Skin Picking: A Sign of Deeper Problems

Medical Reviewer

A number of psychological problems are associated with one or more compulsions (a pressing need to do something). Dermatillomania, also referred to as Compulsive Skin Picking (CSP) or neurotic excoriation, refers to excessive picking, scratching or squeezing of skin. Skin picking is frequently focused towards spots, pimples, old scars and blemishes, but it may also include moles and freckles and other areas of healthy skin.

Compulsive skin picking is often associated with mental health problems but it can occur as a result of organic problems such as anemia, liver disease and uremia. Around 50 percent of people diagnosed with obsessive-compulsive disorder (OCD) are thought to pick their skin. Other psychological problems typically include anxiety disorders and depression.

People who compulsively skin pick will frequently describe high levels of tension or anxiety and a pressing need to scratch. Once the habit is formed it may also occur during otherwise absent-minded activities such as watching television or listening to music. The act of scratching is often accompanied by a sense of pleasure, relief and gratification. Once over however, the mood of the individual may slump.

More women than men seem to be affected. It is also a problem associated with Body Dysmorphic Disorder (BDD), as those affected believe that attempts to scratch or pick away freckles, scabs, scars, etc, will make them appear more normal.

It can be difficult to persuade people who skin pick compulsively that they need help. Most will simply brush off attempts at help in the mistaken belief that they don't have a problem at all. The effects of skin picking can be relatively easy to cover up, especially if the parts of the body affected are normally underneath clothing. Face picking is more difficult to cover over, even when using cosmetics.

Avoiding treatment may lead to unforeseen complications. For example, sometimes the person may need medical help for an unrelated problem, but they will avoid the doctor as removal of clothing will reveal their skin. In some unusually severe cases, people have developed deep and infected wounds.

In some cases treatment can be quick and highly effective. Breaking the association between say, anxiety and scratching, can be achieved fairly quickly by use of Cognitive Behavioral Therapy (CBT). For others, more time may be needed in order to uncover and work with the underlying cause of the problem. In such cases, psychotherapy or other forms of psychological intervention may be coupled with medication.