
Canada
Skin Picking Disorder is becoming more common in Canada, particularly among young people. According to a 2022 study conducted by the Canadian Institute for Health Information (CIHI), approximately 1.8% of Canadian adults meet the SPD criteria. The study also found that comorbid mental health conditions, such as depression and anxiety, can exacerbate skin picking behaviors.
Canadian mental health organizations have emphasized the significance of early intervention and comprehensive treatment for people with SPD. Efforts are also underway to reduce the stigma associated with the condition and encourage people to seek help.
Risk Factors of Skin Picking Disorder (Excoriation)
Skin Picking Disorder is caused by a combination of biological, psychological, and environmental factors. Understanding these risk factors is critical for identifying people who are at a higher risk of developing the condition, as well as developing effective prevention and treatment strategies.
Biological Factors.
- Genetic Predisposition: Studies indicate that genetic factors may play a role in the development of Skin Picking Disorder. People with a family history of OCD, anxiety disorders, or other BFRBs may be more prone to developing SPD. Genetic studies have also revealed possible links between SPD and neurotransmitter systems such as serotonin and dopamine, which regulate mood and impulse control.
- Brain Chemistry: SPD has been linked to abnormalities in brain chemistry, particularly in the regions of the brain that control impulses, process rewards, and form habits. For some people, skin picking causes the release of endorphins or other neurotransmitters, resulting in a sense of relief or pleasure that reinforces the behavior and makes it difficult to stop.
- Hormonal Influences: Hormonal changes, particularly those associated with puberty, menstruation, or pregnancy, can worsen skin picking behaviors. For example, some people may experience an increase in skin picking during times of high hormonal fluctuation, which can trigger or worsen the compulsion to pick.
Psychological factors
- Emotional Regulation: One of the primary psychological factors underlying SPD is the use of skin picking to regulate emotions. Individuals with SPD may pick their skin to relieve anxiety, stress, boredom, or frustration. While the behavior may provide temporary relief, it is ultimately harmful and can trigger a cycle of dependency and worsening symptoms.
- Perfectionism and Body Image Issues: People who are perfectionists or have body image issues may be more likely to develop SPD. They may pick at their skin in an attempt to correct perceived flaws or gain control over their appearance. This behavior is frequently associated with intense self-criticism and dissatisfaction with one’s appearance.
- Trauma and Abuse: A history of trauma, abuse, or neglect is a strong predictor of SPD. People who have been physically, emotionally, or sexually abused may use skin picking to cope with the long-term effects of trauma, such as flashbacks, dissociation, or feelings of worthlessness. Skin picking can also be used to vent anger, frustration, or self-punishment in response to unresolved trauma.
- Co-occurring Mental Health Disorders: SPD is frequently associated with other mental health conditions, including OCD, depression, anxiety, and BPD. These conditions can aggravate skin picking behaviors, making it more difficult to break the cycle of compulsion. The presence of co-occurring disorders can also complicate treatment, as each condition may necessitate a unique therapeutic approach.
- Environmental factors
- Stressful Life Events: Stressful life events, such as academic pressure, relationship issues, or financial difficulties, can cause or exacerbate skin picking behaviors. Individuals may turn to skin picking as a coping mechanism for the stress and emotional turmoil caused by these events. During times of stress, the behavior may become more pronounced, reinforcing the habit and making it more difficult to control.
- Peer Influence and Social Environment: Interactions with peers and family members can have an impact on the development of Skin Picking Disorder. Individuals who witness others engaging in body-focused repetitive behaviors (BFRBs) may be more likely to mimic those behaviors. Furthermore, social pressure to conform to certain beauty standards or maintain a flawless appearance can exacerbate skin picking, especially in people who are already predisposed to perfectionism.
- Accessibility of Triggers: The presence of easily accessible triggers, such as mirrors, magnifying glasses, or lighting that highlights skin imperfections, can exacerbate the urge to pick. For some people, specific settings or environments, such as being alone in a bathroom or lying in bed at night, can trigger skin picking behavior. The availability of these triggers can make it difficult for people to resist the urge to pick, especially when combined with other psychological factors.
Symptoms and Behaviors of Skin Picking Disorder (Excoriation)
Skin Picking Disorder manifests as a range of physical, psychological, and behavioral symptoms that can have a significant impact on a person’s quality of life. Recognizing these symptoms is critical for timely intervention and treatment, as the condition can cause significant physical and emotional harm.
Physical symptoms
- Visible Skin Lesions: The most noticeable physical symptom of SPD is the presence of visible skin lesions, which can vary in size, severity, and location. These lesions can appear as open sores, scabs, or scars and are frequently found on easily accessible areas of the body, such as the face, arms, hands, and legs. Continuous picking can prevent wounds from healing, resulting in chronic skin damage.
- Scarring: Repeated skin picking can cause permanent scarring, which can be a significant source of distress for people with SPD. Scars can serve as a constant reminder of the behavior, leading to feelings of shame and embarrassment. In some cases, people will go to great lengths to conceal their scars with clothing, makeup, or other methods, further isolating themselves from social interactions.
