Skin Picking Disorder: Signs, Symptoms & Medication

Skin-picking disorder is a behavioral obsession that can be a source of considerable shame and other types of psychological distress. But when someone with this condition gets help, which may involve both therapy and skin-picking medication, they can learn to manage their symptoms, improve their self-esteem, and start living a healthier and more satisfying life.

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What Is Skin-Picking Disorder?

The clinical term for this condition is excoriation (skin-picking) disorder. It is also sometimes referred to as SPD and dermatillomania. 

Symptoms

According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the five criteria for a diagnosis of excoriation (skin-picking) disorder are:

• Recurrent skin picking that results in lesions on the skin
• Repeated attempts to decrease skin picking or stop altogether
• The skin picking causes significant distress or impairs a person’s ability to function at work, in social situations, or in other important areas of life
• The skin picking cannot be attributed to the physiological effects of a substance (such as cocaine) or other medical conditions (such as scabies)
• The skin picking is not better explained as the symptom of another mental disorder or as a form of nonsuicidal self-injury (NSSI or self-harm)

Warning signs

Potential warning signs that someone has skin-picking disorder include:

• Frequently making self-deprecating remarks or otherwise speaking negatively about themselves
• Becoming extremely upset with themselves over relatively minor mistakes or failures
• Having cuts, scabs, or other signs of skin damage that never seem to fully heal
• Refusing to go swimming or change clothes in front of others
• Wearing long sleeves even in hot weather to hide evidence of their behavior
• Using makeup excessively as a means of hiding skin damage

None of these warning signs are definitive proof that a person has skin-picking disorder. But anyone who exhibits them may be in crisis and should be evaluated by a qualified mental health professional. Whether they have SPD or another mental health concern, an assessment can be a vital first stop on the path toward appropriate care and improved quality of life.

Causes

According to an August 2022 article in the Turkish Journal of Psychology, risk factors for compulsive skin-picking and similar conditions include:

• Gender (the disorder is more common among women and girls than among boys and men)
• Certain genetic influences
• Abnormal levels of various brain chemicals, including dopamine, glutamate, and γ-aminobutyric acid (GABA)
• Structural and functional differences in the amygdala
• Family history of body focused repetitive behaviors (which will be discussed in more detail in the next section)
• Personal or family history of substance abuse and addiction
• Low familial support for emotional expressiveness
• Poor emotion regulation
• Having OCD
• History of untreated trauma
• Personality traits such as impulsivity, perfectionism, neuroticism, and introversion
• Tendency to self-criticize or be easily embarrassed

Similar conditions

In the DSM-5, excoriation (skin-picking) disorder is included in the Obsessive-Compulsive and Related Disorders section. Other disorders in that section are: 

• Obsessive-compulsive disorder (OCD)
• Hoarding disorder
• Body dysmorphic disorder
• Trichotillomania (hair-pulling disorder)

Skin-picking disorder is also sometimes classified as a body focused repetitive behavior (BFRD), which is an informal umbrella term that isn’t found in the DSM-5. In addition to skin-picking and hair-pulling, other BFRDs involve repeatedly and compulsively:

• Grinding teeth
• Chewing on lips or cheeks 
• Biting fingernails
• Cracking knuckles
• Eating hair

Is Skin-Picking Dangerous?

To be accurately diagnosed with skin-picking disorder, a person’s behavioral compulsions must be severe enough to cause significant emotional distress or impaired functioning. So, by definition, this is a dangerous conditions.

Left untreated, it can also put a person at risk for other types of physical and psychological damage, such as:

• Infections and other medical problems
• Scarring
• Onset or worsening of other mental health concerns
• Overwhelming shame or guilt
• Withdrawal and isolation
• Difficulty forming and maintaining healthy relationships
• Diminished confidence and low self-esteem

How Is Skin-Picking Disorder Treated?

Treatment for skin picking disorder can occur in several environments (levels of care) and involve a variety of medications and therapies. 

Levels of care

When developing a treatment plan for someone with skin-picking disorder, one of the first steps is to determine which of the following levels of care are right for them:

• Inpatient/residential treatment
• Partial hospitalization program (PHP)
• Intensive outpatient program (IOP)
• Outpatient therapy

Patients may enter or exit treatment at any of these levels. Some will only need to spend time at one level, while others may benefit from receiving care at two, three, or all four. 

Medication 

Various skin-picking medications can alleviate the compulsion to engage in this behavior, which can make it easier for a person to resist the urges that have been causing them such intense distress.

Depending on the nature of a person’s struggles, they may benefit from skin-picking medications such as:

• N-Acetylcysteine (NAC)
• Memantine
• Clomipramine
• Olanzapine
• Benzodiazepines
• Allopregnanolone

Therapy 

The therapeutic component of treatment for skin-picking disorder can help people learn to better manage their symptoms and develop healthier ways of dealing with stress. 

Cognitive-behavioral therapy (CBT) is often a main element of care for patients with skin-picking disorder. CBT is a short-term, goal-oriented approach that is based on the belief that psychological distress is caused in part by unhealthy thought patterns and self-defeating behaviors.

Over multiple CBT sessions, clients can identify how these concerns have been negatively impacting their lives and contributing to their compulsive skin-picking. With the guidance of a trained professional, they can then replace these maladaptive characteristics with healthier ways of thinking and more productive behavior patterns.

Other therapies that have proved to be effective at helping people with skin-picking disorder include:

• Acceptance and commitment therapy (ACT)
• Habit-reversal training (HRT)
• Family counseling and support

If a person with skin-picking disorder has also been affected by any co-occurring mental or behavioral health concerns, their treatment plan should also address those issues. Patients with co-occurring conditions may benefit from services such as:

• EMDR and other types of trauma therapy
• Biofeedback therapy
• Art and/or music therapy
• Yoga, mindfulness, and meditation
• Red light therapy
• Life skills development sessions
• Experiential therapies
• Process groups
• Psychoeducational groups

Learn More About Treatment for Skin-Picking Disorder in Atlanta

Time Wellness Georgia is a trusted source of personalized outpatient care for adults and adolescents with skin-picking disorder, other mental health concerns, and substance use disorders (addictions).

Treatment options at our center in Atlanta, GA, include a PHP, IOP, evening IOP for adolescents, and virtual (online) care. A member of our team will be happy to discuss the features and benefits of each options with you, so that you can make the best choice for yourself or your child.

To learn more about our programs and services or to schedule a free assessment, please visit our Contact page or call us today.