Compulsive/ chronic picking (CSP), dermatillomania, skin picking disorder, acne excoriee, neurotic excoriation, pathological skin picking, and psychogenic excoriation are all terms used to describe a psychological disorder that manifests through an overwhelming urge to pick at one’s own skin to the extent that damage is caused. It falls under the umbrella term of body-focused repetitive behaviors (BRFBs) which includes hair pulling and nail-biting.
When the DSM 5 was published in May of 2013 it included compulsive skin picking in the Obsessive-Compulsive and Related Disorders category under the new name excoriation disorder. Diagnostic criteria for excoriation disorder include: 1
- Recurrent skin picking that results in skin lesions
- Repeated attempts to stop the behavior
- 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
Sufferers often go into a “trance-like” state where they become preoccupied with a real, imagined, or exaggerated imperfection which makes time appear to pass quickly. They can pick at pre-existing spots on their skin or create new lesions often leaving more visible scabbing than what was originally there. Often times, sufferers also use “tools” such as tweezers, nail clippers, and pins to pick at their skin to reach the goal of clearing the skin of the imperfection. The need to pick at one’s skin creates anxiety that is alleviated when the picking has finished but creates distress when the after effects become visible- thus creating a vicious cycle. The behavior can become so ingrained that sufferers do not even know that they are picking while taking part in another activity (ie, watching tv, reading).
One of the many psychological effects of having this disorder is low self-esteem, often associated with being shunned by peers and the fear of socializing due to appearance and negative attention those who pick their skin may receive. This leads to embarrassment, which can spiral into social isolation as the person may avoid situations where scars become visible to the public. It can affect the workplace, school, and socializing with family and friends, especially if the disorder is kept a secret because it is a time-consuming behavior with a lot of time spent trying to hide the damage with clothing and/ or makeup.
Excoriation disorder can be a co-morbidity with other mental health conditions, including obsessive-compulsive disorder (OCD), depression, anxiety disorders, personality disorders, ADHD, and body dysmorphic disorder. Many sufferers with this disorder believe that they are the only ones with this as it is still not widely known to the public or within the medical field.
- Substance Abuse and Mental Health Services Administration. Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 3.28, Excoriation (Skin Picking) Disorder. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t28/