OCD Center of Los Angeles California
OCD Center of Los Angeles

The ABC’s of Dermatillomania / Skin Picking Disorder

Thursday, October 13th, 2011 Compulsive Skin Picking

    

Not all skin picking is the same

Not all skin picking is the same.

Everybody picks their skin sometimes, right?  If you tell your friends or family that you pick your skin, many of them might say “Oh, I do that, too”.  So, how do you know if your skin picking is severe enough to warrant a diagnosis of Dermatillomania, also known as Skin Picking Disorder or Excoriation?

There are a variety of ways in which assessment of skin picking occurs. Self-assessment might occur by the person doing the skin picking when an individual realizes that he or she is causing scabs, scars, and/or infections. A person with Dermatillomania may also be aware that he or she is avoiding social situations, including work, school, and/or social functions such as weddings and parties.  After all, those who have picked to the point of bleeding and scabbing may be too embarrassed to be seen by others who might judge them or ask questions about their skin.

An assessment of Dermatillomania might also come from a dermatologist, aesthetician or family member who sees the physical and emotional consequences of the person’s skin picking. This person may recommend that the skin picker seek professional assistance for the picking.

Dermatillomania / Skin Picking TestGenerally, most people do pick their skin, pimples, nails, or cuticles at some point. So, what makes the difference between someone who has Skin Picking Disorder and someone who does not?

I heard a great classification of skin picking in a workshop by Dr. Charles Mansueto at the Trichotillomania Learning Center’s (TLC) 2006 Conference. I was inspired to create my own version of his classification system. I use it with all of my skin picking clients, and I call it the ABC’s of Skin Picking.

An “A” is something that almost “anyone” would pick. This could be a piece of dry skin hanging off your arm, a pus-filled whitehead on your chin that pops at your mere touch, or a scab that’s barely hanging on which you easily detach.

Skin Picking ReportA “B” is a “bump”, pimple, scab, etc. that only a skin picker would pick. This is something that would either become an “A” over time or go away on its own if left alone. But, a skin picker will frequently start picking at it and make it significantly worse. It may then bleed, ooze, scab, and possibly become infected.  This in turn will cause two additional problems – it will cause the picker significant distress, and it will give him or her something new to pick at later. In my experience, I have found that clients with Skin Picking Disorder classify at least 50% of their picking as “B’s”.

“C” stands for “Create”, meaning the individual with Dermatillomania is not picking at anything objectively “real”, but in the process of picking at his / her skin, the person “creates” something such as a blemish, scratch or scab.  A “C” is something that only someone with Dermatillomania would pick. There is often nothing apparent on the individual’s skin, but the picker starts picking or scratching, and in the process creates a wound.

Mindfulness WorkshopTreatment for Dermatillomania / Skin Picking Disorder

The recommended treatment for Skin Picking Disorder is with a trained psychotherapist who specializes in treating this misunderstood and often misdiagnosed condition.  Effective treatment focuses on Cognitive-Behavioral Therapy (CBT), with an emphasis on Habit-Reversal Training (HRT) and Mindfulness Based CBT.

In Cognitive Behavioral Therapy for Dermatillomania, the first behavioral goal is to stop picking any “C’s” – in other words, to stop creating new skin problems where none previously existed. Usually, a skin picker can learn to do this relatively easily by becoming more aware of their picking patterns.  Building awareness is generally done by keeping a skin picking log, and with the assistance of a habit-blocker such as wearing gloves.

Gloves provide a barrier to unconscious picking, and help in two ways.  First, the skin picker cannot easily pick at existing scabs, blemishes, etc.  Second, the gloves prevent identification of new places to pick that would otherwise be felt by random, unconscious, mindless “investigation” (touching) of the skin. If you are a skin picker, the previous sentence may resonate with you, and you may say, “I do that!” That would make sense as the two main triggers for skin pickers are touching and looking at their skin.

Removing the opportunity to touch your skin by wearing gloves is a good first start to becoming more aware of your unconscious “scanning”, and reducing the impulse to pick. After you get used to using a “habit blocker” like gloves, the focus of treatment turns to reducing your picking of “B’s.” What are the two most important factors to address in successfully reducing picking of “B’s”? You can read about that in Part 2 of The ABC’s of Skin Picking.

To take our free online test for Skin Picking Disorder / Dermatillomania, click here.

To read part two in our series of articles on Dermatillomania / Skin Picking Disorder, click here.

To read an excerpt of from our free special report “Skin Picking Disorder: Top Twelve Roadblocks to Recovery”click here.

•Karen Pickett, MFT is a psychotherapist at the the OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) and related conditions, including Dermatillomania / Skin Picking Disorder.  In addition to individual therapy, the center offers six weekly therapy groups, as well as online therapy, telephone therapy, and intensive outpatient treatment.  To contact the OCD Center of Los Angeles, click here.

Update: 2014 TLC Conference on Hair Pulling and Skin Picking Disorders

We are proud to be sponsoring this year’s annual conference of the Trichotillomania Learning Center (TLC), which is being held in Los Angeles on April 25 – 27, 2014. As part of our sponsorship, we are awarding six scholarships which will provide free admission to the conference (a value of up to $450 for each admission). These scholarships are being awarded via a Facebook promotion which requires entrants to have an account on Facebook, and to “like” the OCD Center of Los Angeles on Facebook. For your chance to win free admission to the 2014 TLC Conference on Hair Pulling and Skin Picking Disorders, just do the following:

1. click below to be taken to the entry form
2. “like” our Facebook page on the form (note: if you already “like us on Facebook, you don’t need to do this step)
3. if you are not logged onto Facebook, you may be prompted to log on
4. complete the simple entry form
5. click enter to submit the form

That’s it! We will be awarding six scholarships over six weeks leading up to the conference. Good luck!

