Understanding Dermatillomania:Why Can’t I Stop Picking My Skin?

Understanding Dermatillomania: Why Can’t I Stop Picking My Skin?

Most of us have picked at a pimple, scratched a scab or tried to smooth out a patch of uneven skin. But what happens when skin picking becomes something you feel unable to control?

Perhaps you find yourself picking at your skin while watching television, working or lying in bed. You might promise yourself you’ll stop, only to realise you’ve started again without thinking. For some people, the behaviour becomes a daily struggle, bringing feelings of frustration, embarrassment or shame.

When skin picking becomes repetitive, difficult to control and causes distress or physical damage, it may be a sign of dermatillomania, also known as excoriation disorder or skin-picking disorder.

Understanding why skin picking happens is an important first step towards managing it.

What is dermatillomania?

Dermatillomania is a mental health condition characterised by repetitive skin picking that causes damage to the skin, often despite repeated attempts to stop.

It belongs to a group of conditions known as body-focused repetitive behaviours (BFRBs), which also includes hair-pulling disorder, or trichotillomania.

People experiencing dermatillomania may repeatedly pick at pimples, scabs, blemishes, dry skin or areas that appear uneven. Some pick at otherwise healthy skin.

Common areas include the face, arms, hands, scalp and legs, although skin picking can affect almost any part of the body.

The behaviour may happen consciously, in response to a noticeable urge, or automatically, without the person immediately realising what they’re doing.

Importantly, dermatillomania is not simply a bad habit or a lack of willpower. It is a recognised mental health condition that can significantly affect someone’s wellbeing and daily life.

Why can’t I stop picking my skin?

There isn’t one simple explanation for compulsive skin picking.

For some people, picking provides temporary relief from feelings of tension, anxiety or restlessness. For others, it happens during periods of boredom, concentration or distraction.

You might find yourself picking more frequently when:

• You’re feeling anxious, overwhelmed or stressed.
• You’re bored or sitting still for long periods.
• You’re concentrating on work, studying or watching television.
• You notice a blemish or area of skin that doesn’t feel smooth.
• You’re feeling frustrated or experiencing difficult emotions.
• You’re looking closely at your skin in a mirror.

Sometimes, the behaviour creates a cycle that’s difficult to interrupt.

You notice an imperfection or experience an urge to pick. Picking may provide temporary satisfaction or relief, but this is often followed by regret, discomfort or concern about the appearance of your skin.

Those uncomfortable feelings can then contribute to further picking.

Over time, the behaviour may become increasingly automatic, making it feel as though your hands are moving before you’ve consciously decided to do anything.

Is skin picking a sign of anxiety or OCD?

Skin picking can be associated with anxiety, stress and obsessive-compulsive disorder (OCD), but they are not the same condition.

Dermatillomania is classified within the obsessive-compulsive and related disorders category of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

While someone with OCD may perform repetitive behaviours in response to intrusive thoughts or fears, skin picking may be driven by sensory experiences, emotional discomfort, the urge to correct perceived imperfections or automatic habits.

Some people experience both conditions, while others have dermatillomania without OCD.

Similarly, anxiety can make skin picking worse, but not everyone who experiences dermatillomania has an anxiety disorder.

A qualified mental health professional can help determine whether skin picking is occurring independently or alongside another condition.

How do I know if my skin picking is becoming a problem?

Occasional skin picking is common. Dermatillomania involves a more persistent pattern that causes distress, skin damage or difficulties in everyday life.

Some signs that skin picking may be becoming problematic include:

• Frequently picking until your skin bleeds, becomes irritated or develops sores.
• Repeatedly trying to stop but finding it difficult.
• Spending significant amounts of time examining or picking your skin.
• Feeling embarrassed or ashamed about visible marks or scars.
• Avoiding social activities, photographs or situations where your skin may be visible.
• Covering affected areas with clothing or makeup.
• Experiencing infections, scarring or wounds that struggle to heal.

You don’t need to experience every one of these difficulties for your concerns to be worth discussing with a professional.

How is dermatillomania diagnosed?

A diagnosis involves assessing the pattern of skin picking, its impact on daily functioning and whether another medical or psychological condition better explains the behaviour.

The DSM-5 diagnostic criteria include:

1. Repeated skin picking that causes skin lesions.
2. Repeated attempts to reduce or stop the behaviour.
3. Significant distress or impairment associated with skin picking.
4. Skin picking that is not caused by a substance or another medical condition.
5. Symptoms that are not better explained by another mental health condition.

