Have you ever found yourself picking at your skin without realizing it, only to notice later that you’ve created a sore or caused bleeding? Or perhaps you’ve spent years trying to stop picking, promising yourself “this will be the last time,” only to find yourself returning to the behaviour again and again.

If this sounds familiar, you are not alone. While many people occasionally pick at a scab or blemish, some individuals experience persistent, repetitive skin picking that becomes difficult to control. When this behaviour begins to impact your emotional well-being, physical health, and daily life, it is known as Excoriation Disorder (also referred to as Skin Picking Disorder or Dermatillomania).

Skin picking is far more than just a “bad habit.” It is a recognized Body-Focused Repetitive Behavior (BFRB) classified under Obsessive-Compulsive and Related Disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). Those living with Excoriation Disorder often experience intense, repetitive urges to pick despite a strong desire to stop, which can lead to deep feelings of frustration, embarrassment, and shame.

Fortunately, effective treatment is available. Research shows that Cognitive Behavioral Therapy (CBT), particularly when combined with Habit Reversal Training (HRT), is highly successful in helping individuals understand their triggers, manage urges, and develop healthier, more sustainable coping strategies to break the cycle.

What is Excoriation Disorder or Dermatillomania?

Excoriation Disorder is a mental health condition characterized by recurrent skin picking that results in skin damage, along with repeated attempts to reduce or stop the behaviour.

Although the hands are most commonly used, individuals may also use fingernails, tweezers, pins, or other objects to pick at the skin.

While individuals with Excoriation Disorder (Dermatillomania) can pick at any part of the body, they most commonly target areas that are easily accessible, highly visible, or prone to minor imperfections. This often includes the face, scalp, arms, legs, hands, shoulders, back, and chest.

People may pick at:

• Pimples or acne
• Scabs
• Dry skin
• Cuticles
• Calluses
• Bumps or uneven areas of skin
• Healthy skin that feels “imperfect”
• Insect bites
• Areas of healing skin

Some individuals pick from only one area, while others pick from multiple areas depending on where they notice imperfections. For many people, the behaviour becomes repetitive and difficult to control. Picking may continue for several minutes, or even hours, without the individual realizing how much time has passed.

Is Skin Picking More Than Just a Habit?

Yes. Many people occasionally squeeze a pimple or remove a scab without it becoming problematic. Excoriation Disorder or dermatillomania is different because the behaviour becomes repetitive, difficult to control, and causes significant distress or impairment.

These experiences can have a profound impact on self-esteem, relationships, work, school, and overall emotional well-being. Importantly, skin picking is not a sign of laziness, poor hygiene, or a lack of willpower. It is a treatable condition that often serves emotional, behavioural, or sensory functions.

How Common is Dermatillomania?

Although many people have never heard of dermatillomania or Excoriation Disorder, it is more common than many realize. Researchers estimate that approximately 1–2% of the population experiences clinically significant skin picking at some point in their lives, although occasional skin picking behaviours occur much more frequently.

Symptoms often begin during adolescence, particularly around puberty when acne becomes more common. However, skin picking can begin during childhood or adulthood as well.

Many individuals delay seeking treatment because they feel embarrassed, worry that others will not understand, or believe they simply need more self-control. Unfortunately, this can leave people struggling in silence for years before discovering that effective treatments such as Cognitive Behavioural Therapy (CBT) and Habit Reversal Training (HRT) are available.

Signs and Symptoms of Skin Picking Disorder

Excoriation Disorder or dermatillomania can affect people in different ways, but several common symptoms are frequently reported. Signs may include:

• Compulsive Picking & Urges: Experiencing strong, persistent urges to pick at the skin, and spending significant amounts of time engaging in the behavior.
• Physical Damage: Noticeable sores, scabs, infections, or scarring resulting from repeated picking.
• Unsuccessful Attempts to Stop: Making repeated, frustrating efforts to reduce or control the behavior without success.
• The Cycle of Relief and Regret: Feeling a temporary sense of relief or gratification while picking, followed quickly by feelings of guilt, shame, and frustration.
• Concealment: Frequently using makeup, bandages, or specific clothing to hide affected areas from others.
• Social and Emotional Impact: Avoiding social activities, photographs, or public situations due to embarrassment over the skin’s appearance.

Some individuals pick intentionally in response to stress or emotional discomfort, while others find themselves picking automatically while reading, studying, watching television, scrolling on their phone, or lying in bed. Understanding these different patterns is one of the first steps in effective treatment.

