Is There a Skin Picking Personality? Exploring the Role of Personality Traits in Dermatillomania

Your personality is what distinguishes you from others. It’s what makes you uniquely you. How you navigate your world, your preferences and tolerances, even how you interact with others is largely driven by personality. 

It might surprise you that personality is also a key factor in physical and mental health. Personality has been linked to levels of happiness, relationship satisfaction, goal achievement, and even physical health and longevity. 

Personality has been linked to a number of mental health conditions. In fact, it is well-documented that personality and psychopathology can influence each other. 

• They can influence the presentation or appearance of one another, a phenomenon known as a pathoplastic relationship. How a mental disorder presents can vary depending on a person’s unique personality traits. Likewise, the appearance of personality can be affected by the presence of a mental disorder.
• They can share a common etiology, also known as a spectrum relationship. In other words, the personality trait and the mental disorder may coexist along a continuum. A personality disorder is an example of this relationship. 
• One can play a causal role in the development or etiology of the other. This causal relationship is bidirectional. A person’s a person’s way of thinking, feeling, behaving, and relating to others can sometimes contribute to the development of a mental disorder. A severe or chronic mental disorder can contribute to fundamental changes to personality.

So, could personality influence a disorder like skin picking? 

Just why someone develops skin picking disorder (clinically known as excoriation disorder or dermatillomania) isn’t really clear. Research has found support for a number of causes and correlates including brain structure and function, reward processing, trauma and more as potential reasons someone might develop a body focused repetitive behavior (BFRB) like skin picking. But not everyone who has these experiences develops skin picking disorder.  

Is there something within an individual’s psychological makeup that is protective? Could it be that there is a “type” of personality that might be more susceptible to developing skin picking? 

The Big Five

Your personality is the combination of traits that make up your unique persona. One of the most well-known ways of describing personality is known as the OCEAN model or “Big Five” personality traits:

• Openness to experience (inventive/curious vs. consistent/cautious)
• Conscientiousness (efficient/organized vs. extravagant/careless)
• Extraversion (outgoing/energetic vs. solitary/reserved)
• Agreeableness (friendly/compassionate vs. critical/judgmental)
• Neuroticism (sensitive/nervous vs. resilient/confident)

We all have a unique blend of these traits.

Personality and Picking

Personality traits provide an intriguing lens through which to understand the complexity of skin picking and other mental health disorders. While a distinct personality profile for someone with skin picking hasn’t been identified, certain personality traits seem to have a significant role in picking behaviors and how a person may cope. 

Neuroticism in particular seems to be a particularly strong influence but that mechanism is not completely understood. It is well-documented that higher degrees of neuroticism may present a greater general vulnerability for developing a mental health issue. Increasing neuroticism has been linked with skin picking and other BFRBs. 

Introversion, the relative lack of extraversion, has also been linked with skin picking. Introversion can be viewed as a reduction in social participation and a person’s  tendency to focus on their own thoughts or feelings. People with skin picking often report an avoidance of social engagement due to fear of judgment from others. Rather than being protective, research has found that introversion was significantly linked to increased severity of skin picking, worsening in mood, and higher perceived stress. One explanation may be that extraversion may actually promote healing and result in more stable mood. 

Conscientiousness, a personality trait characterized by high levels of thoughtfulness, good impulse control, and goal-directed behaviors, seems to present a double-edged sword in the context of skin picking. On one hand, individuals high in conscientiousness may develop structured routines and effective coping strategies that mitigate picking. 

On the other hand, an excessive focus on perfectionism—a common trait among highly conscientious individuals—can exacerbate the condition. Perfectionists may become fixated on perceived imperfections in their skin, leading to compulsive picking as an attempt to rectify these flaws. Eliminating a perceived flaw is often cited as a trigger for picking.

A lack of conscientiousness has been significantly associated with more depressive symptoms, more impulsivity, and higher perceived stress in skin picking and other BFRBs. It is thought that there may actually be a subtype of skin picking that is marked by increased impulsivity. Individuals who struggle with impulsivity may find it difficult to resist the urge to pick, especially in stressful or monotonous situations. The immediate tactile feedback and sense of relief reinforce the behavior, making it increasingly habitual.

Cognitive behavioral therapy, the gold standard for treating skin picking and other BFRBs, may be helpful in increasing conscientiousness.   

So, is there a skin picking personality type?

It’s too soon to say. What is clear is that certain traits seem to play a role. While much more research is needed, these findings strengthen the need for understanding the unique characteristics that someone has and how they can impact mental health. Taking individual characteristics and tailoring treatment to the person increases the chances for positive treatment outcomes. 

References

1. Anglim, J., Horwood, S., Smillie, L. D., Marrero, R. J., & Wood, J. K. (2020). Predicting Psychological and Subjective Well-Being from Personality: A Meta-Analysis. Psychological Bulletin, 146, 279-323. https://psycnet.apa.org/doiLanding?doi=10.1037%2Fbul0000226

2. A Widiger T. (2011). Personality and psychopathology. World psychiatry : official journal of the World Psychiatric Association (WPA), 10(2), 103–106. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3104878/

3. Özten, E., Sayar, G. H., Eryılmaz, G., Kağan, G., Işık, S., & Karamustafalıoğlu, O. (2015). The relationship of psychological trauma with trichotillomania and skin picking. Neuropsychiatric disease and treatment, 11, 1203–1210. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4440428/#b23-ndt-11-1203

4. https://www.kemalarikan.com/en/personality-traits-in-trichotillomania-and-skin-picking-disorder.html

5. Grant, J. E., & Chamberlain, S. R. (2021). Personality traits and their clinical associations in trichotillomania and skin picking disorder. BMC Psychiatry, 21(1). https://pubmed.ncbi.nlm.nih.gov/33882867/

6.  Anderson, S. (2021). The Problem with Picking: Permittance, Escape and Shame in Problematic Skin Picking (Doctoral dissertation, University of the West of England). (2021). Retrieved from https://uwe-repository.worktribe.com/preview/8675330/The%20Problem%20with%20Picking%20-%20Full%20thesis_%20with%20Appendix%206%20redacted.pdf

7. Grant, J. E., Peris, T. S., Ricketts, E. J., Lochner, C., Stein, D. J., Stochl, J., Chamberlain, S. R., Scharf, J. M., Dougherty, D. D., Woods, D. W., Piacentini, J., & Keuthen, N. J. (2021). Identifying subtypes of trichotillomania (hair pulling disorder) and excoriation (skin picking) disorder using mixture modeling in a multicenter sample. Journal of psychiatric research, 137, 603–612. https://pubmed.ncbi.nlm.nih.gov/33172654/