- Infections and Complications: Frequent skin barrier breakdown increases the risk of infection, especially if wounds are not properly cleaned or non-sterile instruments are used. In severe cases, infections can progress to complications such as cellulitis, abscesses, or systemic infections, necessitating medical attention. Chronic skin damage can also cause hyperpigmentation, keloid formation, and sensory disturbances.
Psychological symptoms
- Preoccupation with Skin Picking: People with SPD frequently become preoccupied with thoughts about skin picking, including when and how they will pick their skin. This preoccupation can interfere with daily activities, work, and social interactions because the individual may struggle to focus on anything other than their urge to pick.
- Emotional Dysregulation: Skin picking is a common maladaptive coping mechanism for managing emotions. Individuals may engage in skin picking to relieve anxiety, stress, frustration, or boredom. While the behavior may provide temporary relief, it eventually leads to increased emotional dysregulation, as the individual becomes more reliant on skin picking to cope with their emotions.
- Guilt and Shame: Following skin picking, people with SPD may experience intense feelings of guilt, shame, and self-loathing. These negative emotions can feed back into the picking cycle, as the individual may resort to skin picking to deal with the emotional consequences of their behavior. This cycle of guilt and shame can lead to the emergence of co-occurring mental health disorders like depression and anxiety.
Behavioral symptoms
- Compulsive Skin Picking: A key behavioral symptom of SPD is a compulsive desire to pick at the skin, even if the individual is aware of the harm it causes. This compulsion may manifest as a daily or even hourly ritual in which the individual feels compelled to pick in response to specific triggers or stressors. The behavior is frequently difficult to control, resulting in repeated bouts of skin picking despite attempts to stop.
- Time-Consuming Behavior: Skin picking can take up a significant amount of time, with some people spending hours per day engaging in the behavior. SPD’s time-consuming nature can interfere with an individual’s ability to carry out their responsibilities at work, school, or home. It can also cause a decrease in social interactions because the individual may avoid activities that would expose their skin lesions to others.
- Avoidance of Social Situations: Because their skin lesions are visible, people with SPD may avoid social situations where their condition will be noticed by others. This avoidance can lead to social isolation, as the individual withdraws from friends, family, and social activities for fear of being judged or embarrassed. Social isolation can amplify feelings of loneliness and depression.
Effects of Skin Picking Disorder (Excoriation)
Skin Picking Disorder can have long-term consequences for a person’s physical health, mental well-being, relationships, and overall quality of life. This condition can have a profound impact, resulting in a cycle of emotional pain, dissatisfaction, and compulsive behavior.
Physical health impact
- Chronic Skin Damage: Excessive skin picking can cause chronic skin damage, such as open wounds, scarring, and changes in skin texture and pigmentation. This damage can be permanent, resulting in long-term physical problems that may necessitate medical or dermatological treatment.
- Increased Risk of Infection: Frequent skin barrier breakdown increases the risk of bacterial infections, which can result in complications like cellulitis, abscesses, and sepsis. In severe cases, antibiotics may be required, as well as surgical intervention. The risk of infection is especially high if the person uses non-sterile instruments or does not properly care for their wounds.
- Sensory Disturbances: Repeated picking can cause chronic skin damage, resulting in sensory disturbances such as numbness, tingling, or hypersensitivity. These sensory changes can be upsetting and may impair the individual’s ability to participate in daily activities.
Mental Health Impact
- Increased Risk of Depression and Anxiety: SPD’s emotional instability can cause the onset or worsening of mental health conditions such as depression and anxiety. The constant cycle of compulsive behavior followed by feelings of guilt and shame can result in a long-term state of emotional distress. Furthermore, the effects on relationships and personal life can exacerbate feelings of loneliness and hopelessness.
- Development of Co-occurring Disorders: SPD is frequently associated with other mental health disorders such as OCD, depression, anxiety, and BPD. The presence of co-occurring disorders can complicate treatment and recovery because each condition may necessitate a unique therapeutic approach. The presence of multiple disorders can also exacerbate the individual’s emotional distress, making it more difficult to break the cycle of skin picking.
Individuals with SPD frequently experience emotional isolation, as they may be unable to share their struggles with others for fear of judgment or misunderstanding. This isolation can worsen feelings of loneliness, depression, and hopelessness, making it even more difficult for the individual to seek assistance and support.
Social and Relational Impact
- Strained Relationships: SPD can have a significant impact on relationships with family, friends, and romantic partners. Loved ones may struggle to comprehend the behavior, leading to feelings of frustration, helplessness, and worry. In some cases, the secrecy and deception associated with skin picking can cause a breakdown in trust and communication, further isolating the person.
- Impact on Daily Life: Skin picking, as well as the physical and emotional toll it takes, can impair a person’s ability to function in everyday life. This could include difficulty keeping a job, going to school, or fulfilling domestic responsibilities. The impact on daily life can lead to feelings of failure or inadequacy, reinforcing the cycle of compulsive behavior.
- Stigma and Discrimination: People with SPD may experience stigma and discrimination from others, such as healthcare providers, employers, and peers. This stigma can make it difficult for people to seek treatment and support because they are afraid of being judged or misunderstood. Stigma can also reinforce negative self-perceptions, leading to feelings of shame and worthlessness.
