Excoriation (dermatillomania, skin-picking disorder)

Skin-Picking Disorder is characterized by frequent and intense picking of skin resulting in bleeding, sores, and scars, in spite of recurrent attempts to stop. This is often done in an attempt to remove small irregularities or perceived imperfections, but individuals may pick at healthy skin as well. The most commonly picked sites are the face, arms, and hands; however, in some cases, multiple body sites are picked. People usually use their fingernails to pick, but often tweezers and other instruments may be used. Skin picking frequently starts as a regular grooming behaviour (everyone picks their skin at times), but it may change into a highly disturbing and embarrassing condition. The majority of skin-pickers are women, and this disorder often starts in adolescence. 

The act of picking can be preceded by a sense of tension and may be followed by a sense of relief or pleasure. It is often accompanied by feelings of shame and guilt and can lead to significant impairment in one's daily functioning.

Excoriation disorder is classified as a body-focused repetitive behavior (BFRB) and is considered a subtype of obsessive-compulsive and related disorders. It can occur alone or in combination with other BFRBs such as trichotillomania (hair-pulling disorder) or onychophagia (nail biting).

Unfortunately, many people with skin-picking disorder are reluctant to seek help because of embarrassment and shame. It is important, however, to see a psychologist who is knowledgeable in treating excoriation, as even though skin-picking intensity frequently fluctuates, it rarely remits completely. Some of the treatments of choice for excoriation are Habit Reversal Training, Stimulus Control, and Cognitive Behavioural Therapy (CBT). 

In treatment, you will increase your awareness of this habit by identifying the emotional, social, and other consequences of picking, and whether your picking is usually preceded by a feeling or by a thought. Your therapist will then help you develop a new behaviour (a competing response) that would compete with your picking. You will be then guided in consistently implementing that response.