What is skin picking? The causes of the urge to pick cuticles, lips and spots, its effects on skin and mood, and therapy approaches that help change this cycle.
You are in a meeting. Under the table, your thumb is moving around the cuticle of your index finger; it finds a small rough edge and tears it off. A little blood appears; you make a fist to hide your hand. In the evening, standing at the sink, you start squeezing a small spot on your face, telling yourself "I'll just deal with this one"; when you lift your head, forty minutes have passed, your skin is red, and you are wondering how you will cover it up tomorrow. Although the urge to pick at your skin may look from the outside like "a bad habit", for many people who live with it, it is an urge that is very hard to control. In this article we describe the cycle behind picking, scraping and squeezing the skin, why this behaviour is not easy to give up, and the steps through which change can become possible.
What Is Skin Picking? The Basics of Dermatillomania
Skin picking is known in medical language as dermatillomania. It is defined by a person repeatedly picking, scraping, squeezing or biting their own skin, and being unable to stop even though this behaviour causes wounds on the skin. In clinical classification it belongs to the disorders related to obsessive compulsive disorder, and together with hair pulling it is considered part of the family of "body-focused repetitive behaviours". We discuss the urge to pull out hair, eyebrows or eyelashes separately in our article on hair pulling disorder.
The areas most commonly targeted are:
- Cuticles and fingertips
- The lips and the area around them
- Spots, blackheads and small bumps on the face
- Scabs, spots and insect bites on the back, shoulders and arms
- Hard skin on the soles of the feet and heels
- The scalp
Everyone squeezes a spot or tears off a bit of cuticle from time to time. What turns this into a problem is how often the behaviour happens, the marks it leaves on the skin, the time spent on it and the person being unable to stop despite wanting to.
How it differs from self-harm
Dermatillomania is not a behaviour carried out in order to cause oneself pain deliberately. The person usually picks to "fix" a rough patch, to calm tension or to reach a sense of relief. This distinction matters, because the approach is different. Nevertheless, a person who picks at their skin may also have thoughts of self-harm. In that case, it is necessary to talk about this openly with a professional.
What Are the Symptoms of Skin Picking?
- Recurring wounds, scabs, marks and scars on the skin
- Repeated unsuccessful attempts to reduce or stop the behaviour
- Rising tension before picking, an urge to touch the skin or a need to "get rid of the bump"
- Brief relief after picking, followed by shame and regret
- Searching for the slightest irregularity on the skin, scanning the skin with the fingertips
- Using tools such as tweezers, needles or scissors
- Hiding wounds with make-up, long-sleeved clothes, plasters or gloves
- Avoiding shaking hands, wearing short sleeves, and swimming pools and beaches
As with hair pulling, two forms are seen here too. Automatic picking happens without the person realising it, while watching television, listening in class or driving. Focused picking, on the other hand, is usually experienced in front of the mirror as a conscious and prolonged effort to "clean" or "fix" the skin.
What Causes the Urge to Pick the Skin?
Soothing emotions: Many people use picking their skin as a way of coping with anxiety, tension, anger, boredom or tiredness. Because the behaviour brings relief in the short term, it is repeated.
The search for perfect skin: Some people feel a strong need for their skin to be "smooth" and "clean". Even a bump too small to be seen with the naked eye feels unbearable. Unfortunately, every bump that is picked creates a new scab, and every scab a new bump.
Sensory satisfaction: A scab coming away, a spot emptying or a piece of hard skin being torn off can give the person a particular sense of satisfaction. This feeling reinforces the cycle.
Skin problems: Conditions such as acne, eczema or dry skin can trigger this behaviour. The skin problem and the picking behaviour feed each other.
Predisposition and stress: Similar behaviours in the family, a temperament prone to anxiety and periods of intense stress can play a part in the behaviour starting or increasing.
How does the cycle work?
Skin picking usually progresses through a familiar five-stage cycle. First there is a trigger: tiredness, the tension created by an email, or simply a finger catching on a rough patch. Then the urge arrives: the feeling of "let me just deal with this". Picking begins and brief relief or satisfaction follows. Immediately afterwards come regret, shame and anger at oneself. These negative feelings in turn create new tension, preparing the ground for the next round of picking. Seeing the cycle in these stages helps the person understand where they can intervene, because each stage is a separate doorway to change.
Adolescence is one of the periods in which this cycle often begins. With acne, touching the face increases, time spent looking in the mirror grows longer, and after a while squeezing spots can turn into an entrenched habit.
The Effect of Skin Picking on Daily Life and Emotions
Imagine a woman in her mid-twenties who, a week before her younger sister's henna night (the traditional pre-wedding celebration), starts working on a few spots on her face. Every evening she goes into the bathroom to squeeze "just one" and stays there for more than an hour. The next morning she applies thick foundation to cover the wounds, but as they scab over she picks them again. At the henna night she keeps turning to the side when photos are taken and feels all evening that people are looking at her face. A relative's question, "What's happened to your skin, dear?", stays on her mind for days. Yet what troubled her most that week was not the spots, but the tension of the wedding rush and her hand constantly going to her face to soothe that tension.
As this example shows, the effects of skin picking are not limited to the skin:
- Physical effects: Infection, scars and marks, wounds that take a long time to heal. Wounds with redness, swelling or fever require a visit to a doctor.
- Lost time: Hours spent in front of the mirror, being late for work or school.
- Social avoidance: Being unable to wear short sleeves in summer, not going into the sea, avoiding close contact and shaking hands.
