Find Therapy for Dermatillomania

Everyone picks their skin occasionally—at a hangnail, a blemish, or out of boredom. But dermatillomania is different. It’s a mental health condition characterized by repetitive, compulsive skin picking that causes distress or physical damage and feels difficult—or impossible—to control.

You might have dermatillomania if:

• You spend significant time picking at your skin, even when you try to stop
• You pick to relieve anxiety, boredom, or tension
• You experience shame, guilt, or isolation afterward
• You have visible wounds, scars, or infections from picking
• You avoid social events or physical intimacy to hide marks

If this sounds familiar, therapy for dermatillomania may help you understand your behavior and begin healing from the inside out.

Recognizing the symptoms

Symptoms of dermatillomania can vary in severity, frequency, and emotional impact. Common signs include:

• Repetitive picking of the skin, often at the face, arms, hands, or scalp
• Use of fingernails, tweezers, pins, or other tools to pick
• Bleeding, scabbing, scarring, or infections from the behavior
• Pre-picking rituals or post-picking routines (examining, squeezing, etc.)
• Attempts to stop or reduce picking, often unsuccessfully
• Emotional distress, especially shame, anxiety, or frustration
• Avoidance of social activities, intimacy, or photographs

Some people are aware of their picking while doing it (focused picking), while others do it automatically, without noticing (automatic picking). A therapist for skin picking can help you identify which patterns show up for you—and how to shift them.

What do the diagnostic criteria mean?

According to the DSM-5, Excoriation Disorder (Dermatillomania) is diagnosed when:

1. Recurrent skin picking results in skin lesions
2. Repeated attempts to stop the behavior are unsuccessful
3. The behavior causes significant distress or impairs daily functioning
4. The behavior isn’t due to a medical or dermatological condition
5. The behavior isn’t better explained by another mental health disorder (e.g., OCD)

Diagnosis is typically made by a licensed mental health professional. If you're unsure, therapy for dermatillomania can provide both clarity and support—diagnosis is just the beginning of the healing process.

Getting diagnosed

A diagnosis of dermatillomania begins with a conversation. Your therapist will ask questions about your behaviors, emotional experiences, and medical history. You won’t be judged or blamed—your provider is there to understand, not to shame.

You may be asked:

• When the behavior started
• How often it happens
• What triggers it (stress, anxiety, boredom, etc.)
• Whether there’s a family history of similar behaviors
• If you’ve experienced trauma, anxiety, or other mental health conditions

Understanding the full picture allows your therapist to create a treatment plan tailored to your needs, habits, and goals.

No—dermatillomania is not just a bad habit. It’s a recognized mental health condition, part of a group of behaviors called Body-Focused Repetitive Behaviors (BFRBs).

While habits are often manageable with willpower or routine changes, BFRBs like dermatillomania are compulsive and anxiety-driven. They serve a purpose—usually to self-soothe, regulate emotions, or reduce distress—but over time, they can cause physical and emotional harm.

A therapist for skin picking will approach the behavior with compassion, helping you understand the need it’s serving and offering healthier ways to meet that need.

The exact cause of dermatillomania isn’t fully understood, but it likely results from a combination of:

• Genetic predisposition (BFRBs often run in families)
• Neurological differences related to impulse control or emotional regulation
• Emotional factors like anxiety, stress, trauma, or perfectionism
• Behavioral reinforcement—the temporary relief or satisfaction you feel after picking can reinforce the habit over time
• Environmental triggers, such as mirrors, lighting, or idle time

You didn’t choose this behavior—and it doesn’t define your worth. With the right therapy for dermatillomania, you can learn to understand and interrupt the cycle.

Effective treatment for dermatillomania often includes a combination of:

Cognitive Behavioral Therapy (CBT)

A structured, goal-oriented approach that helps you:

• Recognize the triggers and thought patterns behind picking
• Build healthier coping strategies
• Practice habit reversal training (HRT), a proven method for BFRBs

Dialectical Behavior Therapy (DBT)

Especially helpful if your picking is linked to emotional dysregulation or trauma, DBT teaches:

• Mindfulness
• Distress tolerance
• Emotional regulation
• Interpersonal effectiveness

Environmental Strategies

• Keeping hands busy with fidgets or sensory tools
• Using bandages, gloves, or skincare as barriers
• Altering mirror use or lighting that prompts picking
• Creating structured daily routines to reduce idle triggers

Medication (when appropriate)

Some individuals benefit from:

• SSRIs (for co-occurring anxiety or depression)
• N-acetylcysteine (NAC), a supplement that has shown promise in reducing BFRBs

Psychoeducation

Learning about the science and psychology of BFRBs helps reduce shame and increases motivation for change.