TLC Scholarship

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60 Comments to The ABC’s of Dermatillomania / Skin Picking Disorder

  1. Hello Karen,

    I was wondering if maybe you could tell me if I have dermatillomania I understand you cannot give me a formal diagnosis but maybe some strategies to help reduce my picking. As of right now the area where I pick the most is the back of my scalp it started as a small patch of dandruff however over this past year my picking has gotten worse and that one patch has spread to most of my lower scalp. I pick every single day and for most of the time during the day it usually starts off as an itch, sometimes I try to avoid to scratch but it becomes overwhelmingly itchy and I cant resist. I also have the idea that the more I pick the dry skin the better it will be , but then my scalp becomes raw and it stings when I wash my hair . I have had some other episodes with picking, when I was younger I used to take toe nail clippers and clip the dead skin off the bottom of my feet, thinking that it would make my feet softer but I would often do it to excess where the bottom of my feet would be pink raw skin, sometimes with blood and it would hurt when I walked . I’ve also had problems with picking my face, popping pimples/blackheads thinking it would improve my skin but I would go overboard with that as well I once burned a part of my face by laying close to a space heater because I read that heat would make pimples go away. I have also been diagnosed with OCD by 6 different doctors and I know this disorder is part of the OCD spectrum I just want some advice if it is worth it to treat it . I am not distressed or anxious because of my scalp picking but I am a little embarrassed because I do it in public especially in class and I feel like people are watching me pulling dead skin off of my scalp. any feedback would be helpful

    Thanks!

  2. Gaby on October 14th, 2011
  3. Hi Gaby:
    Thank you so much for your comments and questions. While I can’t provide a diagnosis or treatment via this blog, the symptoms you describe sound consistent with those of Dermatillomania. I suggest you seek consultation with a CBT therapist in your area. You can find a list of therapists specializing in Dermatillomania at http://www.trich.org.

    I also recommend continuing to read our blogs for suggestions and tips. If you haven’t already done so, you might also consider consulting a dermatologist as the itching on your scalp may be a symptom of a skin condition.

    All the best,
    Karen Pickett MFT

  4. Karen Pickett on October 17th, 2011
  5. Hi,just wondered when part 2 of this will be coming?

  6. Sar on April 15th, 2012
  7. Hi Sar,

    Thank you for your interest. We just posted part two a few days ago at http://www.ocdla.com/blog/treatment-dermatillomania-compulsive-skin-picking-csp-1532

  8. OCD Center of Los Angeles on April 16th, 2012
  9. Dear Karen Pickett MFT,

    Thank you for sharing some fairly simple steps (notice I didn’t say “easy”?) for those who don’t currently have access to a therapist, medical insurance, etc.

    The A, B, C concept resonates deeply for me. It all starts with those A blemishes – even without my picking issues, I’m not blessed with gorgeous skin – the A blemishes are always going to be there, so it helps greatly not to hear a blanket “just don’t pick” response. Of course, I spend hours of my life on the B blemishes and then I’ve spent many, many other wasted, shameful (and painful) hours on the C blemishes which are of my own making. Imperfections that are real to me, but no “normal” person would ever detect or bother mutilating themselves over.

    I really think having this mental reference will help me to check myself and take that challenging step backward from the mirror before I get lost in the numbing/soothing sea of pores where the world is suspended…until I finally stop and the reality of my actions crashes down.

    I will begin my journaling process today and follow the advice you’ve given. I have been somewhat aware of my worst triggers for some time, but that doesn’t meant of done much with that knowledge. I’m 40, tired of failing myself and I do NOT want to model this behavior for my children anymore than I (sadly) already have.

    Thank you again,
    ~Tammy

  10. Tammy on June 16th, 2012
  11. Tammy,

    Thank you for your comment. I’m glad to hear that the ABC model was helpful to you. I’d love to hear how you are doing using it as a reference and also how your journalling is going.

    Best,
    Karen Pickett, MFT

  12. Karen Pickett on July 17th, 2012
  13. I have a habit of picking at my elbows. It started when one was dry and i just started picking it and then it felt good so i picked the other. Now whenever im stressed or even just bored i pick them, as a relief. Sometime’s they bleed and it’s really embarrasing but i cant stop.

  14. Alexandra on November 6th, 2012
  15. Hi Alexandra:

    Your experience is one I hear very often — picking starts when something is on the skin, then picking continues because it feels pleasurable. Being either stressed or bored are the most active times for skin pickers.

    First, I encourage you to visit your medical doctor or dermatologist, if you have not done so already,to see if there is an underlying condition or any infection present, and to have anything present addressed.

    The fact that you are aware of the “triggers” to your picking (being stressed or bored) is very important because you can prepare a habit-blocker to prevent you from picking at times when you are feeling stressed or bored. For instance, you might wrap your elbows in cloth bandages or wear light cotton gloves. These habit-blockers will provide a physical barrier to prevent automatic, unconscious picking because you won’t be able to directly access the skin on your elbows to pick.

    Next, you can use mindfulness to be present and notice that the urges to pick intensify and then fade away. When you learn by your own experience that the urge to pick will fade – no matter how strong it feels at any time – you will then have the power to make the choice not to pick but to ride out the urge.

    Remember, anytime you do not pick is time in the bank which can never be erased even if you pick again. The less you pick, the less intense the urge to pick will be; therefore, the less difficult it will be to stop.

