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Excoriation or also more commonly referred to as skin picking disorder is a classified disorder of OCD in the DSM-5-TR. The essential features of skin picking include, but are not limited to picking from multiple body sites for extended periods of time and picking not only at minor skin irregularities, but also healthy skin. Commonly picked sites include the face, arms, and hands. Factors that lead to an individual wanting to engage in recurrent skin picking include: displeasement of one’s appearance (pimples), sensations (a scab or bump), and unpleasant emotions. Although the severity of skin picking is vastly different for each individual, many individuals exhibit noticeable skin damage and make a significant effort to camouflage their imperfections and scars with makeup or clothing.
Due to the criteria one must meet to be classified as having excoriation disorder, it is important to take into consideration whether the behavior is characterized as skin picking or whether it is a symptom of a dermatological disorder, an autoimmune disorder, body dysmorphic disorder or psychosis.
Autoimmune disorders including rheumatoid arthritis, lupus, Hashimoto’s thyroiditis, multiple sclerosis (MS), psoriasis, and even Type 1 diabetes can lead to obsessive skin picking behavior. When an individual has an autoimmune disorder their immune system attacks their healthy tissue due to mistaking it for a virus or bacteria. Therefore, itchiness becomes a persistent symptom of many autoimmune disorders.
Treatment for skin picking disorders includes, but is not limited to a combination of cognitive behavioral therapy, habit reversal therapy, and SSRI medications. Stimulus control is also useful in making picking harder and may involve wearing long-sleeved shorts, wearing gloves, and distracting one’s hands with fidget toys to reduce unhealthy picking behavior.
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