Understanding Body-Focused Repetitive Behaviours (BFRBs)

Excoriation Disorder belongs to a group of conditions known as Body-Focused Repetitive Behaviours (BFRBs). BFRBs involve repetitive self-grooming behaviours that result in physical damage to the body and are difficult to stop despite repeated efforts.

Other Body-Focused Repetitive Behaviours include:

• Trichotillomania: Hair-Pulling Disorder
• Onychophagia: Chronic Nail-Biting)
• Morsicatio Labiorum: Chronic Lip-Biting
• Morsicatio Buccarum: Chronic Cheek-Biting
• Rhinotillexomania: Compulsive Nose-Picking

Although these behaviours may appear similar on the surface, they are complex conditions involving emotional regulation, sensory experiences, habits, and neurological processes.

Many individuals experience more than one BFRB. For example, someone who struggles with skin picking may also engage in hair pulling or chronic nail biting. Because each person’s experiences are unique, treatment is individualized to address the factors contributing to their specific behaviours.

Is Skin Picking Related to OCD?

Excoriation Disorder is classified within the Obsessive-Compulsive and Related Disorders section of the DSM-5-TR, but it is not the same as Obsessive-Compulsive Disorder (OCD). People living with OCD typically experience intrusive thoughts (obsessions) followed by repetitive behaviours (compulsions) intended to reduce anxiety or prevent feared outcomes.

Skin picking is generally different. It is often driven by urges, sensory experiences, emotional regulation, or automatic behavioural patterns rather than intrusive fears.

That said, some individuals experience both OCD and Excoriation Disorder. Others may also have anxiety disorders, depression, Attention-Deficit/Hyperactivity Disorder (ADHD), or Autism Spectrum Disorder (ASD).

A comprehensive assessment can help identify any co-occurring conditions and ensure therapy addresses the individual’s needs as a whole, rather than focusing solely on skin picking.

Why Do People Pick Their Skin?

One of the most common questions individuals with Excoriation Disorder (dermatillomania) ask is: “Why can’t I just stop?”

Understanding why skin picking occurs is one of the most important steps toward meaningful change. Many people living with skin picking have tried repeatedly to stop the behaviour. They may hide their hands, avoid mirrors, cover affected areas, or make personal promises to stop. However, without understanding the factors that trigger and maintain skin picking, relying on willpower alone is often not enough.

Skin picking is a complex behaviour influenced by a combination of emotional, sensory, behavioural, and environmental factors. For many individuals, picking becomes a learned response that temporarily provides relief, comfort, satisfaction, or a sense of control.

Over time, the brain begins to associate skin picking with emotional regulation or sensory relief, strengthening the behaviour and making it more difficult to interrupt.

Emotional Triggers and Skin Picking

For many individuals, skin picking is connected to emotional experiences. The behaviour may become more frequent during times of increased stress, anxiety, frustration, boredom, or emotional exhaustion.

Common emotional triggers include:

• Feeling overwhelmed
• Stress from school or work
• Anxiety about uncertainty or change
• Frustration
• Sadness
• Loneliness
• Anger
• Feeling out of control
• Perfectionism or self-criticism

Some people describe skin picking to temporarily “escape” difficult emotions. The behaviour may create a brief sense of calm or relief, even if feelings of regret or frustration occur afterward.

This relief is an important part of understanding why the behaviour continues. The brain learns that picking changes how someone feels in the moment, which can unintentionally reinforce the cycle.

Skin Picking Is Not Always Caused by Stress

Although emotional distress can contribute to skin picking, many individuals also pick when they are calm, relaxed, or focused. Automatic skin picking is extremely common and may happen during activities such as:

• Watching television
• Reading
• Studying
• Working on a computer
• Driving
• Scrolling through a phone
• Sitting in meetings or classes
• Lying in bed
• Talking on the phone

In these situations, people may not consciously decide to pick. Their hand may move toward their skin without awareness, and they may only realize what has happened afterward.

This is why increasing awareness is such an important part of treatment. Before someone can change a behaviour, they first need to understand when and how it occurs.

Sensory Experiences and the Urge to Pick

For many individuals, skin picking is not only connected to emotions, it is also influenced by sensory experiences. Some people describe feeling unable to ignore:

• A rough patch of skin
• A bump or uneven area
• A scab
• A perceived imperfection
• A sensation that something feels “wrong”

The urge to pick may continue until the person feels that the area is smooth, even, or “fixed.” However, repeated picking can create additional skin irritation, which may then create new sensations that trigger further picking. This can result in a frustrating cycle that feels difficult to break.

Therapy helps individuals understand these sensory triggers and develop alternative responses that provide relief without causing skin damage.