    This kind of change doesn’t happen over night. If you are committed to stop picking, taking it one day or one hour or one minute at a time is the way to reach your goal.

    Karen Pickett, MFT

  16. Karen Pickett on November 8th, 2012
  17. Hey karen. I know you cant say much through here but i dont know if i need the doctors help or not also im embarrased to talk about it. I pick the skin under my feet sometimes i do it without meaning to do so. They look awfull broken and it hurts so much to walk because i come to bleed and take big pieces of skin. I been doing this for over year and i been trying to stop but i cant do it. Even when my feet are nice and smooth i start picking on them until i getomething and after that it wont stop. My mom is really worried about this and has been asking me to atop but i cant it has become a bigger part in me. Please tell me if i should eek help or thi will leave slowly while i grow up. Im 19 years oldand this thing is just getting more nd more embarrasing but i still wont stop.

  18. ally on January 6th, 2013
  19. Hi my name is Kelly I pick at my feet bad its so bad I use toenail clippers to get skin when theres nothing to pick and whats really sick is that I eat it its been 3 years or so when it started befor that I picked at my scalp and bit my nails. until I started getting acrylic nails so picking at my scalp and bighting nails became impossible I think there is something wrong with Me should I get help I dont know what to do

  20. kelly on January 7th, 2013
  21. Hi Ally: Thanks for sharing about your skin picking on your feet. It sounds like you are experiencing dermatillomania. When a person mentions that areas they are picking bleed, I am always concerned about the possibility of infection.

    So, I encourage you to do two things. The first is to see a medical doctor to check for infection and get treatment if appropriate.

    The second is that I encourage you to seek out a good therapist who specializes in Cognitive-Behavioral Therapy (CBT) for Dermatillomania and other body-focused repetitive behaviors. Here at the OCD Center of Los Angeles, we offer such treatment in person and online (via Skype) for persons living in California or outside of the United States.

    Please get help no matter how embarrassed you feel. You are not alone and don’t have to suffer alone.

    Best,
    Karen

  22. Karen Pickett on January 8th, 2013
  23. Hi Kelly: You are not alone and I encourage you to seek help. Dermatillomania can be effectively treated by a good therapist who is experienced with Cognitive-Behavioral Therapy (CBT) for body-focused repetitive behaviors such as skin picking.

    If you live in California, or outside the US, feel free to contact us regarding treatment. If you live in the US, but not in California, one great resource for treatment providers is the Trichotillomania Learning Center at http://www.trich.org. Another good resource is the International OCD Foundation at http://www.ocfoundation.org

    Wishing you all the best,

    Karen

  24. Karen Pickett on January 8th, 2013
  25. Hi Karen. Since I can remember I’ve been biting or picking my nails and every time I try to stop I can’t. I’ll get a random urge to do it even if there’s not enough there to get off. Sometimes I’ve started bleeding because of it. The second thing is I bite my lower lip constantly. My lip has gone all red because of it but hasn’t bled yet and it really stings sometimes and I just can’t stop even after putting on chap-stick. The third thing, and the worse, is my scalp. I’d say roughly 70% of my scalp is dry, scabby skin from my constant picking at it. My parents say it’s from my family? They say it’s something to do with my ultra-sensitive skin. It’s really weird. So far it’s been proven that my face heals from spots within 1 day of applying cream nearly, but my scalp won’t stop randomly flaring up for months on end. And when it does flare up with scabs and cuts with bumps, I’m 24/7 picking at it. It feels like a de-stresser, if you could say that? I really don’t know how to stop it but I’m afraid if I keep doing them, I’ll end up with some skin marks that are permanent. I also pick at my athlete’s foot. It’s really hard not to. Even if there’s nothing there I’ll just scratch and it turns into a scab or something..? I just want to know how to stop all this.

  26. Jennifer on January 20th, 2013
  27. Hi Jennifer: Thank you for your post. First, I recommend that you be evaluated by a dermatologist, if you haven’t already. It sounds like part of what you are picking at may be a skin condition that could be treated. If so, that might help reduce the overall amount of picking you are doing.

    Secondly, I encourage you to get help for skin picking from a qualified therapist. To start, I recommend that you read the blogs, posts and replies on this website. If you live in California or outside the United States, we can provide treatment via Skpye. Trained therapists specializing in Dermatillomania are also listed at http://www.trich.org

    Best, Karen

  28. Karen Pickett on January 23rd, 2013
  29. Hi There
    I am picking my scalp as I read this. I find myself picking at work and home. It is soothing for me but i am picking or making scabs to pick in my scalp. Sometimes it burns when I wash my hair. My favorite time to pick is when I am relaxed in the evenings. I get satisfaction finding scabs to pick. I do have GAD but this has become a coping skill for me.

  30. Becca Scott on February 21st, 2013
  31. Hi Becca: It’s a common theme for skin pickers like yourself: that skin picking temporarily relieves anxiety, if only because you are focused on picking rather than on the discomfort of the anxiety. I encourage you to see a dermatologist if you haven’t already to see if you have a skin condition and if there is any infection that can be treated.

    Secondly, what other ways might you cope with the GAD? Do you exercise, journal, do yoga or meditate? These are all wonderful ways to reduce physical, mental and emotional stress.

    Practicing mindfulness is another excellent tool. Mindfulness involves accepting your anxiety and noticing it without running away or trying to avoid it. ACT (Acceptance and Commitment Therapy) is a behavioral therapy I use with skin picking clients. The book The Happiness Trap by Russ Harris outlines in a clear way how to use ACT to help yourself. I highly recommend this book!

