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Skin picking disorder … Not very nice, but it happens more than we think apparently. Patients who suffer from excoriation tend to pick, scrap or dig into their own skin over and over, making lesions.

What Is Excoriation

Patients have stated that they don't scratch the skin consciously; they first pick and then notice what they're doing. Skin picking disorder or excoriation is a disorder where people pick their own skin repeatedly, over and over again, and when the picking is so bad that causes tissue damage and influences work or other daily activities. It's hard to exactly say when a nervous habit becomes a disorder, but not every skin picking is considered excoriation. Many healthy people pick scabs, pimples or cuticles from time to time, and it's not that uncommon, but when it takes big amount of a day, leaves visible scars, and make you feel guilty and ashamed to show it to others — it should be treated.

Excoriation causes a lot of distress. People who do it often have other related psychological problems like anxiety or depression. It can start at any age, even in early childhood. It develops spontaneously, it two ways.

When a person already has some kind or rash or scab, they fixate on preventing the wound to heal, picking and causing more injury. Itching and scratching leads to even bigger wound, so the cycle begins. Other way to develop excoriation disorder is when a person is under stress. In most of the cases, it starts by biting around the nails. Repetitive actions help a person to relieve anxiety and stress, and by the time they realize they're doing it, it has already become a habit.

Other similar disorders include nail, lip or cheek biting, or pulling own hair. They all fall under body-focused repetitive behaviors, umbrella name for all behaviors that include self-injuries or compulsive damaging of the physical appearance. They're also often classified as obsessive-compulsive disorders, due to the urge for a repetitive behavior.

Causes Of Skin-Picking

Causes of excoriation or any other body-focused repetitive disorder are still not clear. Researchers are still working on the genetic component as a possible reason.

A French survey done on 10 neurotic patients found that most of them linked their excoriation with personal issues; four of them admitted abuse in early or adolescent age. This study was done to prove that skin-picking is an impulse rather than OCD (obsessive-compulsive disorder), but most of the diagnostic manuals still classify skin-picking among obsessive-compulsive disorders.

Sometimes an inciting incident is present, but most of the times not. Most patients with this disorder don't have a specific psychopathology; however, several psychiatric diagnoses that can be linked to excoriation include:

  • obsessive-compulsive disorder

  • depression

  • anxiety

  • body dysmorphic disorder

  • delusions (including schizophrenia)

Psychologists claim that the person hurts the skin to satisfy some internal needs, mostly psychological ones. They want to be taken care of. The patients are often frustrated and angry, denying psychic distress which makes the treatment of excoriation disorder very difficult.

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