The Skin Picking Cycle

A helpful way to understand Excoriation Disorder is by looking at the cycle that often maintains the behaviour. Although everyone’s experience is different, many people recognize a pattern similar to the following:

1. A Trigger Occurs

A trigger may be:

• Stress
• Boredom
• Anxiety
• Fatigue
• A sensation on the skin
• Seeing an imperfection in a mirror
• Feeling emotionally overwhelmed

2. An Urge Develops

The person experiences a desire or need to pick.

This may feel like:

• Tension
• Restlessness
• Curiosity
• A strong urge to “fix” something
• A sensory discomfort

3. Picking Occurs

The person engages in skin picking, sometimes consciously and sometimes automatically.

4. Temporary Relief Occurs

Picking may create feelings of:

• Relief
• Satisfaction
• Calm
• Completion

5. Negative Feelings Follow

Afterward, many individuals experience:

• Regret
• Shame
• Frustration
• Embarrassment
• Disappointment

These emotions can increase distress, which may increase the likelihood of future picking. The goal of therapy is not to criticize this cycle, but to understand it. Once the pattern is recognized, individuals can begin learning where and how to interrupt it.

Cognitive Behavioural Therapy (CBT) for Skin Picking

Cognitive Behavioural Therapy (CBT) is one of the most researched psychological approaches for treating Excoriation Disorder.

CBT focuses on understanding the relationship between:

• Thoughts
• Emotions
• Physical sensations
• Behaviours
• Environmental triggers

Rather than viewing skin picking as a failure of self-control, CBT helps individuals understand that the behaviour has developed as a coping pattern, and that new patterns can be learned.

CBT for skin picking may involve:

Increasing Awareness of Picking Patterns

Many individuals are surprised by how automatic their picking can be. Therapy helps clients identify:

• When picking occurs
• Where picking occurs
• What happens immediately beforehand
• Emotional and sensory triggers
• Situations where picking is more likely

This increased awareness creates opportunities to intervene earlier.

Identifying Thoughts That Maintain Skin Picking

Over time, people may develop thoughts that unintentionally reinforce picking, such as:

• “I need to fix this spot before I can relax.”
• “It will bother me until I remove it.”
• “My skin looks terrible.”
• “I’ve already picked today, so it doesn’t matter.”

CBT helps individuals examine these thoughts and develop more balanced, compassionate ways of responding.

Developing Healthier Coping Strategies

If skin picking serves as a way to manage emotions, therapy focuses on building alternative skills.

These may include:

• Relaxation strategies
• Mindfulness techniques
• Emotional regulation skills
• Stress management tools
• Problem-solving strategies
• Self-compassion practices

The goal is to help individuals have more options available when urges appear.

Habit Reversal Training (HRT) for Skin Picking

One of the most effective behavioural treatments for Excoriation Disorder is Habit Reversal Training (HRT).

Originally developed for tic disorders and later adapted for Body-Focused Repetitive Behaviours, HRT helps individuals become more aware of their picking patterns and replace them with healthier alternative behaviours.

Unlike simply telling someone to “stop picking,” HRT recognizes that the behaviour serves a purpose. Treatment focuses on understanding the urge and creating a different response.

The primary goals of HRT include:

• Recognizing early warning signs.
• Increasing awareness of automatic picking.
• Identifying triggers.
• Developing competing responses.
• Modifying environments that increase picking.
• Practicing new skills until they become easier to use.

The Role of Awareness Training in HRT

Awareness training is the first major component of Habit Reversal Training. Many people with Excoriation Disorder do not realize how frequently they pick or what situations make picking more likely.

During therapy, individuals learn to notice:

• Hand movements toward the skin.
• Specific situations where picking occurs.
• Physical sensations before picking.
• Emotional states connected to urges.
• Times when picking happens automatically.

For example, someone may discover that they frequently pick while watching television in the evening, while another person may notice picking occurs during stressful work tasks.

This information allows therapy strategies to be targeted and practical.

The Core Components of Habit Reversal Training (HRT) for Skin Picking

Habit Reversal Training (HRT) is a structured behavioural approach that helps individuals understand their skin picking patterns and develop healthier responses to urges. While the specific strategies used in therapy are personalized for each person, HRT generally includes awareness training, competing response training, stimulus control, and ongoing skill development.

The goal of HRT is not to create shame around skin picking or to expect someone to simply “stop.” Instead, treatment focuses on understanding the purpose the behaviour serves and creating new ways to respond when urges occur.

1. Competing Response Training

One of the central components of Habit Reversal Training is learning a competing response.

A competing response is an alternative behaviour that is physically incompatible with skin picking. It allows individuals to respond differently when they notice an urge while giving the urge time to naturally decrease.