    Warmly, Karen

  32. Karen Pickett on March 4th, 2013
  33. Hi. Like many others, I realize you can’t give me a diagnosis, but I was looking for some advice. I have read a lot about dermatillomania and my behaviors don’t exactly match up with it, but I would like a second opinion. I think it started when I was younger and I would love peeling off sunburns. I would get disappointed if my mom didn’t let me peel off hers and oddly frustrated when I saw someone else who was peeling that i couldn’t peel their skin because it would be extremely weird if I went up and pulled off their skin. But quite recently (within maybe the last year) I began to get a little dandruff. I scratched it, but because I enjoyed it, not because my scalp was itchy. I loved looking at the flakes. I began almost always having a piece of black clothing somewhere in my bathroom so I could sit and scratch at my head and watch the flakes fall onto the surface. Sometimes this takes a while. It used to be just in my bathroom, but recently I have done it a couple times in public, like in public restroom stalls or in dressing rooms. Also, over this past winter, I noticed one night that the skin on my breasts was quite dry (it’s weird, I know) and I scratched at them for a while. Now, whenever I see my breasts, I feel that I must scratch them. I have drawn blood a few times, but it has never been bad. Any advice would be more than welcomed and thank you for reading this long message!

  34. Hannah on April 1st, 2013
  35. Hi Karen,

    Thank you so much for posting this important and taboo topic. I have dermatillomania for sure, have tried every single acne lotion and dermatologist. Now i went to a spa center where they do facials and peelings, they say it helps, i already did my first peeling and they told me try not to pick on your face, but offcourse the more my parents, boyfriend and others say dont do it, my response is to do it more.

    SO my face is really bad, i have to wear makeup to cover sometimes and when i don’t, i feel very bad but i dont wear it all the time like before because i know that is not good for the skin.
    Anyways, i have a therapist but havent talked about this issue, but reasing all these posts, you recommend going to a dermatologist, my insurance doesnt cover, and i always fail going to a dermatologist because no matter what, the skin picking always messes up everything. The spa treatment (facials and peeling) seems to help since i saw pictures of women who got better with that but it is expensive, so i am not sure what path should i take? im very discouraged but i really want to do the right thing.

    I actually am a MA student of psychology and have actually tried cbt on me, it helped for some time but then i say “oh whatever and the urge to pick becomes more stronger than the thought stopping and changing activity… i tried gloves, cutting my nails, writing things in the mirror, but i always find a way to pick. I know i pick when im bored or have anxiety. But it is the need to clean my face and get rid of them… theni cant focus when i know the B is still there… Im just really tired of this, i would love any suggestions! Thank you so much!

  36. Andrea on April 2nd, 2013
  37. Hi Hannah: Thanks for posting your question. There are many ways that skin picking disorder can show up. Your scratching may be one of those ways, in which case I encourage you to read the page of our website related to Dermatillomania treatment, as well as part 2 of this blog article for suggestions on helping yourself. I also encourage you to seek treatment from a therapist who specializes in skin picking disorder. If coming to Los Angeles for treatment is an option, please feel free to contact me. You can also find specialized Dermatillomania treatment providers at http://www.trich.org, as well as on the “Links” page of our website at http://www.ocdla.com

    However, I strongly encourage you to first see a dermatologist (if you haven’t already done so) to see if any of your symptoms may be caused by a skin condition that could be treated medically.

    All the best, Karen

  38. Karen Pickett on April 3rd, 2013
  39. Hi,
    I bite my nails, the inside of my cheeks and i’m a B at scab picking. I have been able to stop biting my nails several times but when they get damaged I bite them again. I try to be positive and keep trying to stop. I have also been able to reduce biting my cheeks, hopefully I will stop. I have scars on my legs because of scab picking. I mostly pick the ones caused by acne on my face but have been controlling that as well. Not sure if I do it less because I have less acne or I’m really getting better. I also creak my teeth in my sleep (my dentist made me a plastic thingy to wear at night). I don’t really think I have anxiety issues, I am actually so cheerful it annoys people. I am teen but I don’t think I’m that moody. I have a short fuse though, like my dad, but mom is helping me calm down and it’s sort of working. I know you can’t give me a diagnosis but I was hoping you could tell me how to speed up the fading of scars caused by scab picking (I prefer natural medication, I’ve heard honey and sandalwood oil help, is that true?). Also, do you think I can deal with this myself? I think I’m improving and I know it will take a lot of effort but I’m ready to try. I really don’t want to see a doctor, it’s sort of embarrassing, I’ve heard yoga helps, so what do you think? Hope you can help
    Thank you

  40. Ella on April 6th, 2013
  41. Hi Ella: Thank you for posting. It sounds like you are handling your skin picking and biting and your emotions very well. As for healing scars, I suggest you speak to your dermatologist. I have heard of some products that are supposed to help scars heal and a Google search may help you with finding some treatments.

    As for yoga, I’m all for it! And for any other stress-reducing and self-nurturing activities you can do, for example, meditating, deep breathing and exercise.

    It sounds like you’re on the right track. Keep going! You have my support.
    Best, Karen

  42. Karen Pickett on April 9th, 2013
  43. Hi there,
    I don’t remember how long ago I started picking my scalp but I can’t stop. It started off as dandruff on my hairline so I scratched it off. My nails were sharp and I cut my head. Since then I’ve been picking at the scab on my head. I now have two bald spots on my head and one doesn’t seem to be healing. I cut my nails every time I’m able to pick at it. I also wear hats while I’m sleeping as I tend to wake up with my nails caked with blood and a scab on my pillow. Is this normal? I really want to stop as its affecting my life. I feel like I’m going crazy and I can’t afford therapy or fancy treatments. I’m a C picker and it makes me feel horrible yet it calms me. I have done this before and stopped after about three months. Why can’t I stop now?
    Thank you.

  44. Annie on April 11th, 2013
  45. I am almost positive I have this chronic picking disorder. I pick all the time, make sores, draw blood etc.. I also have a habit of wanting to pick at my husbands scabs and bumps, he has to make me stop, gross right? Is this part of this disorder?

  46. JJ on April 12th, 2013
  47. Hi Annie: I hear how distressing your picking is for you. As a first step, I strongly encourage you to have your scalp checked by a dermatologist since one area doesn’t seem to be healing. I’ve heard many skin pickers say that they are too ashamed to go to doctors, but if one or more of your areas is infected, you may end up with a much bigger issue than feeling embarrassed.

    I’m not sure why you can’t stop right now. However, significantly reducing skin picking takes time. Skin pickers often go through many cycles of picking and not picking before they make noticeable progress towards stopping their picking. I think the question to ask is: what can I learn about myself right now as a result of my picking? It may be that you could nurture yourself more often, journal to express your feelings or wear gloves to bed to help stop the picking while you’re asleep. Everything you learn and use is something that helps you toward your goal of stopping your skin picking.

    You have my support. All the best, Karen

  48. Karen Pickett on April 17th, 2013
  49. Hi JJ: Thanks for bringing this subject up in your post. Picking the skin of others is not unusual as part of skin picking disorder. The same tools you use to help yourself resist giving in to the urge to pick your own skin will work for not picking the skin of others.
    Warmly, Karen

  50. Karen Pickett on April 17th, 2013
  51. I’ve always been a picker, but fairly mildly throughout my whole life. In the past 6 months or so, I’ve started getting the bottoms of my feet with nail clippers. It hurts quite a bit, but I can’t seem to stop at all. If there is loose skin, I have to pick it off. My feet haven’t bled yet, but they hurt to walk on and are quite unsightly. I’ve mentioned it to my father and brought up dermatillomania, but he refuses to take me to the doctor because he thinks that dermatillomania is silly & isn’t a real condition. I just want to stop picking my feet so I can feel okay going barefoot.

  52. Allison on May 7th, 2013
  53. Hi Allison: Skin Picking Disorder will be a new diagnostic category in the DSM-V due out this month. Hopefully, more people will then accept it as a “real” condition. In the meantime, I encourage you to have your feet checked for infection by a doctor or dermatologist. Then, I encourage you to freeze your nail clippers!

    “Freeze my nail clippers?” you might ask. Yes! Put them in a plastic container of water and put the container in the freezer. That way, you still have your nail clippers if you really want to use them, but you’ll have to wait until they thaw. While waiting, your urge may disappear. And you could also use that time to consider things that you could do that would be more helpful to you than picking, like doing relaxation breathing, journaling or putting soothing lotion and socks on your feet. You don’t have to pick the skin even if you think that you do. It is just a thought and you can learn not to let it have power over you.
    Warmly, Karen

  54. Karen Pickett, MFT on May 8th, 2013
  55. I have picked since childhood. Its like a dark secret. The ABC ‘s erre very on the point. I think mine started with chicken pox scabs in my head. Ingrown toe nails too. Id perform self surgery. The secret part was i ate or saved and hid what i plucked out of my skin. Eating blavkheads, pus, skin, it is euphoric. If someone catches me i bevome so iratated. I am always examining any lump bump or mark. Lately Ive noticed a nee tic, pulling on my esrlobes. Ive also created a bald spot at the crown of my head. Its a love hate relationship.

  56. Ms. Marinska on May 14th, 2013
  57. I have been wondering if I have a problem, so I researched online and came upon this through Google. Anyway I have always bit my lips and the inside of my cheeks, but I got piercings on my dimples so I can’t bite my inside of my cheeks anymore. My poor lips though I I bite and pulled the skin till I can’t find a piece of skin to pull off or bleed, but even then if I feel the skin, I must keep at it. Also my hair.. I’ve had dandruff problems and chemical burn due to bleaching my hair, so from there I would run my fingers through my hair feeling my scalp for any bump or flake and take it out by scratching then pinching it through my hair till I absolutely feel nothing on my scalp, then comb my hair to get whatever I missed. I don’t draw blood from my scalp, just search for anything to take out, this has continued for yrs now, and its to the point that I do see thinning in my hair as when I constantly comb through my hair with my fingers I pull the hair too, but not painfully, more like it falls out in my hands. My husband brings it to my attention all the time for both my lip biting and hair searching, I didn’t think about maybe having a problem, but with my husband bringing to my attention the constant issue, maybe I do. Maybe its normal… idk.

