People with skin-picking disorder may feel tense or anxious just before they do it, and skin picking may relieve that feeling.
Doctors diagnose the disorder when people pick at the skin enough to damage it, try to decrease or stop picking at their skin and cannot, and are significantly distressed by their behavior or function less well because of it.
Cognitive-behavioral therapy (habit reversal therapy) that specifically focuses on skin-picking disorder and certain antidepressants or N-acetylcysteine or memantine may help lessen symptoms.
People with the disorder repeatedly pick at or scratch their skin. They do not do it to remove a spot or blemish that they think is unattractive (as people with body dysmorphic disorder Body Dysmorphic Disorder In body dysmorphic disorder, a preoccupation with one or more nonexistent or slight defects in appearance results in significant distress and/or impairs functioning. People typically spend hours... read more do) or diseased. Some people pick at healthy skin. Others pick at calluses, pimples, or scabs.
Skin picking often begins during adolescence, although it may begin at other ages. About 1 to 2% of people currently have the disorder. About 75% of them are female.
Symptoms of Skin-Picking Disorder
The methods and areas people pick at vary from person to person. Some people have many sores or scarred areas. Other people have only a few scars or sores. The areas people pick at may change over time.
Some people pick at their skin somewhat automatically, without thinking about it. Others are more conscious of the activity.
People do not pick at their skin because they are concerned about their appearance (which may be a symptom of body dysmorphic disorder Body Dysmorphic Disorder In body dysmorphic disorder, a preoccupation with one or more nonexistent or slight defects in appearance results in significant distress and/or impairs functioning. People typically spend hours... read more ). However, they may feel tense or anxious just before they do it, and skin picking may relieve that feeling. Afterward, they often feel a sense of gratification.
Many activities (rituals) may accompany skin picking. People may painstakingly search for a particular kind of scab to pick at. They may pull the scab off in a particular way—for example, using their fingers or an implement such as tweezers. They may bite or swallow the scab once it is pulled off.
Many people with skin-picking disorder also repeatedly pull out their hair, bite their nails, chew their cheek, or do other repetitive body-focused activities Body-Focused Repetitive Behavior Disorder In body-focused repetitive behavior disorder, people repeatedly engage in activities that involve their body, such as nail biting, lip biting, or cheek chewing, and repeatedly try to stop the... read more . Some people pick at the skin of others.
People may feel embarrassed by or ashamed of the way they look or of their inability to control their behavior. Consequently, they may avoid situations in which others may see the skin damage. They typically do not pick in front of others, except for family members. Many people try to camouflage the skin damage with clothing or makeup. People may also be distressed by their loss of control and repeatedly try to stop or reduce picking at their skin, but they cannot.
If done excessively, skin picking can cause scarring, infections, excessive bleeding, and even a serious infection of the bloodstream (septicemia Sepsis and Septic Shock Sepsis is a serious bodywide response to bacteremia or another infection plus malfunction or failure of an essential system in the body. Septic shock is life-threatening low blood pressure ... read more ).
Many people with skin-picking disorder also have other mental health disorders, such as obsessive-compulsive disorder Obsessive-Compulsive Disorder (OCD) Obsessive-compulsive disorder is characterized by obsessions, compulsions, or both. Obsessions are recurring, persistent, unwanted, anxiety-provoking, intrusive ideas, images, or urges. Compulsions... read more , hair-pulling disorder Hair-Pulling Disorder (Trichotillomania) In hair-pulling disorder, people repeatedly pull their hair out, resulting in hair loss. People with hair-pulling disorder may feel tense or anxious just before they pull their hair out, and... read more 
, and depression Depression Depression is a feeling of sadness and/or a decreased interest or pleasure in activities that becomes a disorder when it is intense enough to interfere with functioning. It may follow a recent... read more .
Symptoms typically vary in intensity but may continue throughout life.
Diagnosis of Skin-Picking Disorder
A doctor's evaluation based on specific psychiatric diagnostic criteria
Doctors diagnose skin-picking disorder based on symptoms:
Picking at skin so much that it damages the skin
Repeatedly trying to decrease or stop picking
Feeling significantly distressed or becoming less able to function because of the skin-picking behavior
Treatment of Skin-Picking Disorder
Cognitive-behavioral therapy (specifically, habit-reversal therapy)
Medications
Cognitive-behavioral therapy Psychotherapy Extraordinary advances have been made in the treatment of mental illness. As a result, many mental health disorders can now be treated nearly as successfully as physical disorders. Most treatment... read more —in particular, habit-reversal therapy that specifically focuses on skin-picking disorder—is the therapy of choice. For habit-reversal therapy, people are taught to do the following:
Become more aware of their skin picking
Identify situations that trigger the behavior
Use strategies to help them stop themselves from picking at their skin—for example, by substituting a different activity (such as clenching their fist, knitting, or sitting on their hands) for skin picking
N-acetylcysteine (NAC) and memantine both act on the glutamatergic system, and may reduce skin-picking. Treatment with selective serotonin reuptake inhibitors Selective serotonin reuptake inhibitors (SSRIs) Agomelatine, a new type of antidepressant, is a possible treatment for major depressive episodes. Several types of drugs can be used to treat depression: Selective serotonin reuptake inhibitors... read more (a type of antidepressant) or clomipramine may also be useful and may improve the symptoms of any coexisting depression Depression Depression is a feeling of sadness and/or a decreased interest or pleasure in activities that becomes a disorder when it is intense enough to interfere with functioning. It may follow a recent... read more or anxiety disorders Overview of Anxiety Disorders Anxiety is a feeling of nervousness, worry, or unease that is a normal human experience. It is also present in a wide range of mental health conditions, including generalized anxiety disorder... read more .
