I Think I Have Skin Picking Disorder! A Guide to Taking the Next Steps

If you find yourself picking at your skin, it can leave you feeling confused, frustrated, and maybe even ashamed. Maybe it’s a new behavior. Maybe you’ve been doing it for years. Sometimes you might pick and not even realize you’re doing it. You’re probably wondering what’s happening and why. Could it be skin picking disorder and more importantly, what can you do about it?

Skin picking disorder (SPD) is a body-focused repetitive behavior (BFRB) characterized by repetitive picking of the skin, often resulting in noticeable skin damage, emotional distress, and impaired psychosocial functioning. While it can sound intimidating, the fact is that despite its challenges, SPD is manageable, and recovery is possible. 

If you suspect you have SPD, clinically known as excoriation disorder, you’ve already taken a powerful first step: acknowledging that the behavior is present and bothersome to you. What’s next? This guide offers suggestions for compassionate, practical steps to help you move towards understanding and learning to manage SPD. 

Step 1: Understand That You’re Not Alone

One of the most commonly expressed and isolating feelings about skin picking is the belief that you’re the only one who struggles with it. In fact, SPD is more common than you might think. It affects an estimated 2.1% of the population at any given time, and has a lifetime prevalence of about 3.1%. That’s literally millions of people. Many others share your experience. 

Step 2: Educate Yourself

Learning about SPD can demystify the disorder and provide reassurance. Understanding why you pick can reduce shame and increase self-compassion. 

Key Facts to Know:

• Triggers – Skin picking can be triggered by things like stress, boredom, anxiety, or the even desire to remove perceived imperfections like blemishes. What your triggers are may be different from someone else’s triggers. 
• SPD is not about vanity - While not completely understood, SPD is thought to be a way to deal with distressing emotions. It is not simply a “bad habit” and it is more than simply picking at a bothersome pimple too long. 
• SPD is cyclical - Many people experience an urge, act on it, feel relief, and later regret or distress, perpetuating the cycle.
• SPD is a recognized mental health disorder. It is not a reflection of your character or willpower, and it’s not something you can “just stop”. 
• SPD often co-occurs with other mental health disorders including anxiety, OCD, or depression. 

Understanding the facts about SPD can help you shift away from self-blame and toward seeking support. Seek out reliable resources. When you’re armed with facts, you are in a strong position to make sound choices regarding your treatment options. 

Step 3: Reflect on Your Behavior

The experience of skin picking is heterogenous, meaning not everyone experiences it in the exact same way. How you experience it can yield information that will be helpful as you make decisions about managing your disorder.

Take time to observe your picking habits without judgement and with curiosity. What is your experience like?

Consider questions like these:

• When do I usually pick my skin? (e.g., when I’m stressed, before bed, while watching TV)
• Can you identify specific emotions or thoughts that precede or follow picking?
• Are there specific tools or situations that encourage your picking behavior?

One way to explore your picking is to keep a journal. Journaling can help you keep track of picking episodes, reveal patterns, and identify potential triggers. 

Step 4: Seek Professional Help

While SPD is considered a chronic disorder, there are effective treatment approaches and strategies for managing the disorder. 

Therapy 

Of the behavioral therapies, Habit Reversal Training (HRT) has perhaps been studied the most extensively and there is ample support in the literature and anecdotally for its effectiveness in treating BFRBs. There is also substantial evidence that combining HRT with other therapies such as acceptance and commitment therapy (ACT) and cognitive behavioral therapy (CBT) seems to support significant reduction in symptoms of both skin picking and dysfunctional cognition and improved psychosocial functioning. 

Medication

Currently, there is no medication that is approved specifically for treating SPD. However, there is some evidence that medications like SSRIs (selective serotonin reuptake inhibitors) may help reduce underlying anxiety or compulsions that contribute to picking.

Step 5: Practice Self-Compassion

It’s easy to feel frustrated or ashamed about skin picking, but self-compassion is a vital part of healing. Remind yourself that SPD is not your fault—it’s a complex condition influenced by biology, environment, and stress.

Celebrate small victories, like noticing an urge without acting on it or seeking information about SPD. Progress may be slow, but every step counts.

Step 6: Build a Support System

Sharing your experiences with others can reduce feelings of isolation and may even help you discover new strategies for dealing with your SPD. Choose people who are nonjudgmental and empathetic. You don’t have to overshare—simply explaining that you’re working through a behavior and need their support is enough.

Aside from supportive family and friends, support groups can connect you with others who understand your experiences. Sharing stories and strategies can foster a sense of belonging and hope. Online forums and social media communities may also provide safe spaces to connect with others living with SPD.

Step 7: Progress Over Perfection

Remember that healing is a journey. Each small step builds momentum toward lasting change. Setbacks are a natural part of the recovery process. 

Set realistic goals and don’t forget to celebrate those small victories. 

The Takeaway

By taking proactive steps and seeking help, you’re strengthening your resiliency and your ability to manage your SPD in healthy ways. Remember, you are not alone in this journey and a brighter, more compassionate future awaits. Take it one step at a time. 

References

1. Grant, J. E., & Chamberlain, S. R. (2020). Prevalence of skin picking (excoriation) disorder. Journal of psychiatric research, 130, 57–60. https://pmc.ncbi.nlm.nih.gov/articles/PMC7115927/

2. Jones, G., Keuthen, N., & Greenberg, E. (2018). Assessment and treatment of trichotillomania (hair pulling disorder) and excoriation (skin picking) disorder. Clinics in Dermatology, 36(6), 728-736. https://doi.org/10.1016/j.clindermatol.2018.08.008