- Shame and secrecy: A person may hide their wounds for years; even their family or partner may not know the extent of the situation. We describe the effect of shame on mood in detail in our article on feelings of shame.
- Emotional burden: Anger at oneself, worthlessness, hopelessness; at times depressive symptoms.
For spouses and parents
Seeing someone you love pick their skin until it bleeds creates worry and helplessness. Yet out of that worry, slapping their hands away, saying "Are you picking at your face again?" or constantly commenting on their skin usually increases shame and moves the behaviour to hidden hours. What helps more is to raise the subject at a calm time, listen without judgement and use a gentle reminder signal agreed together. It is also important for parents of teenagers to avoid comments about appearance and to offer practical support with things such as skincare and dermatology appointments.
Every mark on your skin is not a failure, but the trace of a temporary way out that your mind found for you at a difficult moment.
What Can You Do to Cope With This Urge?
The following suggestions can help you notice this cycle and gradually change it:
- Identify your risky moments. For a few days, note at what times, in which room and during which activity you pick. For many people, the bathroom in the evening, bed and screen time are the riskiest moments.
- Keep your nails short. Short, smooth nails make picking and scraping harder. Regularly applying moisturiser to your cuticles also reduces the rough edges available to pick.
- Put the tools away. Remove tweezers, needles and similar tools from the bathroom, or put them somewhere hard to reach.
- Cover the wounds. Covering scabbed wounds with a suitable plaster can reduce the urge to touch them and give them a chance to heal.
- Change your relationship with the mirror. Limit the time you spend in front of the mirror; avoid looking at your face very closely. You can use a timer to prompt you to leave the bathroom.
- Give your skin a different kind of touch. When the urge comes, applying cream to your hands or gently massaging your skin instead of picking can meet the need for touch in a way that does no harm.
- Be compassionate towards yourself. When you slip up, saying "That was a hard moment; I'm starting again now" instead of scolding yourself makes it easier to get out of the cycle.
If there is acne, eczema or another skin problem, a dermatologist's treatment recommendations can be carried out alongside psychological work.
When Should You Seek Professional Support?
Many people who pick their skin wait for years, telling themselves, "One day I'll stop on my own." Steps taken on your own are valuable; but if one of the following situations sounds familiar, talking to a professional may make the process easier for you:
- Scars, marks or frequent infections have developed on your skin
- Dealing with your skin takes up a significant part of your day
- You have tried many times to stop but have not managed it
- The behaviour is keeping you away from social settings, work or relationships
- You are experiencing intense shame, worthlessness or hopelessness
If you are having thoughts of harming yourself or ending your life, do not wait; call 112 (emergency services) or go to the nearest emergency department. When symptoms are intense, an assessment by a psychiatrist may also be recommended.
How Is Skin Picking Addressed in Therapy?
For dermatillomania, approaches based on Cognitive Behavioural Therapy, especially Habit Reversal Training, are widely used. Where needed, this work is supported by emotion regulation and acceptance-based methods. You can find out how we work with anxiety-related difficulties on our anxiety and panic page.
Mapping the behaviour
In the first stage, we look in detail at the situations, feelings and areas of the body in which picking occurs. The person learns to notice the signs just before picking, such as the fingers starting to scan the skin.
Competing response and changing the environment
When the urge comes, a movement that cannot be done at the same time as picking is carried out, such as clasping the hands together or holding an object firmly. At the same time, risky environments are rearranged: changing the bathroom lighting, putting tools away, keeping the hands busy during screen time.
Making room for the urge
In acceptance-based work, rather than trying to suppress or fight the urge to pick, the person learns to watch it like a wave. They observe where in the body the urge is felt, how high it rises and how it subsides on its own. This skill opens up a small space in which the person can make a choice, especially at moments when automatic picking is common, such as screen time or before going to sleep.
Perfectionism and body image
Beliefs that the skin must be "flawless" and the person's intense worries about their appearance are explored together. Through experience, the person learns to be able to live with small imperfections.
Working with dermatology
If there is a skin problem such as acne, eczema or infection, it is important for psychological work to go hand in hand with dermatological treatment. As the skin heals, there are fewer bumps to pick; as picking decreases, the skin has a chance to heal. When the two areas are aware of each other, it helps the person move forward without having to "start again" in two separate places at once.
Working with emotions and shame
Other ways of coping are developed for the feelings that picking tries to soothe. Being able to talk about shame that has built up over years is also one of the most important parts of therapy.
Frequently Asked Questions
Everyone squeezes spots; how do I know whether mine is a problem?
Squeezing a spot now and then is very common. If the behaviour is frequently repeated, takes hours, leaves scars and wounds on your skin, and you cannot stop even though you want to, it would be helpful to talk to a professional about it.
Will the marks on my skin fade?
Many wounds heal over time once picking decreases, and marks can fade noticeably. For deep or long-standing scars, an assessment by a dermatologist can provide guidance.
I only pick my cuticles; does that count as skin picking too?
Repeatedly picking your cuticles, going as far as making them bleed and being unable to stop, can be a common form of skin picking. How much distress the behaviour causes and how far it affects your life are important in deciding whether support is needed.
Is skin picking a type of OCD?
Dermatillomania is considered a separate diagnosis that belongs to the same family as OCD. Whereas in OCD the behaviour is usually carried out to relieve a fear or doubt, in skin picking the function of soothing tension or meeting a sensory need is more prominent. This difference is decisive in choosing the methods used in therapy.
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Eda Erkan Alapala
Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.
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