Offering telehealth services across the United States and in-person services in multiple NY, NJ & PA locations.

Excoriation (Skin-Picking) Disorder

What is Excoriation (Skin-Picking) Disorder?

Excoriation disorder, also known as skin-picking disorder or dermatillomania, is a body-focused repetitive behavior (BFRB) that involves recurrent, compulsive picking of the skin. This behavior often targets perceived imperfections or irregularities in the skin, resulting in tissue damage, scarring, and emotional distress.

Key Features of Excoriation Disorder

Excoriation often affects various areas of life, including physical health, emotional well-being, and social interactions. Key aspects include:

  • Behavior Patterns: Skin picking can involve scratching, rubbing, or digging into healthy skin or previously damaged areas, often for prolonged periods.
  • Physical Consequences: Common outcomes include visible skin damage, scarring, discoloration, and, in severe cases, infections requiring medical treatment.
  • Emotional Impact: Many individuals experience shame, embarr- assment, and isolation due to their condition. These feelings may lead to avoidance of social settings, intimate relationships, or professional medical care.
  • Time Management Challenges: Significant time may be devoted to picking behaviors and efforts to conceal resulting damage, impacting daily functioning.

Triggers and Emotional Impact

Excoriation disorder often arises during heightened emotional states such as stress, anxiety, or boredom. While the behavior may provide temporary relief, it perpetuates a cycle of guilt and distress, increasing the likelihood of co-occurring conditions like depression or generalized anxiety disorder.

Comprehensive Treatment for Excoriation (Skin Picking) Disorder

At The Center for Emotional Health (CEH), we provide compassionate, evidence-based care designed to help individuals overcome excoriation disorder and regain control of their lives. Our specialized treatment incorporates scientifically supported therapies to address the unique challenges of skin picking behaviors.

Evidence-Based Treatment Approaches

Habit Reversal Training (HRT):

HRT focuses on:

  • Awareness Training: Helping individuals identify triggers, patterns, and urges associated with skin picking. tive tract).
  • Stimulus Control: Modifying environments to reduce urges and promote healthier behaviors.
  • Competing Response Training: Teaching alternative, less damaging actions to replace skin picking.

Comprehensive Behavioral Treatment (ComB)

ComB addresses the physical, emotional, and environmental factors contributing to excoriation disorder. A detailed examination of the factors influencing skin picking behavior and traditional cognitive behavioral therapy (CBT) interventions are provided with attention to:

  • Sensory Experiences: How physical sensations impact skin picking.
  • Cognitive Patterns: The role of thoughts and beliefs.
  • Emotional Responses: The connection between emotions and the behavior.
  • Motor Behaviors: The actions involved in skin picking and level of awareness.
  • Environmental Factors: How surroundings and context play a role.

Integrative Behavioral Therapy (IBT): Enhancing Psychological Flexibility

IBT combines elements of cognitive-behavioral therapy (CBT), acceptance and commitment therapy (ACT), and dialectical behavioral therapy (DBT) skills.

Steps in IBT for BFRBs include:

  • Building self-understanding:
    Gain awareness through mindfulness and identification of the behavior chain.
  • Narrowing down the MAP:
    Address the external and contextual antecedents that lead to BFRB symptoms, including:

    • Movement and Automaticity – build mindful body awareness and self-observation skills.
    • Awareness of Vulnerabilities – reduce underlying vulnerabilities.
    • People, Places, and Spaces – Respond effectively to the environment.
  • Working with the TIMES:
    Change one’s relationship to internal discomforts which have prompted BFRB symptoms:

    • Thoughts, Images, Memories – Foster a healthy relationship with oneself.
    • Emotions – Build emotion regulation, distress tolerance, and self-compassion.
    • Sensations – Observe, allow, and redirect discomforts.
  • Thriving with a BFRB:
    Build confidence, overcome difficult situations, and master BFRB skills to live a full, meaningful life.

Support and Resources for Long-Term Success

  • The BFRB Recovery Workbook
    Authored by CEH Founder Dr. Marla Deibler and Dr. Renae Reinardy, this workbook offers actionable tools and strategies to support recovery from trichotillomania, excoriation (skin picking) disorder, and other BFRBs.

  • Community Support Groups
    Join our free monthly support groups, where individuals impacted by trichotillomania and other BFRBs can connect, share experiences, and receive ongoing encouragement in a judgment-free space.

Request Your Appointment

Take the first step toward better mental health. Whether in person or through telehealth, The Center for Emotional Health is here to support you every step of the way. Contact us today with any questions and to schedule your appointment.