A personalized plan developed in therapy for skin picking will combine these tools based on your history, triggers, and goals.

There’s no one-size-fits-all timeline. Some clients notice significant progress within a few months; for others, deeper change may take longer, especially if trauma or anxiety is also present.

Factors that influence therapy duration include:

• How long you’ve struggled with the behavior
• The frequency and severity of picking
• Co-occurring conditions (anxiety, depression, OCD, etc.)
• Your support system and environment
• Your consistency and engagement in therapy

Many people benefit from weekly sessions for 3–6 months, followed by less frequent check-ins as they build confidence. The goal is not perfection, but progress and self-compassion.

Treatment should be provided by a licensed mental health professional trained in BFRBs. This includes:

• Therapists for skin picking (LPCs, LCSWs, LMFTs)
• Psychologists specializing in CBT, DBT, or HRT
• Psychiatrists (if medication management is needed)
• Online therapists experienced with dermatillomania and related disorders

You can also find BFRB-informed therapists through organizations like the TLC Foundation for Body-Focused Repetitive Behaviors.

Yes—even if you don’t fully understand your behavior, a trained therapist will help you explore the emotional, cognitive, and environmental roots of your picking. You don't need to have all the answers before starting.

Through therapy, many people begin to uncover:

• Emotions that lead up to picking
• Hidden stressors or perfectionist tendencies
• Sensory or tactile needs driving the behavior
• Past experiences that shaped current patterns

Understanding is not a prerequisite for healing—it’s a process that unfolds in therapy. Your job is to show up. Your therapist’s job is to help you find clarity and tools that work.

Not at all. Relapse is part of recovery, not a sign that therapy won’t work. Like any behavior rooted in emotion and habit, skin picking can take time to unlearn.

Previous attempts to stop likely relied on willpower alone—without addressing the emotional or neurological factors involved. Therapy for dermatillomania gives you structure, tools, and insight that go far beyond surface-level change.

What matters most is persistence, not perfection. Many people succeed in therapy after years of failed attempts on their own. It’s never too late to try again—with better support this time.

At first, it might. That’s because picking serves a function—often as a coping mechanism for anxiety, stress, or boredom.

When you remove that coping tool without a replacement, anxiety can increase temporarily. But therapy addresses this directly by:

• Teaching emotional regulation skills
• Providing alternative coping strategies
• Helping you build distress tolerance

The goal isn’t to just “stop picking”—it’s to reduce the underlying anxiety so that picking no longer feels necessary. Over time, your nervous system can settle, and your emotional resilience grows.

Anxiety is a broader mental health condition that involves excessive worry, restlessness, or fear. Dermatillomania is a specific behavior pattern that may be triggered by anxiety—but it’s not the same thing.

Think of anxiety as the storm, and skin picking as one way you’ve learned to weather it.

That said, many people with dermatillomania also have anxiety disorders, and treating both together often leads to better outcomes. Therapy for dermatillomania typically includes anxiety management techniques as part of the plan.

While dermatillomania and OCD both involve repetitive behaviors, they differ in motivation and experience.

In OCD, compulsions are usually responses to intrusive thoughts or fears (e.g., “If I don’t wash my hands, I’ll get sick”). The behavior is driven by an urgent need to prevent something bad from happening.

In dermatillomania, picking is often sensory or emotional. It’s not usually driven by specific obsessions, but rather by tension, discomfort, or a desire to fix perceived imperfections.

That said, the two disorders can overlap. A trained therapist for skin picking can help distinguish the difference and tailor your treatment accordingly.

You are not broken. You are not alone. And you are not beyond help.

If you're struggling with repetitive skin picking, there is hope. A compassionate therapist for skin picking—whether local or through online therapy for dermatillomania—can help you understand your behavior, reduce shame, and build lasting tools for recovery.

You don’t have to keep hiding. You can heal—and therapy can help you get there.