  58. Lola on May 18th, 2013
  59. Dear Ms Marinska: You describe the dance of skin picking very well: a love-hate relationship. I encourage you to move to a place of acceptance of your thoughts, feelings and urges so that you can move your relationship with skin picking to a more neutral space. From there, you will be less activated and more likely to ask yourself “What action can I take right now that will support my long-term goals?” If stopping skin picking is one of those goals, you will be more likely to decide not to pick. And the less you pick, the weaker the urges to pick get, so it does get easier not to pick over time. I wish you all the best, Karen

  60. Karen Pickett, MFT on May 21st, 2013
  61. Dear Lola: From your description, it sounds like you are experiencing Skin Picking Disorder. I tend not to use the word “normal” as I don’t believe anything is “normal.” The question to ask yourself is “Do I want to continue doing these behaviors or do I want to learn the skills and tools to stop?” If you decide you want to continue the behaviors, that’s okay. But it sounds like you are concerned about thinning hair and the biting of your lip, so if you’d like support in learning how to stop the touching, biting and picking, you might want to find a qualified therapist to assist you. All the best, Karen

  62. Karen Pickett, MFT on May 21st, 2013
  63. Hi I think I have skin picking disorder because I pick my face 24/7 and I can’t stop picking even if I already picked there I keep on picking there my family tries helping me telling me what I’m doing too my face but I just can’t stop my face is getting worse and no one could help me would you please help me I really try too stop thank you very much

  64. cathy on May 31st, 2013
  65. Okay I’m not sure if I have OCD or not. I love peeling skin. Especially dandruff, I will look on my scalp for peeling spots and I will use like a comb or bobby pin to flake it off more. I love to see it on my fingers or watching it fall or seeing it fall on something black. Same thing with sunburns. I will rub the peeling spots and look at the skin. I have to look at it. I do feel a sense of relief when I do this. Also notice I do it if I’m bored or stressed. ?????

  66. Shaye on June 1st, 2013
  67. Hi,

    I think I have a problem with picking my skin and I don’t know what to do to stop it. It’s not major (I guess), but I pick at one specific finger A LOT. I don’t even realize when I do it. It is sort of like an impulsive thing. I do it when I’m bored, etc. I put bandaids on it when I’m in public because I’m really embarrassed by it. People who do it get really disgusted and it’s just embarrassing because nobody understand why I do it (I don’t either actually.) I’m starting to pick at the skin on another one of my fingers but I’m trying not to so it doesn’t get as bad as the original finger. I pick so much I get scabs and it’s even painful but I can’t stop. What should I do?

  68. CR on June 2nd, 2013
  69. Hi Cathy: Thank you for reaching out to us. Skin picking is challenging because there is both enjoyment/relief and shame/scabbing. You can stop; just know it is a process. We just published a special report entitled “Skin Picking: Top Twelve Roadblocks to Recovery” which may help you. You can click here to get a free download of the report.
    Best, Karen

  70. Karen Pickett, MFT on June 4th, 2013
  71. Hi Shaye: What you are describing sounds like one of the many variants of Skin Picking Disorder. People who engage in Skin Picking notice that they are more likely to pick when experiencing either boredom or anxiety. You might be interested in a special report we just published called “Skin Picking: Top Twelve Roadblocks to Recovery” which you can download for free at http://www.ocdla.com/skin_picking_ebook_signup.html“.
    Warmly, Karen

  72. Karen Pickett, MFT on June 4th, 2013
  73. Hi CR: Thank you for writing. I encourage you first to have your finger examined by a doctor to make sure it is not infected. Next, I encourage you to seek treatment from a qualified professional. A good resource for treatment providers can be found at http://www.trich.org. You can search their database by location.

    You may also be interested in a special report we just published called “Skin Picking: Top Twelve Roadblocks to Recovery”. You can click here for a free download of the report.

    I wish you all the best, Karen

  74. Karen Pickett, MFT on June 4th, 2013
  75. Thank you so much for this site!!! My parents and my siblings are “pickers.” Could some of my problem be hereditary or learned? Also what is an effective otc lotion or cream to apply to reduce the redness and scarring? Thank you again! Sonra

  76. Sonra on June 19th, 2013
  77. I’m so glad I found this! When I was a child, I bit my nails and cuticles for a year or two. Then I moved into biting the loose skin inside my cheeks, creating little bits to bite off. It’s rare for me to draw blood, but when I do I stop. A few years ago I had a bump on the back of my arm that I can’t stop picking. Not the skin is thick, dark and rough. I compulsively pick at it … just can’t leave the rough edges alone. I’m wondering if a dermatologist can do anything to smooth it out so it (1) looks normal again and (2) won’t have the rough bits that I pick at. Thank you for sharing this information. I’m feeling better already :o )

  78. Jill on June 19th, 2013
  79. Hi Sonra: You are so welcome! Glad our site is helpful to you and your family.

    It is likely that there is a genetic predisposition for skin picking disorder, although research has yet to confirm this. Learning the behavior is also a possibility. However, my sense is that a person would not continue to pick their skin if it was not pleasurable or urge-driven.

    Since I am not a physician, I can’t recommend a lotion or cream, but I encourage you to consult a dermatologist with your question.

    Warmly, Karen

  80. Karen Pickett, MFT on June 26th, 2013
  81. Hi Jill: Thanks for writing and for letting us know that you are finding our information helpful. We love that!

    Sure – talk to a dermatologist. But I’ll let you know that my clients who have consulted a dermatologist have all been told the same thing: you have to stop picking at the bump and let it heal or they won’t be able to do any procedures.

    All the best, Karen

  82. Karen Pickett, MFT on June 26th, 2013
  83. I am almost 13 and I’ve been picking at my scalp for at least 5 months. I think I started picking because I thought I had dandruff because I saw white flakes in my hair. So I began picking the flakes out. I went online and I saw something that said that something about it being dry dead skin, so I looked at my scalp and I guess I must have seen dry skin and tried to pick it off but it kept scabbing over and now I can’t stop picking at it. I pick the skin off most of the day and it normally bleeds when I do pick at it. I really want to stop because the hair there isn’t getting a chance to even grow back. I jut can’t stop and I don’t wanna have to talk to my doctor about it. I just need some advice to keep me from doing it. I don’t really wanna have to wear gloves all the time.

