What Is Excoriation Disorder: Symptoms, Treatment and Causes

Excoriation disorder, also known as skin picking disorder or dermatillomania, is a mental health disorder characterized by continuously picking the skin. The affected person tends to pick the skin around the toes, nails, scars, acne, blackheads, or skin lesions and even pulls their own hair from the scalp. The patient can spend hours picking their skin causing it to bleed. Perhaps, the patient starts enjoying the pain when the wound starts bleeding.

Excoriation disorder comes under Body Focused Repetitive Behaviors (BFRB), which is a type of an obsessive-compulsive disorder (OCD). People suffering from this class of disorder try to hide their body imperfections (which they have conceived themselves) by harming their own bodies. The mental disorder can further trigger conditions such as onychophagia and trichotillomania.

Symptoms of Excoriation Disorder

Excoriation disorder is not caused as a reaction to taking any substances or medications. Neither is it a kind of a skin disorder. It is more of a psychological disorder most likely a response to stress or some other mental conditions. The most common symptoms of excoriation disorder include the following:

  1. Skin damage which more often than not triggers skin infections needing medical attention
  2. Unable to stop oneself from picking skin
  3. Significant physical discomfort or worsening of skin conditions
  4. Feelings of inferiority because of the wounds

Causes of Skin Picking Disorder

Skin picking disorders usually begin during puberty and may initially be related to acne (although abnormal skin pinching behavior can begin at any age). Bruising skin are also related to childhood abuse, trauma, developmental disorders, poor ability to regulate emotions or deal with stress.

Usually, patients with exfoliation report the following triggers:

  1. Physical impulse or nervousness, uncomfortable emotions, cognition (including beliefs or thoughts about the appearance and feeling of the skin) .
  2. Skin sensation (pain, itchiness, tension etc.), this sensation is completely psychological. They feel that these skin blemishes distorts their personality, therefore they try to remove them.
  3. After people with this disease blemishes their skin their stress and anxiety subsides giving them a feeling of pleasure.

People suffering from this disorder many also experience symptoms of anxiety, blemishes, skin infections, depression, sense of isolation from society, loss of focus, and loss of productivity.

If a person is suffering from excoriation disorder from a prolonged time it results in a wounded appearance which in turn leads to embarrassment and shame triggering avoidance behavior.


The treatment for excoriation disorder involves Habit Reversal Training (HRT) and Cognitive Behavioral Therapy (CBT). In HRT the psychologist identifies what factors are responsible for skin picking such as any particular ambience, stress, stimulus, anxiousness, etc. Then they train the patient’s mind to control these factors as a treatment goal. They also focus on making the patient aware of the condition.

Another therapy is stimulus control which involves wearing gloves or bandages to avoid skin picking. This has also proved to be an effective.

Research has proved that some antidepressants drug called selective serotonin reuptake inhibitors (SSRIs) can help people with this disease, but research is limited and the results are mixed. SSRIs are mostly helpful for people suffering from anxiety and depression, which triggers their skin picking disorder.

Another drug called NAC (N Acetyl Cysteine) has proved to be successful in decreasing the symptoms of excoriation disorder especially in women. NAC acts as a neurotransmitter that helps decrease levels of anxiety and depression.

When to See a Therapist?

Excoriation disorder is a chronic but highly treatable disorder that should be treated at the earliest. A mental health professional caregiver can ascertain the severity of the condition and customize a treatment plan comprising medications, alternate therapy, and behavioral therapy.

If you or someone you know is battling excoriation disorder or any other mental health disorder, then get in touch with Medical Concierge. We offer compassionate and empathetic care in complete confidentiality. For more information on inpatient and residential mental health treatment programs, call our 24/7 mental health treatment helpline 877 636 0042 and talk our trained mental health counselor. You can also chat online to understand the various modalities and treatment interventions available.

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