We’ve all been there — you’re about to walk out of the bathroom when something catches your eye in the mirror. You do a double-take, and just as you suspected, you spy a brand new blackhead that’s taking up precious real estate on your forehead. After a couple of gentle(ish) squeezes, it’s out, with no damage done other than a bit of redness that’ll go down in a couple of minutes. No big deal.
Unfortunately, for millions of people, it’s not that simple. For anyone suffering with excoriation disorder (more commonly referred to as skin picking disorder), the urge to pick is compulsive and often stems from a psychological place.
To break down exactly what skin picking is — and how to stop the cycle — we talked with Matthew Traube, a California-based licensed clinical therapist who specializes in psychodermatology (a niche field focused on the psychological stress of dealing with skin issues).
Keep reading to learn more about excoriation disorder.
What is skin picking?
Excoriation disorder, or skin picking disorder, officially became recognized as a mental disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) in 2013. It’s one of a group of body-focused repetitive behaviors (BFRBs), falling under the same umbrella as chronic nail-biting and trichotillomania (chronic hair pulling).
How common is it?
Traube says that estimates fall between two and five percent of the general population, so it’s definitely more common than you think. “And yet, there’s still this stigma around it,” says Traube. In fact, those numbers could even be an underrepresentation because skin picking can be overlooked as a symptom of another mental illness or simply goes unreported due to feelings of guilt or shame.
How is skin picking diagnosed as a disorder?
In order for excoriation disorder to be diagnosed, a therapist will look at how intrusive the behavior is. “We look at whether it’s causing functional impairment—if it’s impacting your work, your school and your social life,” says Traube. “Is it a behavior that you can’t stop doing? We all pick our skin at some point, but for people with skin picking disorder, it’s really invasive.”
What are some of the psychological reasons someone might pick their skin?
“There are a lot of different reasons,” explains Traube. “But one of the most common is using skin picking as a way to regulate emotions. So when people are feeling stressed or anxious, they might pick their skin.” However, for others, it’s just something to do when they’re relaxed. “Some people pick their skin when they’re not engaged with other activities in a mindful way, like when they’re watching TV at night or in bed just scrolling on their phone.”
What are some common triggers?
As you can probably imagine, mirrors are a big trigger. “If you've got a ton of mirrors in your house, I'm pretty quickly going to suggest reducing either the number of mirrors or how much time you're spending in front of them,” says Traube. Another big trigger for patients is social media. “The way people look on social media is unrealistic. All the filters and impossibly smoothed out imperfections cause a lot of pressure for anyone with skin picking disorder.”
What are some common triggers?
If there are other issues at play, like OCD, depression, or other underlying psychological conditions, those need to be addressed in conjunction with excoriation disorder. “It’s less straightforward if there are coexisting illnesses,” says Traube. “The mechanisms, mindset and the environment in which people pick their skin if they have, say, OCD, is really different than if someone just has excoriation disorder.”
However, if a patient presents with only skin picking disorder, Traube says the first step is to identify the triggers and patterns in the behavior. “Is it when you’re at work, in social gatherings, around your in-laws?” asks Traube. “Treatment will be a combination of manipulating the physical routine and understanding some of the deeper psychological elements that are influencing the physical behavior.” For example, if someone is in the habit of mindlessly picking at their skin first thing in the morning as they scroll through Instagram, Traube says he’ll suggest changing that routine to break the habit. This can mean implementing a change as small as getting out of bed as soon as you wake up. “Or let’s say someone tells me their skin-picking tends to happen at like three o'clock while they’re at work because they get tired then. I’ll suggest taking a walk at three o’clock and making that a new habit instead.”
Traube says these small tweaks can make a big difference, but it takes time. “One of my favorite lines is ‘practice, not perfect.’ You don’t need to believe it’s going to work, but you do need to practice. And if you do even 50% of what we talk about in sessions, you're going to see yourself get better. It’s going to go slower than you want it to, but it will happen.”
What are some ways you can start to shift your skin-picking habits?
1. Take notes
Start jotting down the times of day you feel a desire to pick, and make note of your surrounding circumstances, too. Once you start to notice patterns of when and where you pick your skin, you can begin implementing some of the changes Traube mentioned above, like going for a walk or making a cup of tea instead of waiting for the urge to come on.
2. Throw out those magnifying mirrors
Seriously. No one needs to see their pores that close up. And if you’ve got a ton of mirrors in your home, consider getting rid of a couple.
3. Remember: practice, not perfect
Shifting behavior takes time, so be kind to yourself. Progress probably won’t be linear, and that’s okay. Experienced a setback? It happens! Just keep moving toward your goal.