A little scratching of skin is no big thing. But have you ever noticed your child repeatedly picking at skin and scabs, or causing a sore? Maybe, you even catch her picking idly while watching TV, unaware of what she’s doing.
She could be experiencing an urge to do this due to a compulsive skin picking disorder, also known as excoriation disorder. Obsessive skin picking falls under the body-focused repetitive behaviors category, and can be likened to a disorder called trichotillomania, which is the same type of urge to pull out body hair, says Laura Lokers, a licensed clinical social worker who co-founded the Anxiety and OCD Treatment Center of Ann Arbor.
“The emotions that we see activate (skin picking) – and not to say that it only occurs in the context of anxiety – but I would say that those are most common emotional triggers. Or, boredom or being upset,” Lokers explains.
Identifying a skin picking disorder
Diagnostically, although “very, very different in a lot of ways,” skin picking falls under the OCD-related disorders, she notes.
Often times, skin picking starts at a younger age. There are a few theories on why these disorders manifest. Lokers explains that aside from the boredom or anxiety, “biologically, we think this is … a grooming behavior that’s kind of in overdrive.”
She explains those who have a compulsive skin picking disorder “describe that intensity kind of like an itch that’s not supposed to be scratched.”
According to the Anxiety and OCD Treatment Center of Ann Arbor’s website, “individuals may pick at healthy skin, at minor skin irregularities, at lesions such as pimples or calluses, or at scabs from previous picking. Most individuals pick with their fingernails, although many use tweezers, pins, or other objects.”
It’s not always a conscious action, either, Lokers adds. She says an estimated 50-60 percent of those who skin pick don’t realize they’re doing it – and sometimes, kids may even do it in their sleep.
That’s not to say that all scab-picking behaviors would always be classified as a disorder as needing treatment. “A lot of us have these habits,” she notes, like picking skin and even biting nails. “Really, when is it becoming a problem? Seeing visible damage,” she adds. And, when your child says they “can’t stop” or are “unaware” of when they’re engaging in the behavior.
Although picking can lead to physical wounds, this behavior is not to be confused with a self-harming behavior, like cutting, Lokers says. Often, the picking isn’t purposeful and “patients are certainly not seeking pain.” If they’re digging at a blemish, she adds, they’re trying to help themselves – not hurt.
Skin picking treatment
Parents can take steps to address compulsive skin picking in children. Talk to your child to see if he recognizes he’s skin picking. And, taking your child to a therapist who can help address the behaviors is a good step.
“The evidence-based treatment we have for (body-focused repetitive behaviors) is cognitive behavioral therapy,” Lokers says. The idea is to help kids recognize what triggers the behavior, whether that be a certain activity or environment, and help the child plan and prevent.
For example, skin picking happens most often when kids are engaged in what Lokers calls sedentary activities, like being in front of the TV or computer and while in the car or bathroom.
Therapists may also work on stress management and “finding safer ways to act on the urges,” like using a fidget toy to keep hands busy while watching TV.
At home, parents shouldn’t turn to punitive measures and simply saying “stop it.” The child is not being “willful or trying to upset you” with these actions, she adds. “You could tell them to stop and they stop and two seconds later those hands are right back in that picking position.”
Instead, ask your child how they feel when they’re skin picking. Follow any plans your child’s therapist has laid out for you. Encourage the use of a fidget toy – and use an incentive when they do keep their hands busy.
Therapy is meant to be a short-term treatment, Lokers says. “The goal is always for them to be able to manage these urges as much as they can in the home.”
For more information and resources, Lokers directs parents to The TLC Foundation for Body-Focused Repetitive Behaviors.
This post is updated regularly.