Dermatillomania -- Compulsive Skin Picking

Dermatillomania (also known as neurotic excoriation, pathologic skin picking (PSP), compulsive skin picking (CSP) or psychogenic excoriation is an impulse control disorder characterized by the repeated urge to pick at one's own skin, often to the extent that damage is caused.

Dermatillomania is characterized as "scratching, scraping, picking at or squeezing the skin in response to itching or another dermal sensation or in order to dig at a dermal lesion.

dermatillomania may be thought of as a type of obsessive compulsive disorder (OCD)

skin picking are often preceded by tension, anxiety or stress.

During these moments, there is commonly a compulsive urge to pick, bite, or scratch at a surface or region of the body, often at the location of a perceived skin defect.

The region most commonly affected is the face, but other frequent locations include the arms, legs, back, gums, lips, shoulders, scalp, stomach, chest, and extremities such as the fingernails,
cuticles, and toenails

Most patients with dermatillomania report having a primary area of the body that they focus their picking on, but they will often move to other areas of the body to allow their primary picking area to heal.

Complications arising from dermatillomania include: infection at the site of picking, tissue damage, and septicemia

Damage from picking can be so severe as to require skin grafting to fix

In some cases, severe picking has resulted in epidural abscess resulting paralysis.

Severe cases of dermatillomania can even cause life threatening injuries.

For example, in one reported case a female picked her nose so severely that she managed to pick a hole through the bridge of her nose, which required surgery to fix.

physical injuries, dermatillomania can cause severe physical scarring and disfiguirment


Dermatillomania can cause feeling of intense guilt, shame, and embarrassment in individuals.

The feelings can have drastic effects with dermatillomania.

Studies have shown that dermatillomania caused suicidal ideation in 12% of individuals with this condition, suicide attempts in 11.5% of individuals with this condition, and pyschiatric hospitalizations in 15% of individuals with this condition.

Those with dermatillomania often do not seek help for the problem due to the shame and embarrassment associated with the condition

There have been many different theories regarding the causes of dermatillomania

One theory is that picking behavior is a result of repressed rage felt towards an authoritarian parents.

Another theory is that overbearing parents can cause the behavior to develop in their children.

Still other theories holds that individuals with dermatillomania have an impaired response to stress and using picking as a coping mechanism

Drugs such as cocaine and methamphetamine that are dopamine agonists, cause uncontrollable picking in users.


Dermatillomania in many patients began with the onset of acne in their adolescence but the compulsion continued after the acne cleared up

Certain stressful events including marital conflicts, deaths of friends or family, and unwanted pregnancies have been reported to be linked to the onset of the condition.


Many dermatillomania sufferers find that the disorder interferes with daily life.

Plagued by shame, embarrassment, and humiliation, they may take measures to hide their disorder by not leaving the home

, wearing long sleeves and pants in summer,

or covering visible damage to skin with cosmetics and/or bandages.

Those who pick at the fingers or hands may find normal activities such as typing to be difficult, due to pain and soreness in the fingertips.


Some individuals have found relief through cognitive-behavioral therapy.

They are also sometimes prescribed medications, such as those prescribed for obsessive compulsive disorder.

Also, artificial fingernails (acrylic or gel) have been found to be useful to some in stopping the picking behavior.

Another treatment method is habit reversal training.

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