What is Excoriation (Skin Picking) Disorder?
Excoriation disorder, also known as skin picking disorder or dermatillomania, is characterized by the repetitive picking of one’s own skin. Individuals who struggle with this disorder touch, rub, scratch, pick at, or dig into their skin in an attempt to improve perceived imperfections, often resulting in tissue damage, discoloration, or scarring. Excoriation disorder is conceptualized to belong to a collection of behaviors known as body focused repetitive behaviors (BFRBs), self-grooming behaviors in which individuals pull, pick, scrape, or bite their own hair, skin, or nails, resulting in damage to the body.
Those who engage in skin picking tend to pick from multiple body sites, for extended periods of time, targeting both healthy and previously damaged skin. Medical complications as a result of excoriation disorder are not uncommon. Infection may require medical treatment. Although the severity of excoriation disorder varies, noticeable skin damage, discoloration, or scarring is common. As a result, individuals who struggle with skin picking make efforts to cover, hide, or camouflage damaged skin and may have difficulty with time management due to the significant time involved in engaging in the behavior as well as efforts to conceal it.
Individuals who struggle with skin picking may experience shame and embarrassment, and as a result, may avoid certain social situations or activities (e.g., pools, gyms, beaches, physical intimacy), and medical care. The emotional impact of the disorder can lead to painful isolation and emotional distress, placing them at risk for co-occurring mood or anxiety disorders.
Treatment for Excoriation (Skin Picking) Disorder
CEH provides evidence-based treatment for excoriation disorder and other BFRBs including individually-tailored cognitive behavioral therapies (CBT), namely habit reversal training (HRT) and comprehensive behavioral model (ComB) intervention. Behavioral therapies, HRT and ComB both involve psychoeducation, awareness training, behavior analysis, and behavioral intervention strategies. In HRT, interventions are primarily based upon modifying antecedents and consequences, including stimulus control (modifying the environment to decrease the likelihood of picking urges and behaviors) and competing response training (responding to picking urges with substitution behaviors that are incompatible with picking). ComB interventions may include a wider range of cognitive, behavioral, and other evidence-based interventions aimed at the most relevant aspects (sensory, cognitive, affective, motoric, place/environmental) of the individual’s behavior analysis. Acceptance and commitment therapy (ACT) and dialectical behavior therapy (DBT) skills training may also be among these interventions, which have been demonstrated to be effective adjuncts to such behavioral interventions. Family involvement in treatment may also be included to assist loved ones in learning how to best support their family member.
In addition to treatment, CEH provides free, monthly community support groups for those whose lives are impacted by excoriation disorder and other BFRBs.