Excoriation Disorder Explained 1:40
Understanding Skin Picking Disorder (Excoriation Disorder)
If your child or teen repeatedly picks at their skin, struggles to stop despite wanting to, or experiences distress related to sores, scarring, or skin damage, specialized skin picking treatment can help.
Anxiety Institute provides evidence-based assessment and treatment for skin picking disorder (excoriation disorder) and other body-focused repetitive behaviors (BFRBs) in adolescents and young adults. Our experienced clinicians use proven approaches including cognitive behavioral therapy (CBT), exposure and response prevention (ERP), habit reversal training (HRT), and parent support to help individuals reduce skin picking and improve daily functioning.
Early intervention can reduce symptoms, prevent medical complications, and improve confidence and quality of life. Contact us for a complimentary consultation to learn which treatment option may be the best fit for your family.
Signs & Symptoms
Skin Picking Disorder, also known as Excoriation Disorder, involves recurrent picking at one’s skin that leads to skin damage and repeated unsuccessful attempts to stop.
Individuals may pick intentionally or automatically, often without fully realizing they are doing it.
Common Emotional and Cognitive Symptoms
- Strong urges to pick skin
- Difficulty resisting picking behaviors
- Feelings of tension, anxiety, or discomfort before picking
- Relief or gratification after picking
- Shame or embarrassment about skin appearance
- Frustration over unsuccessful attempts to stop
- Worry about others noticing sores or scars
Common Behavioral Symptoms
- Picking at healthy skin, pimples, scabs, or minor skin imperfections
- Using fingers, tweezers, pins, or other tools
- Examining picked skin or scabs
- Avoiding social situations due to skin concerns
- Spending significant time picking or attempting to stop
- Wearing clothing or makeup to conceal skin damage
- Picking during periods of stress, boredom, anxiety, or relaxation
Common Physical Symptoms
- Open sores or wounds
- Scarring
- Skin discoloration
- Recurrent infections
- Tissue damage
- Delayed wound healing
Early Skin Picking Assessment Matters
A comprehensive assessment can help determine whether symptoms are related to excoriation disorder, OCD, anxiety, perfectionism, sensory-seeking behaviors, or another concern.
Our assessments evaluate:
- Frequency and severity of skin picking
- Triggers and emotional patterns
- Awareness of picking behaviors
- Medical complications
- Impact on school, social functioning, and self-esteem
- Co-occurring anxiety, OCD, depression, or related concerns
- Recommended level of care
Early identification often leads to better treatment outcomes and reduced long-term impairment.
Impact on School, Family, and Relationships
School Impact
Students with skin picking disorder may:
- Feel distracted by urges throughout the day
- Avoid participation due to embarrassment
- Have difficulty concentrating
- Experience increased anxiety about appearance
- Miss activities due to skin-related concerns
Social Impact
Skin picking can affect:
- Friendships
- Dating and romantic relationships
- Participation in social activities
- Self-esteem and body image
- Confidence in public settings
Many adolescents work hard to conceal sores, scars, or areas of skin damage, which can increase isolation and shame.
Family Impact
Families often experience:
- Concern about worsening symptoms
- Frustration when attempts to stop are unsuccessful
- Uncertainty about how to help
- Conflict related to picking behaviors
- Worry about infection or scarring
Skin Picking Disorder Treatment
Evidence-Based Skin Picking Treatment: CBT, ERP, and Habit Reversal Training
The gold standard treatment for skin picking disorder includes cognitive behavioral therapy (CBT), exposure and response prevention (ERP), and habit reversal training (HRT).
These approaches help individuals:
- Increase awareness of picking behaviors
- Identify emotional, sensory, and environmental triggers
- Develop competing responses
- Reduce urges and automatic picking patterns
- Build healthier coping strategies
Habit Reversal Training (HRT)
Habit Reversal Training is one of the most effective treatments for skin picking disorder.
