What Does It Mean When My Child Picks Their Skin?

If you’ve noticed your teen picking, scratching, or digging at their skin, you might feel worried and unsure about what this means or how to help. For many adolescents, this behavior goes beyond a simple bad habit and may develop into what mental health professionals call excoriation disorder (also known as dermatillomania or skin-picking disorder).

Excoriation disorder is characterized by recurrent, compulsive skin picking that causes tissue damage, significant distress, and impairment in daily functioning. What might start as occasional picking at a scab or blemish can evolve into a serious condition that affects your teen’s physical health, emotional wellbeing, and social development.

At Hillcrest Adolescent Treatment Center, we understand the complexities of adolescent behavior and mental health challenges like excoriation disorder.

Learn more about our teen treatment programs in California or call us now at 800-275-1707.

What Does It Mean When My Child Picks Their Skin?

When adolescents repeatedly pick at their skin, causing damage or scarring, it may indicate several underlying symptoms.

For some teens, skin picking might be a temporary response to stress or anxiety. For others, it could be a manifestation of a body-focused repetitive behavior (BFRB) known as excoriation disorder or dermatillomania.

Skin picking can occur for various reasons:

• As a stress relief mechanism
• Due to boredom or restlessness
• In response to skin imperfections (real or perceived)
• As a self-soothing behavior during emotional distress
• As part of another underlying mental health condition

While occasional picking at scabs or acne is common, persistent skin picking that causes significant distress or impairment may require professional attention.

Understanding Excoriation Disorder

Excoriation disorder, also known as skin-picking disorder or dermatillomania, is a recognized mental health condition in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It falls under the category of Obsessive-Compulsive and Related Disorders.

This condition is characterized by:

• Recurrent picking at one’s skin, resulting in skin lesions
• Repeated attempts to decrease or stop the skin picking
• Significant distress or impairment in daily functioning
• The behavior is not attributable to another medical condition or substance use

Excoriation disorder affects approximately 1-5% of the general population, with onset typically occurring during adolescence, often coinciding with puberty. The disorder can be chronic, with periods of remission and relapse.

Causes of Excoriation Disorder and Skin Picking

The exact causes of excoriation disorder aren’t fully understood, but research suggests a combination of factors may contribute:

Biological Factors

• Genetic predisposition: Studies suggest a higher prevalence among first-degree relatives
• Neurological differences: Potential imbalances in neurotransmitters like serotonin and dopamine
• Sensory processing differences: Some teens may have heightened sensitivity to physical sensations

Psychological Factors

• Perfectionism and difficulty managing negative emotions
• Poor impulse control
• Distorted body image or heightened attention to perceived flaws
• Trauma responses and maladaptive coping mechanisms

Environmental Factors

• High-stress environments
• Learned behaviors from family members
• Social isolation
• Academic pressure

Signs and Symptoms of Excoriation Disorder

Parents should be aware of these potential indicators of problematic skin picking:

Physical Signs

• Noticeable sores, scabs, or scarring on the face, arms, hands, or other accessible body areas
• Tissue damage ranging from minor to severe
• Skin infections
• Band-Aids or coverings over multiple areas
• Attempts to conceal affected areas with makeup or clothing

Behavioral Signs

• Spending excessive time (30+ minutes daily) picking skin
• Rituals around skin picking, such as specific tools or settings
• Avoidance of activities that might expose affected skin areas
• Difficulties stopping despite wanting to
• Collecting or examining removed skin

Emotional Signs

• Shame, embarrassment, or guilt about the behavior
• Anxiety before or after picking episodes
• Relief or satisfaction during picking
• Social withdrawal or diminished self-esteem
• Academic or social impairment

The Brain and Skin Picking In Teens

Adolescence is a critical period of brain development, particularly in areas responsible for impulse control, decision-making, and emotional regulation. This developmental stage may contribute to the onset or intensification of excoriation disorder.

Research suggests that skin picking may involve:

• Disruptions in the brain’s reward circuitry, where the act of picking temporarily reduces anxiety or provides satisfaction
• Difficulties with cognitive control and inhibition
• Altered neurotransmitter activity affecting mood regulation
• Problems with body-focused attention and sensory processing

Mental Health Disorders That May Lead to Skin Picking

Skin picking often co-occurs with other mental health conditions, including:

Obsessive-Compulsive Disorder (OCD)

Teens with OCD may develop skin picking as a compulsion in response to intrusive thoughts or as part of ritualistic behaviors.

Anxiety Disorders

Anxiety disorders such as generalized anxiety, social anxiety, or specific phobias can manifest in skin picking as a physical outlet for emotional distress.

