Skin picking disorder

You may have skin picking disorder if the picking causes cuts and bleeding. You may do it when you're stressed, or not always realise you're doing it.

Skin picking disorder is usually treated with talking therapies and medicines.

It's not clear what causes skin picking disorder. It can be triggered by boredom, stress or anxiety, and feelings of guilt or shame.

Most people pick at their skin from time to time, but you may have skin picking disorder if you:

• cannot stop picking your skin
• cause cuts, bleeding or bruising by picking your skin
• pick moles, freckles, spots or scars to try to "smooth" or "perfect" them
• do not always realise you're picking your skin
• pick your skin when you feel anxious or stressed

You may pick your skin with your fingers, fingernails, teeth or with tools like tweezers, pins or scissors.

If you have skin picking disorder there are things you can try that may help.

• keep your hands busy – try squeezing a soft ball or putting on gloves

• identify when and where you most commonly pick your skin and try to avoid these triggers

• try to resist for longer and longer each time you feel the urge to pick

• care for your skin when you get the urge to pick it – for example, by applying moisturiser

• tell other people – they can help you recognise when you're picking

• keep your skin clean to avoid infection

• do not let your nails grow long – keep them trimmed

• do not keep things like tweezers and pins where you can easily get at them

Talking therapy is currently thought to be an effective treatment to help change skin picking behaviour.

If you're offered this, it'll usually be given through community mental health services.

The most common type of talking therapy offered for skin picking disorder is cognitive behavioural therapy, and may include a technique called habit reversal training.

Habit reversal training works by helping you:

• recognise and be more aware of your skin picking and what's triggering it
• replace skin picking with a less harmful behaviour

Medicines for skin picking disorder

Your doctors may recommend some types of medicine to help you control your skin picking behaviour.

This may be prescribed by a GP, but more often it'll be prescribed by a specialist (psychiatrist).

Skin picking disorder is related to obsessive compulsive disorder, where the person cannot stop themselves carrying out a particular action.

It can be triggered by:

• boredom
• stress or anxiety
• negative emotions, such as guilt or shame
• skin conditions, such as acne or eczema
• other blemishes that the person wants to get rid of (these may not be noticeable to other people)

It's sometimes called a body-focused repetitive behaviour and is similar to repetitive hair pulling disorder (trichotillomania).

It's also related to other obsessive compulsive disorders, such as body dysmorphic disorder, where the person is excessively preoccupied with their appearance.

People with skin picking disorder often also have other obsessive compulsive disorders. These may require their own assessment and treatment.