Dermatillomania

Dermatillomania is a condition where a person feels compelled to pick at their skin, to the point where it causes visible wounds.

It is an impulse-control disorder – a psychological condition where the person is unable to stop themselves carrying out a particular action.

Do I have it?

A person with dermatillomania will habitually and excessively pick, scratch, gouge or squeeze at otherwise healthy skin.

They usually pick at the skin on their face and lips, but it can be any area of the body, such as the hands, scalp or arms.

They may pick at normal skin features such as freckles or moles, or at imaginary skin defects that no-one else can see.

They might pick with their fingernails, or use tools such as pins or tweezers. The result is often bleeding or bruising, which carries a risk of infection and scars.

Emotions

A person with dermatillomania will experience intense emotions as part of their compulsion. 

It's typical to experience an intense urge to pick the skin, with increasing tension until they do. After picking, there is a sense of relief.

Dermatillomania can cause negative feelings, such as guilt, shame and embarrassment. It's common to try to deny it or cover up the skin with make-up.

A person with dermatillomania may feel unattractive and develop low self-esteem, avoiding others.

Who develops dermatillomania?

Impulse-control disorders in general are more common among teenagers and young adults. 

Dermatillomania tends to develop in the teenage years or early 20s, and affects more girls than boys. It might start as a habit, then become uncontrollable.

It is regarded as a form of obsessive-compulsive disorder (OCD). Learn about the causes of OCD.

Why does dermatillomania happen?

It's not known what causes dermatillomania, but there are several theories.

Some experts think it is a type of addiction. The more you pick your skin, the more you want to keep doing it.

Dermatillomania may be a reflection of a mental health problem. Psychological and behavioural theories suggest that skin picking may be a way of relieving stress or anxiety.

In some cases, dermatillomania may be a form of self-harm, where you deliberately injure yourself as a way of seeking temporary relief from emotional distress.

Another very similar disorder is trichotillomania – where a person compulsively pulls their hair out. It's not uncommon for someone to have OCD and to both compulsively pick at their skin and pull their hair out.

What should I do?

See your GP if you're compulsively picking your skin or if you notice your child doing so.

Your GP can refer you to a psychologist or psychiatrist for a form of talking therapy.

You may need to be referred to a dermatologist (skin specialist) first, if the skin is badly damaged.

Talking therapy for dermatillomania

Little medical research has been conducted into treatments for dermatillomania.

The most effective treatment is therapy to change your skin-picking behaviour, combined with a network of emotional support.

Psychotherapy is a type of talking therapy that can be used to treat emotional problems and mental health conditions. It involves discussing emotional issues with a trained therapist.

Cognitive behavioural therapy (CBT) is a type of psychotherapy that may be recommended. It helps you to manage your problems by changing how you think and act.

CBT often involves behavioural therapy, also known as habit-reversal therapy, which aims to change your behaviour – in this case, reducing your skin picking.

First, you learn how to become more consciously aware of situations and events that may trigger your skin picking. Then, you'll learn to use alternative behaviours as a response. You may be asked to keep a record of when, where and under what circumstances you normally pick.

The aim is to replace the harmful skin-picking habit with a habit that is harmless.

Tips for quitting

• Occupy your hands with something else until the urge passes, or put on gloves.
• When tempted to pick, care for your skin instead – for example, apply moisturiser.
• Aim to hold off the urge for longer and longer each time if you can't resist it altogether. 
• Keep skin clean to avoid infection.
• Stay busy.
• Get rid of tweezers, pins and any other instrument you might be tempted to use.
• Try squeezing a soft ball or playing with blue tack instead.

Support

If you have dermatillomania, it's important that you receive emotional help and support. This can be from family, friends or self-help groups.

Organisations such as OCD UK are good places to start if you're looking for support. See the "Useful links" on this page for more contacts.