A competing response should be:

• Easy to use in everyday situations.
• Subtle enough to use in public when needed.
• Comfortable to maintain for a short period of time.
• Effective at preventing picking movements.

Examples of competing responses may include:

• Making a gentle fist and holding it briefly.
• Placing hands flat on a surface.
• Holding a stress ball, fidget object, or textured item.
• Folding hands together.
• Sitting on hands temporarily.
• Engaging in a hands-on activity such as drawing, knitting, or crafting.
• Applying moisturizer or engaging in a calming skincare routine instead of picking.

The best competing response is different for everyone. A strategy that works well for one person may not be practical for another, which is why therapy focuses on finding approaches that fit naturally into the individual’s routines.

Over time, practicing competing responses helps the brain develop new pathways for responding to urges.

2. Stimulus Control Strategies

Another important component of HRT is stimulus control, which involves modifying the environment to reduce situations that make skin picking more likely. Stimulus control is not about avoiding life or creating strict rules. Instead, it focuses on making small, supportive changes that reduce automatic picking and make healthier choices easier.

Examples may include:

• Keeping nails trimmed to reduce skin damage.
• Covering mirrors during times when mirror checking triggers picking.
• Using a fidget object while watching television.
• Wearing clothing that creates a barrier during high-risk situations.
• Keeping hands occupied during activities where automatic picking occurs.
• Creating structured routines during periods of boredom.
• Using reminders or cues to increase awareness.

For example, someone who notices they pick while watching television in the evening may keep a fidget object nearby and practice a competing response whenever they notice their hand moving toward their skin.

These strategies are not intended to create dependence on avoidance. Instead, they help individuals become more intentional and aware while they build new habits.

3. Understanding and Managing Urges

A common concern people have is:

“If I don’t pick, what will happen to the urge?”

Many individuals worry that the urge will continue increasing until they eventually have to pick. However, through practice, many people learn that urges can rise and fall naturally without acting on them. Therapy helps individuals practice:

• Observing urges without immediately responding.
• Recognizing that discomfort is temporary.
• Using coping strategies while urges decrease.
• Building confidence in their ability to tolerate uncomfortable sensations.

This process is sometimes called urge surfing, where individuals learn to notice an urge like a wave that rises, peaks, and eventually passes.

The goal is not to eliminate all urges. Everyone experiences impulses and uncomfortable sensations. Instead, therapy helps individuals develop greater flexibility and choice in how they respond.

Relapse Prevention and Maintaining Progress

Changing a Body-Focused Repetitive Behaviour takes time, practice, and patience.

Many people experience periods when skin picking improves significantly, followed by times when urges return, especially during stressful life events. This does not mean therapy has failed. CBT and HRT help individuals develop skills for responding to setbacks in a constructive way.

Relapse prevention strategies may include:

• Recognizing early warning signs.
• Identifying situations that increase vulnerability.
• Reviewing strategies that have worked previously.
• Practicing self-compassion rather than self-criticism.
• Adjusting coping strategies as life circumstances change.

Progress is not measured only by whether someone never experiences an urge again. Success may also include:

• Spending less time picking.
• Feeling less distressed by urges.
• Reducing skin damage.
• Recovering more quickly after setbacks.
• Feeling more confident and in control.

Skin Picking Therapy at Colibri NeuroWellness

At Colibri NeuroWellness in Kitchener-Waterloo, individuals experiencing skin picking are supported through a compassionate, evidence-based approach that recognizes the complexity of Body-Focused Repetitive Behaviours.

Teodora Kostadinovska, Registered Psychotherapist (Qualifying), works with children, adolescents, and adults who are experiencing skin picking, hair pulling, and other repetitive behaviours that feel difficult to control. She provides in-person services in Waterloo and virtual (online) therapy across Ontario.

Through approaches such as Cognitive Behavioural Therapy (CBT) and Habit Reversal Training (HRT), Teodora helps clients:

• Understand their unique skin picking patterns.
• Identify emotional, sensory, and environmental triggers.
• Increase awareness of automatic behaviours.
• Develop practical competing responses.
• Build healthier strategies for managing stress and uncomfortable emotions.
• Reduce shame and self-criticism associated with skin picking.

Therapy is collaborative and individualized. Rather than focusing only on stopping the behaviour, treatment explores what purpose skin picking serves and helps clients develop alternative ways to meet those needs.

For some individuals, skin picking may be connected to anxiety, perfectionism, sensory sensitivity, boredom, or emotional regulation challenges. Understanding these factors allows therapy to address the whole person rather than focusing only on the visible behaviour.