  84. Elizabeth on July 7th, 2013
  85. Hi Elizabeth: First, I acknowledge you for recognizing and seeking help for your Skin Picking Disorder. Secondly, I encourage you to have a doctor check your scalp since there has been bleeding and scabbing. If there are any signs of infection, you’d want to have treatment right away.

    As far as advice to help yourself stop, our free report on Skin Picking Disorder is a good start. Wearing gloves is one option and a good one. You don’t have to wear them all the time but if you wear them when you are likely to pick, you will be taking an excellent first step in preventing yourself from touching and feeling things to pick on your scalp.

    I encourage you to do all you can to stop the picking now. The more years you do it before you stop, the harder it can be to stop and the more potential damage you may do to your scalp and hair.

    All the best, Karen

  86. Karen Pickett, MFT on July 10th, 2013
  87. Hello my name is Kayla. I have a fiancé named Andrew that will be watching television or on the computer and he will start picking at anything scabs, pimples, and bumps. The bumps he is picking at he say could some how in the future become a pimple so he wants to go ahead and get rid of it. Now keep in mind this bump is the size of a Beebe or smaller, not that big right, But the thing is he will pick at it until it is the size of a quarter. They bleed like crazy and then scab over. When I ask him to stop he gets irritated and fidgety like it is killing him to not pick at it. Then he will go behind my back and pick at it again and again. He will hide in the bathroom. Its really starting to scare me because it has gotten to the point to where he is lying to me about it. Would this be considered Dermatillomania. Thanks for your time.

    Kayla H.

  88. Kayla Hamel on July 26th, 2013
  89. Hi Kayla: I can’t say for sure since I have not met your fiancé, but what you describe sounds like a description of someone with Skin Picking Disorder.

    It sounds like you care about your fiancé, and the best way to help him is to support him and to understand that he may have Skin Picking Disorder, and that someone with this condition usually can’t “just stop” even though he might really want to stop.

    The best way to support your fiancé is to read about Skin Picking Disorder yourself (there is a lot of good information here on our website), and then share the information with your fiancé without pressuring him to change. Hopefully, he will want to seek treatment with a qualified professional.

    Warmly, Karen

  90. Karen Pickett, MFT on July 29th, 2013
  91. I feel so much better knowing that im not the only one.i also pick at my skin when there is nothing there to pick at.ive scarred my skin over the years but its improved over the last 10.the scars wont do away though.i simpathise with anyone going through this.regards Nicky

  92. nicky on September 19th, 2013
  93. Hi Nicky: Thanks for posting to offer your experience and your support to others. We are glad you are part of our community.
    Warmly, Karen

  94. Karen Pickett, MFT on October 1st, 2013
  95. I do it on my head, I get what I think is probably a ‘B’ piece of skin and dig my nail under it to pick it off, then usually pull it through my hair or sometimes just leave it when I can’t be bothered. I’ve done it so many times in different places on my scalp until they literally bleed and they do heal but then I just pick them again. It’s just so SATISFYING! It stings when I wash my hair, and every time I promise myself I will not do it but I just automatically do when I’m stressed or bored or trying to get to sleep. Recently I’ve had a scab on my arm which I pick too and quite a few on my back. Does it sound like it could be a skin picking disorder?
    Thanks x

  96. Kaylie on October 18th, 2013
  97. I’m 31 years old, and I have been picking at skin since I was a little girl. In general I’m not a nervous or high-anxiety person,and I’m not really even that bored! I just see dead skin and want it ‘gone.’ The only twist to my story that I have not read in other’s accounts is that I tend to do it to other people more than to myself. Mainly close family, but I also do massage therapy and if I’m working on someone and come across any kind of skin issue I find myself going over it gently until it’s gone. I would never and have not ever caused discomfort or bleeding, this is not desirable. I simply just want the dead skin-whatever ‘gone.’ My family jokes at me about it, and I really don’t mind actually. After all, it is a bizarre thing I do! But I am getting tired of it being such a thing for me. I mean, the urge to pick at dead skin, or dry skin of any kind is nearly unavoidable! Do I have true dermatillomania, or just a bad habit? And why? I just wish I knew what caused me to start doing this and why I still do it. I want to stop, but I don’t. I feel a weird sense of satisfaction in removing the dead/dry skin issues. Ugh! So weird!!

  98. Mandy on October 20th, 2013
  99. Hi Kaylie: The behavior of picking and getting pleasure from it fits the criteria for Skin Picking Disorder. If you are interested in help for controlling skin picking, you can call or email us via the “Contact Us” page of our website, or find other resources on the “Links” page of our site.

    Since you also mention bleeding, I encourage you to be examined by a dermatologist (if you haven’t already done so) to be treated for a possible skin condition or infection.
    Warmly, Karen

  100. Karen Pickett, MFT on October 21st, 2013
  101. Hi Mandy: I wouldn’t say that what you describe is so weird. It sounds like you have a strong urge regarding removing dead or dried skin, on yourself or others. This appears to cause you both pleasure and distress, and sounds very much like Skin Picking Disorder.

    It might be helpful to view what you are doing as a behavioral addiction. You’ve done it for so long, it’s hard to resist the urge. Once you start, it’s hard to stop.

    There are ways to get help in dealing with this. You can call or email us via the “Contact Us” page of our website at http://www.ocdla.com, or find other resources on the “Links” page of our site.

