Excoriation Disorder
Excoriation Disorder (Dermotillomania) is marked by recurrent skin picking that causes skin lesions and significant distress or impairment in a variety of areas of functioning such as work, school, friendships, and family. An individual with Excoriation Disorder will spend a great deal of time picking, sometimes up to several hours per day. Avoidance of social situations may be present because of feelings of embarrassment and shame from picking. A person often attempts to stop the skin picking repeatedly but feels unable to do so.
Signs and Symptoms of Excoriation Disorder
Recurrent Skin Picking
Skin picking that persists and can take up several hours per day.
Skin Lesions Caused by Picking
Lesions, scabs, infections, and scars can be caused by skin picking.
Significant Feelings of Distress
Feelings such as loss of control and anxiety caused by picking.
Feelings of Embarrassment
Feelings of shame and embarrassment may be experienced from picking.
Impairment in Functioning
Social, occupational, and academic areas of life are negatively affected.
Attempts to Hide Skin Lesions
Wearing extra clothes or using makeup to cover up skin lesions.
Avoidance of Social Situations
Social situations may be avoided due to wanting to conceal picking.
Repeated Attempts to Stop Skin Picking
Several attempts have been made to reduce or eliminate skin picking.
Treatment for Excoriation
Cognitive Behavioral Therapy
CBT helps clients to identify and work to change unhelpful thinking patterns that tend to keep them “stuck” and explore the way thoughts, feelings, and behaviors are connected and how they have the power to change unhealthy patterns into healthy ones. Coping skills and confidence are developed to assist in achieving treatment goals. With consistent practice, as the ways in which situations are viewed and interpreted changes, often the situations themselves begin to change, too.
Habit Reversal Training
Habit Reversal Training is a form of behavioral therapy that helps clients develop a greater awareness of how and when their urges to skin pick are affecting them as well as identify various situations when they notice the impulse to pick emerge. The client then comes up with a competing response (CR), which is a new behavior that can be done in place of skin-picking, and begins to practice using the competing response when they anticipate the urge to engage in a picking session. For example, a competing response for Excoriation Disorder symptoms may be for the client to write, type, knit, or draw while they wait for the urge to pick to pass.
Acceptance and Commitment Therapy
Acceptance and Commitment Therapy guides clients to discover what is truly important to them in their life and then take action towards living life in ways that they find deeply meaningful. The acceptance component of ACT emphasizes a non-judgmental approach to the way people experience their thoughts and feelings and encourages purposeful living, even in the face of challenges. If you are struggling with Excoriation Disorder, ACT can be an effective supplemental approach to treatment to help provide hope, clarity, and a compassionate path towards healing.
“Self-love and acceptance enable us to grow and change.”
— Melody Beattie