HRT helps individuals:
- Recognize early warning signs
- Interrupt automatic picking behaviors
- Practice alternative responses
- Strengthen self-monitoring skills
- Generalize skills across settings
Treating Body-Focused Repetitive Behaviors (BFRBs)
Excoriation Disorder is one type of body-focused repetitive behavior (BFRB). Treatment focuses on understanding the function of the behavior while helping individuals develop healthier ways to manage stress, anxiety, boredom, and uncomfortable sensations.
Parent and Family Support
For children and adolescents, treatment often includes parent involvement to help families:
- Reduce shame and criticism
- Support treatment goals
- Reinforce healthy coping skills
- Create a supportive home environment
Medication Support
For some individuals, medication may be recommended as part of a comprehensive treatment plan, particularly when anxiety, OCD, or depression are also present.
Skin Picking Treatment Center in CT, NJ, and VA
Anxiety Institute specializes in treating anxiety disorders, OCD-related conditions, and body-focused repetitive behaviors in adolescents and young adults.
We offer:
- Comprehensive skin picking assessments
- Individualized treatment plans
- Cognitive Behavioral Therapy (CBT)
- Exposure and Response Prevention (ERP)
- Habit Reversal Training (HRT)
- Parent guidance and family support
- Intensive outpatient treatment options
- In-person treatment in Connecticut, New Jersey, and Virginia
- Online treatment in eligible locations
Help for Skin Picking Disorder
Skin picking disorder is a treatable condition, and many adolescents experience significant improvement with specialized care. If skin picking is affecting your child’s confidence, relationships, school functioning, or daily life, contact us today for a complimentary consultation.
Our team will answer your questions, explain treatment options, and help determine the right next step for your family.
Resources
Diagnostic and Statistical Manual of Mental Disorders (5th ed.)
American Psychiatric Association. (2013).
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Recommended Reading on Dermatillomania
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Quick FAQs
Skin Picking (Excoriation)
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What is excoriation and how is it treated? 1:40
Excoriation disorder, or dermatillomania, is a mental health condition where a person compulsively picks or scratches their skin, causing injuries or scarring. It is classified as a body-focused repetitive behavior. Unlike OCD, skin picking may not involve compulsions or relief from rituals, and it often results in self-damage.
Symptoms include scratching, digging, rubbing, or squeezing the skin using fingernails, teeth, or sharp objects. Picking can be automatic, happening without awareness, or focused, lasting for hours on a specific area and causing severe damage. Common sites include the scalp, face, arms, fingers, legs, and feet.
The exact cause is unknown, but several factors contribute. A family history of excoriation disorder or related conditions such as OCD increases risk. Brain differences in areas controlling habit formation, as well as stress, anxiety, or boredom, may also play a role.
Diagnosis is based on a clinical evaluation of medical and family history, current behaviors, and impact on daily life. Criteria include repeated skin picking, multiple attempts to reduce the behavior, and negative effects on social or work life. Symptoms must not be caused by a medical skin condition.
No. Excoriation disorder is chronic, and symptoms may fluctuate over time. Early intervention can reduce long-term skin damage and improve outcomes.
Treatment includes habit reversal therapy (HRT), cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), and group or peer support. Medications such as SSRIs may be used in some cases.
Symptoms can worsen with stress, anxiety, boredom, anger, or the appearance of skin imperfections. Skin conditions such as acne or eczema may prompt focused picking, and comorbid mental health conditions like OCD, anxiety, or body dysmorphic disorder can exacerbate symptoms.
Skin picking can cause visible damage, shame, anxiety, and depression. It may lead to social withdrawal and reduce participation in school, work, or social activities. Time spent picking can interfere with daily responsibilities.
Support begins with understanding the disorder and listening without judgment. Encouraging professional treatment, celebrating small successes, reducing triggers, and offering alternative activities can all help. Consistent empathy and understanding are essential even when the behavior is difficult to witness.