If you struggle with skin picking, you’re not alone. Body-focused repetitive behaviors (BFRBs), like skin picking (dermatillomania), hair pulling (trichotillomania), and nail biting, affect millions of people. These behaviors can feel automatic, making it hard to stop—even when you really want to.
But the good news? Your brain is changeable. With the right tools and support, you can retrain it to reduce the urge to pick, helping you regain control and heal.
Why Does Skin Picking Happen? A Look Inside the Brain
Your brain has a built-in system to keep your body well-maintained. The area responsible for grooming behaviors helps you stay clean, remove dead skin, and care for small wounds—important for survival. But for people with BFRBs, this system becomes overactive.
Every time you engage in skin picking, your brain reinforces the behavior, making it more likely to happen again. The act of picking can bring a sense of relief or satisfaction in the moment, but over time, the habit becomes stronger and harder to break.
Think of it like a well-worn hiking path—each time you walk it, the trail gets clearer. But the more you block the behavior and tolerate the urge without engaging, the weaker the signal to pick becomes.
Is Skin Picking the Same as Self-Harm?
Many people with skin picking worry: Am I engaging in self-harm?
The answer is no—while both involve harming the skin, the motivation behind them is very different. Self-harm is often driven by emotional distress and serves as a way to express or cope with pain. In contrast, skin picking happens because the brain is sending a strong urge to “fix” something that feels or looks off.
Your brain might be telling you that a bump, scab, or uneven texture needs to be “smoothed out” or “fixed,” even when it doesn’t. Recognizing this difference can be a key step in reducing shame and shifting your approach to treatment.
Emma’s Journey: A Case Example
Emma, a 27-year-old graphic designer, had been struggling with skin picking since middle school. She would find herself absentmindedly picking at her arms and face while working at her desk, watching TV, or lying in bed at night. Over the years, she tried to stop many times but found that the more she told herself “Just don’t do it,” the stronger the urge became.
Through therapy, she learned that her picking wasn’t about hurting herself—it was her brain’s way of trying to “fix” things that felt off. Her therapist introduced her to the Comprehensive Behavioral (COMB) treatment approach, which combines elements of Cognitive Behavioral Therapy (CBT) and Habit Reversal Training (HRT) to break the cycle of picking.
How CBT, HRT, and COMB Help You Move Past Skin Picking
COMB treatment helps you:
✅ Identify triggers and patterns
✅ Develop alternative responses
✅ Increase tolerance for discomfort
✅ Reduce the reinforcing cycle that keeps skin picking going
Here are five exercises that helped Emma, and can help you too:
1. The Sensory Swap
Emma realized that her hands were used to the feeling of picking. She replaced this sensation by keeping a smooth worry stone and a textured stress ball nearby. Instead of picking, she occupied her hands with these objects, giving her brain a new sensory focus.
2. The Urge Delay Game
When Emma felt the urge to pick, she challenged herself to wait 30 seconds before acting on it. Over time, she increased this delay to five minutes. Each time she resisted, she was training her brain to weaken the picking pathway.
3. The Mirror Shift
Bright lighting and close-up mirrors triggered Emma’s picking. She dimmed the lights in her bathroom at night and used a small mirror only for essential tasks. This reduced the visual triggers that led to picking.
4. The Barrier Method
Applying a thick, soothing lotion before bed helped Emma reduce her urge to pick, as her skin felt less rough and less tempting to touch. She also wore long sleeves at work, preventing mindless picking.
5. The Thought Reframe
Instead of believing “I have to fix this imperfection,” Emma practiced saying:
🧠 “My brain thinks this needs fixing, but my job is to allow my skin to heal.”
This small shift helped her break free from the automatic urge to pick.
The Key to Success: Practice, Patience, and Persistence
The more you pick, the stronger the urge becomes. But the more you resist and tolerate the discomfort, the weaker the urge will get.
Emma’s journey wasn’t about willpower—it was about retraining her brain. At first, she still had slip-ups, but instead of shaming herself, she tracked her progress and celebrated small wins. Over time, the urges became weaker, and she started seeing improvements—not just in her skin, but in her confidence and ability to manage stress in healthier ways.
If you or someone you love struggles with BFRBs, know that effective treatments exist, and help is available. With the right strategies, you can take back control and move toward healing.