A psychologist or other appropriately qualified clinician can assess these factors and consider whether additional support is needed.

What causes dermatillomania?

The exact causes of dermatillomania are not fully understood. Research suggests that several factors may contribute to its development and persistence.

Emotional and psychological factors

Stress, anxiety, frustration and other difficult emotions may increase the urge to pick.

For some people, skin picking becomes a way of responding to uncomfortable feelings, even when the relief is brief.

Sensory experiences

Some people are particularly sensitive to the feeling of uneven skin, scabs or blemishes.

The urge to smooth or remove an imperfection can become difficult to resist, particularly when attention becomes focused on that area.

Learned behaviour and habits

Skin picking can develop into a repeated behavioural pattern over time.

The temporary relief or satisfaction associated with picking may reinforce the behaviour, making it more likely to occur in similar situations.

Biological and individual factors

Genetic and biological factors may also contribute. However, researchers have not identified a single cause that explains dermatillomania in everyone.

Understanding the circumstances surrounding an individual’s skin picking can help guide treatment.

Can dermatillomania be treated?

Yes. Psychological treatment can help people better understand their skin picking, recognise triggers and develop strategies to manage the behaviour.

One commonly recommended approach is cognitive behavioural therapy (CBT), particularly when it incorporates a technique called habit reversal training (HRT).

Cognitive behavioural therapy (CBT)

CBT can help people identify connections between their thoughts, feelings, behaviours and environmental triggers.

For someone experiencing dermatillomania, therapy may involve exploring when picking occurs, what tends to happen beforehand and how the behaviour is maintained.

Treatment can also address associated feelings such as shame, frustration or anxiety.

Habit reversal training (HRT)

Habit reversal training is a behavioural approach used to help manage repetitive behaviours.

It typically involves becoming more aware of when skin picking occurs and learning alternative responses that are incompatible with picking.

For example, someone might practise gently closing their hands or holding an object when they notice the urge to pick.

The aim is not simply to tell someone to stop. It is to help them recognise patterns and develop more manageable responses.

Mindfulness and emotional regulation

Mindfulness-based strategies may help some people notice urges, emotions and physical sensations without immediately responding through skin picking.

Relaxation and emotional regulation techniques can also be useful when stress or anxiety contributes to the behaviour.

Can medication help with skin picking disorder?

Medication may sometimes be considered, particularly when skin picking occurs alongside other mental health concerns.

However, there is no medication that works consistently for everyone with dermatillomania, and evidence for specific medications remains limited.

A GP or psychiatrist can assess whether medication is appropriate.

How can I reduce skin picking at home?

While professional support can be helpful, there are also practical strategies that may make skin picking easier to manage.

Start noticing patterns. Pay attention to when and where you tend to pick. Are you sitting at your desk, looking in the mirror or feeling overwhelmed?

Keep your hands occupied. Holding a stress ball, textured object or another suitable item may help interrupt automatic picking.

Make picking less accessible. Keeping nails trimmed, limiting time examining your skin in magnifying mirrors or putting away tools associated with picking may help.

Look after your skin. Gentle skincare and appropriate wound care can reduce irritation and support healing.

Be patient with yourself. Behaviour change takes time. A difficult day doesn’t mean the strategies aren’t working.

These suggestions are not a substitute for treatment, particularly if picking is causing significant distress or injury.

If you have wounds that are infected, worsening or not healing, seek medical advice.

When should I see a psychologist for skin picking?

Consider seeking professional support if skin picking feels difficult to control, causes ongoing distress or affects your confidence, relationships or daily activities.

A psychologist can help assess the behaviour, identify contributing factors and discuss appropriate treatment options.

You don’t need to wait until skin picking becomes severe before asking for help.

Where can I find support for dermatillomania?

The Picking Me Foundation is an organisation dedicated to raising awareness and providing education and peer support for people experiencing dermatillomania.

Speaking with your GP can also be a useful starting point, particularly if you have concerns about skin damage or would like guidance about psychological treatment.

At The Three Seas Psychology, we understand that repetitive behaviours and the emotions associated with them can be difficult to discuss.

Our psychologists provide support for a range of mental health concerns using evidence-based psychological approaches. Our team can help you explore your concerns and determine whether an appropriately experienced psychologist is available to assist with skin-picking difficulties.

Meet our psychologists or contact The Three Seas Psychology to discuss your needs.