Skin picking and other BFRBs

 What is excoriation disorder? 

Excoriation disorder is a body-focused repetitive behavior (BFRB) where someone recurrently picks at their own skin. It could be picking at healthy or unhealthy skin, scabs, lesions, pimples, or other blemishes. Most people who suffer from this disorder pick at the face, arms, and hands. Some people use tools to poke, squeeze or lance the skin. 


Not all body-focused repetitive behavior involving harming the skin will meet the criteria for excoriation disorder. Some symptoms of other mental disorders can explain the behavior such as anxiety disorder, panic disorder, post-traumatic stress disorder, psychosis, etc. Picking of the skin can also be a side effect of medications or the result of physiological changes due to substance abuse. Excoriation disorder is unique in that one feels compelled to spend a lot of time on the behavior, usually more than an hour per day at times. There are three additional criteria to determine a diagnosis:

• Skin picking results in lesions
• Tried to stop but cannot
• Behavior causes significant distress


People who suffer from excoriation disorder report many differences in how it occurs. Some find themselves doing it automatically while others are more purposeful. Some find thecompulsive action of picking at one’s skin is triggered by stress, anxiety, boredom, or tension while some pick in response to unpleasant sensations or irregularities in the skin. Some report it results in relief, gratification or pleasure, others do not. Most people do it in private and experience negative feelings of embarrassment or shame if others notice itThose with this compulsion report that it interferes with daily life including missing work or school or other responsibilities. 


According to the Diagnostic and Statistical Manual of Mental Health Disorders 5th edition, approximately 1.4% of the population suffers from excoriation disorder and three quartersof them are female. It usually starts some time during adolescence close to the start of puberty. Excoriation disorder is related to obsessive-compulsive disorder (OCD) and is more likely found in those with relatives who have OCD or related disorders. 


There is a tremendous amount of stigma related to this disorder, and most who suffer from it want to stop. Not only do they deal with embarrassment, shame, and low self-esteem, but picking at the skin can lead to skin infections, permanent scarring, and sometimes disfigurement. The physical evidence as well as the negative reactions of others often causes those who suffer from it to isolate themselves, eventually leading to other mental health issues such as anxiety and depression. Each person who suffers with excoriation disorder experiences it differently.


The first step in treatment is recognizing that it is a treatable disorder and support is available. BFRB therapy is designed to meet the needs of a person’s experience. Expect combinations of cognitive behavioral therapy, habit reversal, identification of triggers, stress and anxiety management, and creation of routines focusing on reclaiming the power to choose to engage in skin picking or not.  


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