Whether skin picking has recently become a concern or has been affecting your life for years, seeking support can be an important step toward greater confidence, self-understanding, and well-being.

When Should You Seek Therapy for Skin Picking?

Occasional skin picking is common, but professional support may be helpful when the behaviour becomes difficult to control or causes distress.

You may benefit from speaking with a therapist if:

• You repeatedly try to stop picking but are unsuccessful.
• Skin picking causes wounds, scabs, scars, or skin damage.
• You spend significant time thinking about picking or engaging in the behaviour.
• You avoid social activities because of concerns about your skin.
• You feel shame, guilt, or embarrassment after picking.
• Skin picking interferes with school, work, relationships, or daily activities.
• Picking increases during periods of stress or emotional difficulty.

You do not need to wait until the behaviour feels severe before seeking help. Early support can help individuals understand their patterns and develop effective strategies before the behaviour becomes more deeply established.

Frequently Asked Questions About Skin Picking Disorder and HRT

What is Excoriation Disorder?

Excoriation Disorder, also known as Skin Picking Disorder or Dermatillomania, is a mental health condition involving repeated skin picking that causes skin damage and difficulty stopping the behaviour. It is classified in the DSM-5-TR under Obsessive-Compulsive and Related Disorders.

Is skin picking a form of OCD?

Skin picking and OCD are related but different conditions. Both involve repetitive behaviours, but skin picking is typically driven by urges, sensory experiences, or emotional regulation rather than intrusive thoughts and compulsions commonly seen in OCD.

Does Cognitive Behavioural Therapy help with skin picking?

Yes. CBT is one of the most commonly used evidence-based treatments for Excoriation Disorder. It helps individuals understand triggers, develop coping strategies, challenge unhelpful thoughts, and create healthier behavioural patterns.

What is Habit Reversal Training for skin picking?

Habit Reversal Training (HRT) is a behavioural therapy approach that helps individuals recognize when and why skin picking occurs and replace the behaviour with a competing response. It is commonly used as part of CBT for Body-Focused Repetitive Behaviours.

Why do I pick my skin even when I want to stop?

Skin picking is often maintained by a combination of emotional, sensory, and behavioural factors. Picking may temporarily reduce tension, provide sensory satisfaction, or create a feeling of relief, which reinforces the behaviour over time.

Can children and teenagers receive therapy for skin picking?

Yes. Children and adolescents can benefit from developmentally appropriate CBT and HRT approaches. Parents and caregivers may also be involved to help create supportive environments and reinforce healthy coping strategies.

Can adults develop skin picking disorder?

Yes. Although skin picking often begins during adolescence, adults can also experience Excoriation Disorder. Some individuals have struggled with the behaviour for many years, while others notice it developing during periods of stress or major life changes.

How long does therapy for skin picking take?

The length of treatment varies depending on each individual’s needs, goals, and the severity of symptoms. Some people notice improvements relatively quickly, while others benefit from longer-term support to strengthen skills and address related concerns such as anxiety or emotional regulation.

Will I ever completely stop picking my skin?

Everyone’s recovery journey is different. Some individuals experience a significant reduction or complete remission of symptoms, while others learn to manage urges effectively and reduce the impact skin picking has on their lives. Therapy focuses on meaningful improvement and improved quality of life.

How do I know if therapy is right for me?

If skin picking causes distress, affects your confidence, or feels difficult to control, speaking with a therapist can be a helpful first step. An assessment can help determine whether CBT, HRT, or other approaches may be appropriate.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Association Publishing.

Grant, J. E., & Chamberlain, S. R. (2020). Body-focused repetitive behaviors: Clinical features, assessment, and treatment. Psychiatric Clinics of North America, 43(2), 255–269.

Lochner, C., Roos, A., & Stein, D. J. (2017). Excoriation (skin-picking) disorder: A systematic review of treatment options. Neuropsychiatric Disease and Treatment, 13, 1867–1872.

Selles, R. R., McGuire, J. F., Small, B. J., & Storch, E. A. (2016). A systematic review and meta-analysis of psychiatric treatments for excoriation disorder. General Hospital Psychiatry, 41, 29–37.

Teng, E. J., Woods, D. W., & Twohig, M. P. (2006). Habit reversal as a treatment for chronic skin picking: A pilot investigation. Behaviour Modification, 30(4), 411–422.

Woods, D. W., & Miltenberger, R. G. (2001). Habit reversal: A review of applications and variations. Journal of Behavior Therapy and Experimental Psychiatry, 32(1), 29–43.

The TLC Foundation for Body-Focused Repetitive Behaviors. (n.d.). Understanding body-focused repetitive behaviors. https://www.bfrb.org