What Are the Signs of Excoriation Disorder?
Common signs include recurrent skin picking that causes lesions, repeated attempts to stop or reduce skin picking, significant distress or impairment in social, occupational, or other important areas of functioning, visible skin damage (scabs, scars, discoloration), spending significant time picking (sometimes hours per day), picking with fingers, tweezers, pins, or other instruments, focusing on one or multiple body sites (commonly face, arms, hands), picking occurring automatically or unconsciously, and feelings of tension before picking or relief afterward.
What Causes Excoriation Disorder?
Excoriation disorder appears to result from a combination of factors including genetic vulnerability, difficulty with emotional regulation, anxiety or stress, perfectionism or need for control, learned habit patterns, underlying depression or anxiety disorders, and neurobiological factors related to impulse control. Some people report that picking provides temporary relief from negative emotions or a satisfying sensation. For others, it becomes an automatic behavior that occurs without full awareness.
How Does Treatment Help?
Cognitive-behavioral therapy for excoriation disorder focuses on helping you become more aware of picking behaviors and triggers, learn to tolerate uncomfortable emotions or urges without picking, develop competing responses or alternative behaviors, address underlying thoughts and beliefs that maintain the behavior, and implement strategies to reduce accessibility and opportunity for picking.
Treatment techniques may include habit reversal training, which involves increasing awareness of picking and developing incompatible responses, stimulus control strategies (modifying your environment to reduce picking opportunities), cognitive restructuring to address perfectionism and distorted thinking, emotion regulation skills to manage stress and negative feelings without picking, and acceptance and mindfulness approaches to tolerate urges without acting on them.
Your therapist may also work with you to address shame or embarrassment about the behavior and its visible effects, establish a skin care routine that promotes healing, and involve family members or support persons when appropriate.
How Effective Is Treatment?
Research shows that cognitive-behavioral therapy, particularly habit reversal training, is effective for excoriation disorder. Many patients experience a significant reduction in picking behaviors and improved skin appearance. Treatment requires practice and patience, as changing longstanding habits takes time. The key is consistent application of the techniques you learn in therapy.