    All the best, Karen

  102. Karen Pickett, MFT on October 24th, 2013
  103. I have a family member that severely scraped his hands while working outside several years ago. This left numerous small splinters in his hands for a few weeks and the backs of his hands were cut and scabbed over. But he has continued to pick at his hands for the past few years since the injury. He claims there are still tiny slivers of wood that cause irritation under his skin. He routinely spends hours in the bathroom with a magnifying glass picking at his scabbed hands and it seems like this routine has only gotten worse. His hands have become severely scarred and he often wears bandages or gloves. As a family member I at first wanted to believe that this was indeed a rational response to remove splinters from his skin. But after years later and no sign of healing I doubt that there are really any splinters left in his hands. It seems that this has become a calming or meditative habit that he can’t stop. Can a skin picking disorder start with a real injury like this? I really want to help him stop but he won’t admit that this is a sign of a psychological or behavioral problem. How do I help him acknowledge this or even initiate a productive discussion without making him feel like he’s “crazy”?

  104. Andy on December 22nd, 2013
  105. What I am wondering is if someone has been picking at her scalp for at least 6 months and is getting bald spots, will the hair ever grow back? Thanks.

  106. Mad on December 26th, 2013
  107. Hi Andy,

    It is possible that the severe scraping your family member experienced triggered his skin picking disorder. There may have been some other skin picking going on previously, such as nail biting or other picking. It is not unusual for someone who repetitively focuses on a part of their skin (we call this “over-attending”) to “see” things that are either not there or are so minimal that another person would not notice them.

    You are correct in that many people with skin picking disorder experience the picking as calming or having a meditative quality. Hence, one of the reasons it is challenging for a person to “give up” their skin picking routines.

    Nevertheless, help is available if your family member is willing to seek it and wants to stop picking his skin. If your family member would like to discuss treatment options at our center, they can reach us through our website at http://www.ocdla.com.

    Thank you for writing on behalf of your family member. He is fortunate to have a caring person on his side!

    All the best, Karen

  108. Karen Pickett, MFT on December 30th, 2013
  109. Hi Mad,

    It sounds like you may be dealing with either Trichotillomania (hair pulling) or Skin Picking Disorder or both. I am a psychotherapist, not an expert on hair growth but there are two resources that I recommend. The first is the website of the Trichotillomania Learning Center at http://www.trich.org, and the second is a book called “The Hair Pulling Problem” by Fred Penzel in which he discusses the hair growth cycle.

    Warmly, Karen

  110. Karen Pickett, MFT on December 30th, 2013
  111. Hello Karen,

    I have been dealing with more serious skin picking issues since I was about 16. I am now a graduate student and this remains an issue.I had eczema as a child, so I have probably always picked but by the age of 16 most of the picking belongs to the C category, on my feet and legs. It has gotten to the point where I pick until I bleed, and then just keep picking as different area until I can only walk on my toes. This is really interfering with my life. I havent worn sandals or short sleeves in years and I often have a hard time moving around excavation sites. I have tried to stop, but I find that I do it when I am not paying attention (typically obsessing about my interactions with other people, but even when I a, watching television or studying) and don’t notice that I am doing it until my hand is wet with blood. I have seen my GP for a referral to psych services (I live in Canada) but she told me dermatillomania is an addiction and I should just stop picking. Long story short, I was wondering if you had any tips to help increase awareness of the action of picking before the blood starts?

    Thank-you very much for your advice and time,

    Amélie

  112. Amélie on February 8th, 2014
  113. Hi Amelie: Yes, I encourage you to use what are called “Habit Blockers.” They are things that you wear or put on your fingers so that you can’t pick when your fingers wander to your skin (when you might not even be aware of it until you are bleeding). Habit blockers include cotton or latex gloves, bandages, and tape. They also include wearing clothing over areas you pick to prevent you from picking without removing the clothing. Habit blockers can be very useful because they reduce picking and increase your awareness of when your hands or fingers are going to your skin to pick. Once your awareness increases, you may be able to stop yourself from picking without using the habit blockers. However, habit blockers are always good to have available to prevent picking. Habit blockers are by no means the only step in treatment for Skin Picking Disorder, but for many people, using them is an important step in the recovery process. I encourage you to experiment and find the habit blockers that work for you.
    All the best, Karen

  114. Karen Pickett, MFT on February 19th, 2014
  115. I have skin I’ve been picking at between my pinky toe and my ring toe(like ring finger) and it’s been itching really bad. It bothers me alot and I often scratch and it comes back in a couple hours. Could this be signs of Skin Picking Disorder?

  116. Jordan Smith on April 9th, 2014
  117. Hi Jordan:

    Thanks for your question. What you describe could be Skin Picking Disorder. However, it could also be a skin condition. If you haven’t yet seen a dermatologist, I would recommend doing so as the itching may be due to another condition treatable by a doctor.

    Best, Karen

  118. Karen Pickett, MFT on April 22nd, 2014
  119. I’ve been picking since sixth grade. It started with a scab on my knee and I was bored and I picked it then ate it and its gross but i kept doing this and then it went to my scalp. and I would dig my fingers into my scalp and gather all the black heads and puss and everything then eat that. and I’ve been picking my face a lot the past two or three years (im in 10th grade now) and i’m scarring my face and the back of my neck and my chest and I HATE going out in public with huge scabs on my face and I feel so self-conscious. But a year ago, I stopped the eating part, thinking I would start the process with that and end with not picking at all, but I’m still having trouble controling it. and I’m so sick and tired of failing. Do you think I could have Dermatillomania?

  120. Emi on April 24th, 2014

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