Obsessive-compulsive and related disorders
Excoriation (Skin-Picking) Disorder
Excoriation disorder, also called skin-picking disorder, involves repeated picking, scratching or squeezing that causes skin lesions, together with repeated unsuccessful attempts to reduce or stop the behaviour.
Not simply a bad habit
Picking may be deliberate and focused, for example in front of a mirror, or largely automatic while reading or watching television. It may target spots, scabs or tiny perceived irregularities—or skin without an obvious lesion—and can affect any body area.
The behaviour may follow tension, boredom, anxiety or a sense that the surface is not ‘right’, but a clear trigger is not required. Diagnosis depends on repeated injury, attempts to stop and meaningful distress or interference.
Assessment and health risks
- Possible effects include wounds, scarring, colour changes, pain, bleeding, infection and delayed healing.
- A clinician considers dermatological disease, medicines, stimulants and other mental health conditions, including BDD and non-suicidal self-injury.
- Avoidance of social contact, swimming, medical examination or intimacy can become as impairing as the visible lesions.
Treatment
CBT with habit-reversal training helps identify the earliest urge and practise a safe, incompatible response. Recording the time, place, activity and emotional context can distinguish focused from automatic picking and guide practical changes.
Shorter nails, temporary mirror limits, wound coverings or safe objects for the hands can support treatment without becoming punishment. Medical or dermatological care is important for infection, itching, acne or wound management.
When to seek help
Seek help for recurrent wounds, scarring, repeated failed attempts to stop or disruption to sleep, work or relationships. Increasing pain, swelling, warmth, pus, unpleasant odour or fever needs medical assessment; uncontrolled bleeding or rapidly spreading redness needs urgent care.