Breaking the Cycle: How the Urge to Smooth Out Imperfections Fuels Skin Picking

Just how and why skin picking, clinically known as dermatillomania or excoriation disorder, develops isn’t entirely clear. It is thought to be some combination of genetics, neurobiology (brain structure and function), and emotional regulation. 

For many people with skin picking, the act of picking is not merely repetitive or habitual but deeply sensory. The texture of the skin, the sensation of picking, and the tactile feedback you get from touching, rubbing, or even squeezing the skin can all be intensely satisfying. 

A significant number of people who pick describe feeling the need to “fix” or smooth out areas of their skin that they find bothersome. The presence of skin irregularities like blemishes or textures such as a rough patch of skin can create a sense of distress or discomfort. The brain may interpret this discomfort as something needing to be “fixed” by picking, setting up a cycle of repetitive behavior that is difficult to control, skin damage, and emotional distress. 

This process happens gradually and often goes unnoticed at least at first. The person might start running their fingers over their skin absentmindedly, searching for irregularities. Once an imperfection is detected, the fingers automatically go to work, trying to fix what the brain perceives as a flaw. But instead of achieving smooth, flawless skin, the result is often the opposite: redness, irritation, open wounds, and sometimes scarring. The act of picking is sometimes mistaken for picking a little too long at a blemish or even just a “quirk” or “habit”. But the dynamics of skin picking are much more complicated and require specific strategies for managing them.

The Reinforcement Loop: Why It’s Hard to Stop

Repetitive skin picking is more than just a bad habit. It is a complex mental health disorder that is cyclic in nature. This cycle of picking is self-perpetuating due to a psychological reinforcement loop. 

When there’s the urge to smooth, here’s how the loop typically unfolds:

• Perceived Imperfection – The person notices some imperfection - a bump, blemish, or rough texture on their skin.
• The Urge Hits – The person experiences a strong urge to “fix” the imperfection.
• The Picking Episode – The individual picks, squeezes, or scratches at the skin in order to “fix”, correct, or “smooth” the bothersome area.
• Relief – Following the picking episode, the person experiences a sense of satisfaction or relief. Unfortunately, this sense of relief is temporary, often followed by intense feelings of shame and regret. 
• Regret and Damage – The damage done to the skin, sometimes severe, may be visible. Fears of being judged by others, along with feelings of shame and guilt, lead to increased emotional distress.  Along with feelings of distress, areas of scabs or roughness as the skin is healing, may trigger the urge to pick again, starting the cycle over again.

Because the act of picking provides temporary relief, it reinforces the behavior. Over time, this behavior can become deeply ingrained, making it difficult to stop without conscious effort and intervention. 

When Skin Picking Becomes a Disorder

Of course, not everyone who picks at their skin has dermatillomania. In fact, many people occasionally pick at their skin. However, when the skin picking behavior becomes chronic, creates significant emotional distress, and impairs a person’s ability to function, it may rise to the level of dermatillomania. 

Signs of skin picking disorder include: 

• Spend inordinate amounts of time picking at one’s skin 
• Feeling unable to stop picking (even if you want to)
• Experiencing shame, embarrassment, or anxiety about their skin
• Avoiding social situations 

Skin picking is more than just a bad habit. It’s one of a group of mental health disorders known as body-focused repetitive behaviors (BFRBs) and related to obsessive compulsive disorder (OCD). It has deeper psychological roots that extend far beyond just a habit or desire for smooth skin.

Strategies for Breaking the Cycle

The good news is that there are effective treatment options and strategies for managing skin picking.  

Therapy

One of the most well-recognized treatment approaches is known as Habit Reversal Training (HRT). This behavioral approach helps you to recognize triggers, replace picking with healthier alternative behaviors, and develop healthy coping strategies. 

Because skin picking has both behavioral and cognitive components, HRT is often combined with cognitive-based therapies such as cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT). Seeking the help of a mental health professional help can help you to find the strategies that work best for you. 

Mindfulness and Awareness Techniques

Sometimes you are aware of your picking. Often, picking happens automatically, just outside of your awareness. Because picking is often done automatically, increasing awareness of the behavior is a key part of managing it. Some ways to do that include:

• Journaling – Journaling can help you to identify your triggers and patterns of behavior.
• Fidget toys – Fidgets can help distract you from the urge to pick and keep your hands busy. Some fidgets even have unique textures that can satisfy sensory needs.
• Practice Mindfulness – Mindfulness practices like body scanning or visual imagery can help you to recognize and understand your urges and what needs they may serve.  

Medication

There are currently no medications specifically approved for treating skin picking. In some cases, medications such as selective serotonin reuptake inhibitors (SSRIs) may be prescribed to help manage underlying anxiety or OCD tendencies, often associated with skin picking.

Towards Healing

It’s important to know that you do not have to take this journey alone. There is help and there is support. Breaking the cycle requires patience and self-compassion. Instead of striving for perfect skin, shifting the focus toward self-care, acceptance, and healing can make a world of difference. With the right strategies and support, it is possible to manage skin picking and work toward healthier habits.

References

1. https://www.reddit.com/r/Dermatillomania/comments/11saef8/why_do_you_pick_your_skin/?rdt=38374

2. 3. Anderson, S., & Clarke, V. (2017). Disgust, shame and the psychosocial impact of skin picking: Evidence from an online support forum. Journal of Health Psychology, 24(13), 1773-1784. doi:10.1177/1359105317700254