I like to pick my skin when I’m happy, stressed, and bored. It’s a bad habit that has weakened my nails and has calloused the skin around my fingertips. There are times when I’ve picked my skin to the point of infection. A bump forms with white-yellowish pus inside — disgusting, but satisfying to pop. Surprisingly, many people have noticed that I pick my skin and have asked me what happened. I often tell them I cut myself by accident instead of having a long explanation that it’s a compulsion I’ve had associated with my anxiety. I never knew that skin-picking had a particular disorder until recently—Excoriation.
Excoriation is a mental illness that is affiliated with Obsessive-Compulsive Disorder (OCD) and involves by repeated picking of one’s skin to the point of bleeding and abrasions. People may pick at healthy skin, pimples, callouses, or scabs. The disorder is often continuous and alternates with periods of remission and greater symptom intensity.
In my experience, my skin picking starts when I peel my nails until it turns into a hangnail. Then I challenge myself to see if I can pull the hangnail carefully without bleeding. I often lose the challenge, and I end up pulling the hangnail to the point where it also tears the cuticle.
Excoriation typically begins during adolescence and commonly coincides with or following the onset of puberty around the ages of 13-15, but also may occur among children under the age of 10, or adults between the ages of 30 and 45. It is a disorder that affects 1.4% of adults and experienced more by women than men.
I have picked my skin as long as I could remember. There were periods where I had ragged middle fingers because I’d constantly pull on the skin of my fingertips because it was dry and I was fascinated by the dry, flaky tips. Also, I liked playing with the dry, flaky skin tips by pulling it apart and feeling the roughness.
The Diagnostic and Statistical Manuel of Mental Disorders, Fifth Edition criteria for Excoriation consists of:
- Recurrent skin picking that results in skin lesions.
- Repeated Attempts to Stop the behavior.
- The symptoms cause clinically significant distress or impairment
- The symptoms are not caused by substance or medical, or dermatological condition
- Another psychiatric disorder does not explain the symptoms
There is no particular cause for Excoriation, but there is evidence that supports that it is common for individuals with OCD, Trichotillomania, and major depressive disorder. There is one study that indicates 38% of people suffering from the disorder have a co-occurring Trichotillomania. Also, the disorder may develop from a rash, skin infection, or a small injury. Picking at a rash or scab causes more damage and keeps the wound from healing. More itching leads to more picking and more scabbing, and the cycle continues. It may also develop during a time of stress where picking around the fingernails may help relieve stress.
There are two main types of treatment for skin-picking:
- Habit Reversal Training—The therapist helps you identify the situations, stresses, and other factors that trigger skin-picking. Then he or she will find replacement behaviors for the skin-picking such as squeezing a rubber ball. This helps with stress and helps keep the hands busy.
- Stimulus Control—This therapy involves making changes to the environment to decrease skin-picking such as wearing gloves or adhesive bands to prevent feeling the skin and getting the urge to pick, and or covering mirrors if seeing blemishes or pimples sparks the picking behavior.
Evidence that shows Cognitive Behavior Therapy (CBT) and/or the use of Serotonin Reuptake Inhibitors (SSRI) may reduce symptoms of the disorder. Also, early studies have begun to examine the possible value of some anti-convulsant medications.
Over the years, I’ve become aware of my skin-picking and how it’s been detrimental to my skin. Furthermore, it’s not pretty to look at and brings up too many questions from strangers on why I have wounds on the sides of my nails. Now I’ve decreased my skin picking to only one or two fingers, consisting of the thumbs and index fingers. It’s an improvement from the previous years where I used to pick all my fingers.
Photo By: By HyruleanHero1988 (Own work) [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons