Dermatillomania (Skin Picking) Treatment

What Is Skin Picking Disorder (Dermatillomania)?

Skin picking disorder, also called dermatillomania or excoriation disorder, is repeated picking at the skin that causes damage and that you have tried, and struggled, to stop. It is a body-focused repetitive behavior (BFRB), in the same family as hair pulling and nail biting, and it is very treatable with cognitive behavioral therapy (CBT).

Skin picking is often misunderstood, including by many doctors. People pick for different reasons: to relieve tension, to cope with boredom or stress, or because a bump or blemish feels like it has to be smoothed. Because each person’s picking works differently, a cookie-cutter approach rarely helps. Effective skin picking therapy starts by understanding what drives your picking.

Signs Skin Picking Is More Than a Habit

• Picking at your face, scalp, arms, fingers, or cuticles until the skin is damaged
• Losing time to picking, often without noticing it has started
• Covering marks with makeup, clothing, or bandages
• Avoiding the beach, the gym, dating, or photos because of how your skin looks
• Feeling shame or frustration after repeated attempts to stop

If several of these sound familiar, you’re not alone, and you don’t have to keep fighting the urges by yourself.

How Skin Picking Disorder Is Diagnosed

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) of the American Psychiatric Association defines excoriation (skin picking) disorder by these criteria:

• Recurrent picking at the skin, resulting in skin lesions.
• Repeated attempts to decrease or stop the picking.
• The picking causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• The picking is not attributable to the effects of a substance (e.g., cocaine) or another medical condition (e.g., scabies).
• The picking is not better explained by symptoms of another mental disorder (e.g., body dysmorphic disorder or non-suicidal self-injury).

Skin Picking Therapy in NYC: How Treatment Works

The most important first step is understanding the problem and its treatment. A psychotherapy approach called cognitive behavioral therapy (CBT) is the treatment of choice for BFRBs like skin picking. CBT focuses on the thoughts, feelings, situations, and behaviors that keep picking going, and teaches practical ways to change them, matched to your specific symptoms.

Two CBT approaches are used most for skin picking: habit reversal training (HRT) and the Comprehensive Behavioral (ComB) model. Acceptance and commitment therapy (ACT) and dialectical behavior therapy (DBT) can add support for the emotions and urges behind picking.

Habit Reversal Training (HRT) for Skin Picking

Habit reversal training was developed in the 1970s by Nathan Azrin and Gregory Nunn and is the most researched treatment for BFRBs. Its three core components are awareness training, competing response training, and social support. For a deeper look, read our guide to habit reversal training for dermatillomania.

Awareness Training

Awareness training helps you notice the situations, times, places, and feelings in which picking is most likely to happen. Once you can catch the early warning signs, you have a chance to step in before picking starts.

Competing Response Training

Competing response training teaches you a response that makes picking physically impossible in the moment. For example, when an urge hits, you might clench your hands into fists and hold them at your sides until the urge passes. You practice this response each time you feel the urge or enter a situation where picking is likely.

Social Support

Social support brings a trusted family member, partner, or friend into the process to offer encouragement, gentle reminders in trigger situations, and positive feedback when you use your new skills.

What to Expect in Treatment With Dr. Ori

Research supports HRT for short-term improvement, but lasting change is much easier with an expert to guide you and keep you accountable. Working with an expert in the area of TTM treatment increases your success rate dramatically. Dr. Ori has been in practice for over two decades and has successfully treated thousands of Trichotillomania sufferers.

• A thorough first evaluation to understand your picking patterns, triggers, and goals.
• Weekly sessions to build awareness, competing responses, and coping skills that fit your life.
• Gradually fewer sessions once picking is under control, moving from weekly to every other week.
• Relapse prevention, with monthly “booster” sessions until you and Dr. Ori agree you’re ready to finish.

The goal of weekly treatment is to reduce your skin-picking behaviors and replace them with healthier alternatives. With those who are highly motivated, significant improvements can be seen within the first couple of months of treatment.

Most clients will reduce picking behaviors by 50% in the first month and up to 75% in the second month of treatment. Clients typically find that the final handful of “picks” per week is the most stubborn, but once they reach zero “picks” for 5-6 consecutive weeks, we can reduce treatment frequency from weekly to biweekly sessions.

Some clients choose to keep meeting to work on related goals, such as anxiety, ADHD-related executive function, depression, or relationship issues. Sessions are available in person at Dr. Ori’s Midtown Manhattan office or virtually on request. Dr. Ori is out of network with insurance plans and provides superbills for possible reimbursement; see insurance and fees for details.

Is Medication Used for Skin Picking?

Some people benefit from medication first or alongside CBT, especially when depression, anxiety, or ADHD is adding to the urges to pick. Medication alone is not a cure for skin picking, and studies suggest CBT outperforms medication for BFRBs. Psychologists don’t prescribe medication; if you’re considering it, talk with your physician or a psychiatrist.

Self-Help Between Sessions

Small changes can make urges easier to manage: keep your hands busy with a fidget, cover tempting spots, and dim or avoid magnifying mirrors. Our article Is skin picking self-harm? explains the difference between picking and self-injury. Self-help works best alongside professional treatment, not instead of it.

Skin Picking Treatment FAQs

What is skin picking disorder?
Skin picking disorder, also called dermatillomania or excoriation disorder, is repeated picking at the skin that causes damage and that a person has tried, and struggled, to stop. It is a body-focused repetitive behavior (BFRB), in the same family as hair pulling and nail biting, and it is treatable.

What is the best therapy for skin picking?
Cognitive behavioral therapy (CBT) is the treatment of choice for skin picking. The most studied CBT approach is habit reversal training (HRT), which builds awareness of picking and teaches a competing response to use when urges hit. Approaches such as ACT and DBT can add support for the emotions that drive picking.

Is skin picking a form of self-harm?
Usually not. Most people pick to relieve tension, boredom, or an urge to smooth the skin, not to hurt themselves. Picking that is meant to cause harm is assessed differently, which is one reason a careful evaluation matters.

Can medication help skin picking?
Medication is not a cure for skin picking. It is sometimes used alongside therapy when depression, anxiety, or ADHD is adding to the urges. Psychologists don’t prescribe medication, so talk with your physician or a psychiatrist if you’re considering it.

Do you offer virtual skin picking therapy?
Yes. Dr. Ori sees clients in person at the Midtown Manhattan office and virtually on request.

Does insurance cover skin picking treatment?
Dr. Ori is out of network with insurance plans. The practice provides invoices (superbills) that you can submit to your insurer for possible out-of-network reimbursement.

How do I get started?
Schedule a free 15-minute consultation or call Dr. Ori at 917-806-0155.