When Your Child Is Picking Their Skin: Tips for Parents

When you find that your child is picking their skin, your first response is probably to tell them to stop. Why won’t they just stop?

Some picking at the skin, like picking at a scab or a hang nail a little too long, is normal and generally not a concern. For some kids, though, the picking becomes more than just a moment of picking. Sometimes, repetitive skin picking is indicative of a disorder known as excoriation or dermatillomania, commonly referred to as skin-picking disorder (SPD).  

Skin picking is a type of disorder known as a body-focused repetitive disorder (BFRB) and is classified as an obsessive-compulsive related disorder. Skin picking disorder is not OCD but the two disorders do share some similarities. It is thought that skin picking and similar disorders develop as a way to cope with negative feelings and emotional distress.

When does skin picking go from a habit to a disorder? Skin picking becomes problematic when:

• the picking becomes repetitive and causes injury to the skin
• attempts to stop are not successful
• the picking and resulting skin damage can impact your child’s daily functioning. That might look like being teased by peers, not wanting to go to school or other social events, attempting to cover the skin damage (e.g., long sleeves even in the summer, wearing concealing makeup), or even planning their day around the picking.

If your child is dealing with skin picking, it can be hard to know how to help. What’s the right thing to do? If you find yourself wondering what to do, here are some things you can do to help.

Talk to Your Child

When something difficult arises, especially with a child, often the first inclination is to avoid bringing it up. What do I say? Will I upset them or make it worse? It’s every parent’s worry.

It’s ok to talk to them about what’s happening. Talking to them won’t make it worse. In fact, acknowledging that you see their struggle can be reassuring and comforting. It’s important to keep those lines of communication open so that you can work together to find solutions that work for your child.

Be Gentle With Them

People who pick often experience a lot of shame surrounding their picking and the visible damage it causes. Negative criticism, scolding, or shaming can reinforce their feelings of shame and emotional distress. This is especially true for kids who may be particularly anxious or distressed. They’re trying to process big feelings in the only way they know how.

Instead, try a positive approach. An “I love you” or “I am here with you” lets them know that they are not alone. If your child says they can’t stop, they are telling you the truth. It might seem easy to “just stop” but the urge to pick can be overwhelming. Of course, you have to intervene when they’re doing things that are harmful. Positive feedback and supportive language can help your child to feel more empowered and positive that they can overcome their skin picking. Offer positive suggestions and alternatives.

Help Them Notice Their Behavior 

Sometimes, skin picking occurs without the person knowing it’s happening. It’s sometimes referred to as “trance picking” or automatic picking.

It’s ok to ask your child if they realized they were picking. Can they tell you what they were feeling or what might have triggered it? If they can’t, that’s ok. This kind of information helps your child to become more self-aware. Learning to recognize picking is an important skill to learn. Keeping a log of the picking behaviors can also be helpful if you decide to seek treatment.

Seek Treatment

Treatment can help reduce skin-picking behaviors. Cognitive Behavioral Therapies (CBT), specifically Habit Reversal Training (HRT) and Acceptance and Commitment Therapy (ACT), have been shown to help reduce skin picking. Therapy can help your child to learn to recognize triggers and cues related to picking and choose alternative responses.

While there is no single medication to eliminate skin picking and medication is not the first line of treatment, it can be helpful in some cases. One class of medication, Selective Serotonin Reuptake inhibitors (SSRIs) have shown to be helpful in reducing symptoms for some people. Medication is sometimes used to treat other symptoms such as anxiety or depression that may accompany the skin picking.

Try Fidgets

One of the theories about skin picking is that it may be a kind of sensory processing disorder. The person is picking to satisfy a sensory need. Therapeutic interventions such as HRT rely on the use of competing responses or replacing unwanted behaviors with more acceptable alternatives. Sensory tools, like fidget toys, can provide a competing response to the urge to pick and help provide that sensory stimulation as an alternative to skin picking.

Fidget toys come in all kinds of shapes, sizes, and forms. Some common fidget toys include stress balls, silly putty, buckyballs, and even textured rocks or key chains can work. Tangles are particularly popular. What feels good and soothes your child’s urges to pick is highly personal. Try out a few options and see what they like.

Learn Together

You play an important role in the treatment process. It’s important to educate yourself about skin picking so that you can understand and advocate for your child. Your child will likely have a lot of questions and look to you for guidance and support. They can also actively participate in the learning process too!

Their level of participation and treatment options will vary with the age of your child. Very young children will rely on you to make care decisions for them. Older children and teens may be able to participate more in the process. You won’t have all the answers and that’s ok. You can learn together.

Find Resources

You don’t have to take this journey alone. It’s important to know that there are resources to help you and your child navigate this journey. Resources can come from any number of sources:

• Support groups (in-person or online)
• Online therapy
• Outpatient therapy
• Books
• Self-help tools

The BFRB Foundation is a great place to start. You can learn more about skin picking and find information about treatment, resources, and more.

Wondering where to start? If you suspect your child is picking their skin, your personal healthcare provider can help you determine what is happening and recommend next steps. Working with a treatment team will help guide care and provide you and your child with support. And, as the parent, you are a very important part of that treatment team!

References

1. Excoriation disorder workup: Approach considerations, diagnosis, histologic findings. (2022, August 22). Diseases & Conditions - Medscape Reference. https://emedicine.medscape.com/article/1122042-workup#c8

2. For parents – TLC Foundation for BFRBs. (2023, January 15). TLC Foundation for Body-Focused Repetitive Behaviors. https://www.bfrb.org/faq-categories/for-parents

3. Owen, D. J., Slep, A. M., & Heyman, R. E. (2012). The effect of praise, positive nonverbal response, reprimand, and negative nonverbal response on child compliance: a systematic review. Clinical child and family psychology review, 15(4), 364–385. https://pubmed.ncbi.nlm.nih.gov/22918669/

4. Parent series: My kid is picking his skin- what is dermatillomania and what to do about it? (2020, May 20). https://eastbaybehaviortherapycenter.com/parent-series-dermatillomania/

https://eastbaybehaviortherapycenter.com/parent-series-dermatillomania/

5. Grant, J. E., Odlaug, B. L., Chamberlain, S. R., Keuthen, N. J., Lochner, C., & Stein, D. J. (2012). Skin picking disorder. The American journal of psychiatry, 169(11), 1143–1149. https://pubmed.ncbi.nlm.nih.gov/23128921/