Depression

Depression, including feelings of worthlessness, negative self-image, and emotional numbness may contribute to self-damaging behaviors like skin picking.

Autism Spectrum Disorder

Skin picking may serve as a self-stimulatory behavior or response to sensory processing differences in adolescents with Autism spectrum disorder.

ADHD

Impulse control challenges and restlessness associated with ADHD can increase the likelihood of body-focused repetitive behaviors.

Trichotillomania

Hair pulling disorder often co-occurs with skin picking, as they share similar neurobiological mechanisms.

Finding Help For Skin Picking In Your Teen

If you’ve recognized signs of problematic skin picking in your teen, understanding that multiple treatment options exist is crucial. The appropriate intervention will depend on the severity of the condition, presence of co-occurring disorders, and your teen’s individual needs.

Here are the primary approaches to consider:

Talk Therapy: Talk therapy, particularly Cognitive Behavioral Therapy (CBT), is widely considered the first-line treatment for excoriation disorder. A specialized form called Habit Reversal Training has shown significant effectiveness for skin picking behaviors. In these sessions, therapists work with teens to identify triggers and develop awareness of picking patterns. They teach competing responses—alternative behaviors to engage in when the urge to pick arises—while building motivation for lasting change. Many teens benefit from weekly outpatient therapy sessions, where they learn practical tools like stimulus control strategies and mindfulness techniques to break the cycle of compulsive picking.

Medication: For some teens, especially those with moderate to severe excoriation disorder or co-occurring conditions like anxiety or OCD, medication may be beneficial. Selective Serotonin Reuptake Inhibitors (SSRIs) have shown promise in reducing skin picking behaviors by addressing underlying neurochemical imbalances. A psychiatrist can assess whether medication is appropriate, determine the right type and dosage, and monitor for effectiveness and side effects. Medication typically works best when combined with therapy rather than as a standalone treatment. The decision to use medication should involve careful consideration of your teen’s complete medical and psychological profile.

Residential Treatment: When excoriation disorder significantly impairs daily functioning, causes serious physical complications, or doesn’t respond to outpatient interventions, residential treatment may be necessary. Programs like those at Hillcrest Adolescent Treatment Center provide comprehensive, immersive care addressing not only the skin picking behavior but also any underlying trauma, dual diagnosis disorders, and family dynamics. In a residential setting, teens receive constant support, structured therapy, and 24/7 monitoring to prevent skin damage while learning healthier coping skills. This intensive approach creates a healing environment free from typical triggers, while helping teens develop the robust skills needed for long-term recovery before transitioning back to everyday life.

How Can I Talk to My Teen About Skin Picking?

Starting a conversation about skin picking requires sensitivity and careful preparation:

Choose the Right Moment

• Find a private, relaxed time when neither of you feels rushed or stressed
• Avoid bringing it up during or immediately after a picking episode
• Make sure you’re in a calm emotional state yourself

Use Non-Judgmental Language

• Start with “I’ve noticed” statements rather than accusations
• Express concern for their wellbeing rather than frustration about the behavior
• Avoid language that implies blame or shame
• Be careful not to refer to the behavior as “disgusting” or “weird”

Listen More Than You Speak

• Ask open-ended questions about their experience
• Validate their feelings, even if their perspective differs from yours
• Resist the urge to offer immediate solutions
• Acknowledge the difficulty of discussing something so personal

Present Help as Collaborative

• Ask what kind of support they think might help them
• Present treatment options as choices rather than mandates when possible
• Include them in the process of finding the right professional help
• Frame intervention as something you’ll work through together

Address Potential Resistance

• Understand that denial or defensiveness is common and not personal
• Be prepared to have several conversations over time
• Consider sharing educational resources about excoriation disorder
• Emphasize that seeking help is a sign of strength, not weakness

Find Mental Health Help For Your Teen

Discovering that your teen is engaging in skin picking behaviors can be concerning, but understanding the underlying causes and available treatments offers hope. Excoriation disorder is treatable, and with proper support, adolescents can learn healthier coping mechanisms and regain control over these behaviors.

At Hillcrest Adolescent Treatment Center, we specialize in treating complex behavioral and mental health challenges like excoriation disorder. Our comprehensive approach combines evidence-based therapies, medication management when appropriate, and family-centered care to address the root causes of skin picking behaviors.

Our team of adolescent mental health experts understands the unique challenges that teens and their families face when dealing with excoriation disorder. We create personalized treatment plans that address not just the visible behaviors, but the underlying factors contributing to your teen’s condition.

Don’t wait for skin picking to cause further distress or physical harm. Call us now at 800-275-1707 or verify your insurance now.