Excoriation Disorder, more commonly known as a skin picking disorder, where a person compulsively, and sometimes even unawarely, picks at their skin and cannot stop. It becomes a disorder when it is done to the extent that it causes bleeding, lesions, social stress, and anxiety. 

Also known as dermatillomania, it is different from the occasional picking at pimples or blemishes; in fact, most people experience that intermittently. This disorder can begin at any age, though it more often starts in adolescence. Only about 1-2% of people experience this at a time, and “about 75% of them are female.”  It is not done as a cosmetic or health-related thought either, and it lies under the category of OCD due to its repetitive behavior. Skin picking falls into body-focused repetitive behaviors or BFRBs. Nail-biting and hair-pulling are additional types of BFRBs, with hair pulling becoming known as trichotillomania once it reaches the point of disorder. 

The criteria of diagnosing excoriation disorder is as follows:

• Recurrent skin picking that results in skin lesions
• Repeated attempts to stop the disorder
• The symptoms cause clinically significant distress or impairment 
• The symptoms are not caused by a substance or medical, or dermatological condition
• The symptoms are not better explained by another psychiatric disorder

There is no known cause for dermatillomania, but it has been found to be more common in those with relatives and family members who have obsessive-compulsive disorder, meaning there could be “a genetic predisposition to the condition.” Environmental factors, stress, and could also play a part in developing skin picking disorder. This disorder tends to coexist alongside other disorders, commonly found to be OCD, depression, and anxiety. 

People tend to have specific affected areas that they pick at more often than others. The areas can be both healthy skin and areas that had been previously affected. People will try to cover up the evidence of picking through makeup, clothing, and avoiding certain social situations that could expose it due to feelings of shame and guilt. Time being spent picking at skin and having the urges to can be time-consuming and draining. Sometimes people with excoriation disorder use tweezers, long fingernails, or other outside ways to pick. Leading up to giving in to the urges, negative emotions such as stress, sadness, anxiety might be wound up, triggering a picking episode. Pain and bleeding may accompany the action of picking, though sometimes feelings of relief and dissipating tension are also felt. The most common feeling after picking is guilt and embarrassment, adding to the overall psychological impacts of dermatillomania. 

Concerning treatments for excoriation disorder, there is no universally approved or completely effective way to treat this. A few methods have been proven to help, one of those ways is cognitive behavioral therapy, referred to as CBT. Three main types of CBT have been found to have the most fruitful response, habit reversal training (HRT), acceptance and commitment therapy (ACT), and the comprehensive behavioral model (ComB). Part of what CBT does is both replace skin picking with a less harmful habit, like squeezing something in your hand, and it helps you recognize when you’re going to pick and what may be causing it. Several studies have shown that certain antidepressants have shown positive results in helping control dermatillomania. Prozac, fluoxetine, fluvoxamine, and escitalopram have each had results. In some cases, covering mirrors, and wearing gloves have also been employed to control urges and make it harder to pick.

Excoriation disorder can be debilitating depending on the severity of it. Classified as the repetitive picking of one’s skin, to the point where tissue damage, scarring, and discoloration can all occur. Help is available through doctors, therapists, and support groups. If you feel like you or a loved one may be suffering from dermatillomania don’t hesitate to reach out for help.