Skin Picking and OCD

Is Skin Picking a form of Obsessive Compulsive Disorder?

The short answer is no. Although compulsive skin picking is classified within the spectrum of obsessive-compulsive disorders, there are distinct differences between the two. 

Dermatillomania is categorized within a group of disorders called Body-Focused Repetitive Behaviors (BFRBs). However, it is often confused with other conditions. Common misdiagnoses result because the picking behavior is a result of a medical condition, confused with OCD, Body Dysmorphic Disorder (BDD) and in some cases, Non-suicidal Self-Injury (NSSI).

Obsessive Compulsive Disorder (OCD)

There are cases when a person with OCD picks at their skin and cases where people with dermatillomania have OCD. However, the main difference is that the behavior of picking drives someone with dermatillomania not intrusive or obsessive thoughts. Whatever stimulates the urge, once picking occurs, the urge is satisfied. On the other hand, a person with OCD may feel a compulsion to pick their skin but the drive behind it will be intrusive or obsessive thoughts. After the person picks, the thoughts will still be there.

Another theory is that dermatillomania is a repetitive motor response. Behaviors associate with OCD are compulsive rituals essential to satisfying an obsession. The age of onset is also different. Dermatillomania usually starts in early adolescence while OCD usually starts in late adolescence. Treatment is different for BFRBs and OCS. Because of the behavioral focus of BFRBs, treatment targets behaviors such as in Habit Reversal Training. OCD is about thoughts and treatment targets thoughts and uses exposure and response prevention therapy. Selective serotonin reuptake inhibitors (SSRIs) help in treating OCD but in people with dermatillomania, they do not work as well.

OCD

• Thought-driven with obsessions as central focus
• Compulsive rituals relate to obsessions
• Starts in late adolescence
• Exposure and response prevention treatment can be effective
• SSRIs effective

Compulsive Skin Picking

• Behavior-driven - the compulsion to pick, not driven by an obsessive thought
• Repetitive motor system
• Starts in early adolescence
• Habit Reversal treatment can be effective
• SSRIs generally not effective

 A qualified mental health provider will conduct a thorough assessment to determine if the compulsive skin picking behaviors are a part of another condition, which can happen with OCD, or if it is compulsive skin picking disorder. This clarification aids in selecting appropriate treatment methods.