Skin Picking: A Compassionate Guide to Dermatillomania

Excoriation disorder — also called dermatillomania or skin-picking disorder — is a body-focused repetitive behaviour characterised by recurrent picking of skin, causing tissue damage, distress, and significant time spent on the behaviour. It affects an estimated 1.4–5.4% of adults and is more common than most people realise.

Why it happens

Skin picking typically starts with a perceived imperfection — a bump, scab, or pore — and involves a cycle of tension, picking, and temporary relief followed by shame or distress. It can function as a regulation behaviour, providing sensory stimulation or stress relief. Triggers include stress, boredom, anxiety, and sensory cues.

What actually helps

• Habit Reversal Training (HRT) — structured behavioural therapy that identifies triggers and replaces picking with a competing response. Strong evidence base.
• Cognitive Behavioural Therapy (CBT) — addresses the thoughts and emotions that drive the behaviour.
• Acceptance and Commitment Therapy (ACT) — builds tolerance of urges without acting on them.
• N-acetylcysteine (NAC) — a supplement with several positive trials in BFRBs; worth discussing with a doctor.
• The TLC Foundation for BFRBs — the best English-language resource for finding therapists and peer support.