Economic and Social Impact
- Healthcare Costs: Medical treatment for SPD-related issues, such as infections, scarring, and co-occurring mental health disorders, can incur significant healthcare costs. Individuals with SPD may also require long-term mental health services such as therapy, psychiatric care, and medications, increasing the economic burden on healthcare systems.
- Lost Productivity: SPD can cause lost productivity due to absenteeism, poor work performance, and difficulty retaining employment. The emotional and physical toll of SPD can make it difficult for individuals to carry out their professional responsibilities, resulting in financial strain and, in some cases, job loss.
- Societal Costs: In addition to the direct economic impact, SPD imposes broader societal costs, such as the strain on mental health services, the criminal justice system (in cases where self-harm results in legal issues), and the social support systems required to assist individuals in crisis. The societal cost of SPD includes the emotional toll on families, communities, and healthcare providers who care for people struggling with this addiction.
Treating Skin Picking Disorder (Excoriation)
Those affected are critical steps toward resolving this complex issue. Given SPD’s significant impact on physical health, mental well-being, and overall quality of life, it is critical to implement strategies that promote early detection, effective treatment, and ongoing support for people living with the condition.
Public Education and Awareness
- Awareness Campaigns: Public education campaigns can be effective in increasing awareness of SPD. These campaigns can help people recognize the signs and symptoms of skin picking disorder, understand the importance of seeking help, and reduce the stigma attached to the condition. Campaigns can target at-risk populations, such as adolescents and young adults, who may be more likely to develop compulsive skin-picking behaviors.
- Educational Programs: Schools and community organizations can use educational programs to teach students about body-focused repetitive behaviors (BFRBs), such as SPD. These programs can teach about healthy coping mechanisms, emotional regulation, and the value of mental health. By addressing these issues early on, educators can help prevent the development of SPD and encourage students to seek help if they exhibit symptoms.
Screening and early intervention
- Routine Screening: Healthcare providers can use routine screening for SPD, especially in patients who have visible skin lesions, scarring, or symptoms of anxiety, depression, or OCD. Early detection enables timely intervention, potentially preventing skin-picking behaviors from progressing to a more severe disorder.
- Targeted Interventions: For people who are at risk or in the early stages of SPD, targeted interventions like counseling, support groups, and cognitive-behavioral strategies can help address the underlying causes of skin picking and provide healthier coping mechanisms. Early intervention is critical in reducing the likelihood of long-term physical and emotional harm.
Comprehensive treatment
- Therapeutic Approaches: Evidence-based therapeutic approaches, including cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), and habit reversal training (HRT), are effective in treating SPD. These therapies aim to help people develop healthier ways to manage their emotions, reduce impulsive behaviors, and address the underlying psychological issues that cause compulsive skin-picking behavior.
- Pharmacological Treatment: In some cases, pharmacological treatment can be beneficial, especially for people who have multiple mental health disorders. Selective serotonin reuptake inhibitors (SSRIs) and other medications may be prescribed to help regulate mood, reduce anxiety, and alleviate compulsive picking. However, medication is frequently most effective when used in conjunction with therapy.
- Support Systems: Establishing a strong support network is critical for recovery. This can include family therapy, peer support groups, and participation in community activities that promote positive reinforcement and a sense of belonging. Support from loved ones and mental health professionals can make people feel less alone and more empowered to make positive changes in their lives.
- Long-Term Monitoring: SPD is frequently a chronic condition that necessitates ongoing treatment. Long-term monitoring by healthcare providers, combined with ongoing participation in support groups and therapy, can help prevent relapses and promote long-term recovery. Individuals may also benefit from regular check-ins with a mental health professional to discuss any new concerns or challenges.
Additional Resources
Books
- “The BFRB Recovery Guide: A Simple and Natural Approach to Healing Body-Focused Repetitive Behaviors” by Annette Pasternak
This book offers practical advice and strategies for individuals struggling with body-focused repetitive behaviors, including skin picking. It provides a comprehensive guide to understanding and overcoming these behaviors. - “Skin Picking: The Freedom to Finally Stop” by Annette Pasternak
This book specifically addresses skin picking disorder, offering tools and techniques to help individuals break the cycle of compulsive skin picking and reclaim their lives. - “The Habit Change Workbook: How to Break Bad Habits and Form Good Ones” by James Claiborn and Cherry Pedrick
Although not exclusively focused on SPD, this workbook provides valuable insights into habit formation and offers practical exercises for overcoming compulsive behaviors.
Organizations
- The TLC Foundation for Body-Focused Repetitive Behaviors:
The TLC Foundation is dedicated to raising awareness and providing resources for individuals with BFRBs, including SPD. They offer educational materials, support groups, and access to treatment providers. - International OCD Foundation (IOCDF):
The IOCDF offers resources and support for individuals with OCD and related disorders, including SPD. They provide information on treatment options, research, and access to trained professionals. - Anxiety and Depression Association of America (ADAA):
The ADAA provides information and resources for individuals dealing with anxiety, depression, and related disorders, including SPD. They offer access to support groups, treatment providers, and educational materials.
