Is Skin Picking Self-Harm?
Despite a seemingly simple definition, it can be difficult sometimes to draw the line between what does and does not qualify as a self-harm disorder. Excoriation, for example, involves purposely and repeatedly harming your own skin—but is skin picking really self-harm?
Is Skin Picking Classified as Self-Harm?
The official Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) name for self-harm is nonsuicidal self-injury (NSSI). It is defined as consciously and deliberately injuring oneself without the intent of attempting suicide.1
Excoriation disorder, also known as compulsive skin picking or dermatillomania, is a body-focused repetitive behavior. It is most commonly considered to fall under the obsessive-compulsive umbrella of disorders.2
This places skin picking and self-harm in two decidedly different categories, medically speaking. However, it is difficult to deny the obvious overlap between the two.
How Skin Picking Is Like Self-Harm
Both skin picking and self-harm involve causing yourself real, physical harm. Both can lead to medical complications if the wounds are not properly treated. And in both cases, they are habits that are all too easy to form—and, for many, incredibly difficult to break.
Perhaps most importantly, both can act as outlets, albeit unhealthy ones, for overwhelming or negative emotions. In my case, my self-harm was driven largely by feelings of inadequacy and guilt. My skin picking is similarly triggered by perceived flaws, albeit physical ones (i.e. rough spots or scabs) rather than character flaws.
Viewed from this perspective, it's easy to see how skin picking and self-harm might be seen as one and the same. And perhaps that's why I've put off tackling this topic for so long—because to admit they are the same thing is to admit that I am not, and have never been, in recovery. After all, I began struggling with a mild form of skin picking long before I engaged in a more recognizable form of self-harm, and it is a fight I have yet to win, even now.
But here's the thing—I really don't think they're the same thing at all.
Why Skin Picking Is Not Necessarily Self-Harm
Skin picking and self-harm might look the same on the outside, but for me, there is a subtle but crucial difference between the two. In the case of my self-injury, the act was deliberate. While for some NSSI may feel compulsive, in my experience it was always more akin to an emotional addiction. For me, it began with a choice, and from there, spiraled downward into a disorder that became more and more difficult to walk away from.
Skin picking, however, was never a choice for me. I never meant to start, not in the way that I consciously chose to hurt myself. I just caught myself already at it one day, I don't even remember how long ago now, and thought, "How funny. Mom used to do this, too."
I saw it as just another bad habit. Easy enough to break, right?
Excoriation is sneaky that way. You may not even realize it's a problem until it already is. By that point, it's already become exponentially more difficult to solve.
So, in my opinion, skin picking and self-harm aren't precisely the same thing. Whether you agree or not, however, I think the most important thing to recognize is that both do damage to you, body and soul. And in either case, you deserve better. Recovery is hard—believe me, I know—but it's possible. I am 10 years into recovering from self-harm, and I look forward to being able to say the same thing about my skin picking. Not today, perhaps, but someday.
Do you agree? In your experience, are skin picking and self-harm separate issues, or one and the same? Let us know in the comments.
- American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Publishing, May 2013.
- Mental Health America, Excoriation Disorder (Skin Picking or Dermatillomania). Accessed December 2020.
Kim Berkley (2021, January 7). Is Skin Picking Self-Harm?, HealthyPlace. Retrieved on 2022, January 28 from https://www.healthyplace.com/blogs/speakingoutaboutselfinjury/2021/1/is-skin-picking-self-harm
Author: Kim Berkley
When I read your blog, I asked myself the reason why I wanted to distinguish between skin picking and self harm; for me, it was whether I need to seek professional help, not necessarily to label to my behavior per se. My skin picking is definitely related to anxiety, but it is also causing damage to areas of skin cancer treatment, possibly interfering with healing. I haven't yet admitted to my dermatologist that I skin pick, which has become a compulsion. Then last night, a traumatic event happened, and within moments of realizing that there were no good options, I had a strong urge to tear at my cancer scabs and truly cause physical pain to express my emotional pain. Is it possible that what I am describing is a transition from skin picking to self harm? Is this a prompt to seek help? Thank you.
I'm not sure if they are different, I've been skin picking my fingers for years, to the point of making them bleed and become very sore, also knowing that when taking it to an extreme, it will cause lots of pain, hence=self-harm...
I also have OCD, can't remember which came first...
Thanks for your comment. There is definitely some overlap between the two, to be sure. (I also pick excessively sometimes, to the point of needing band-aids.) For me, I think the main difference is that I was always conscious of my actions when self-harming (even if I felt like I "had" to do it), whereas I often start picking unconsciously and don't even know I'm doing it until I suddenly feel it or something draws my attention to it (my boyfriend will reach over and grab my hand to stop me if he sees me doing it).
But everyone experiences these things differently, and for you, maybe they are the same thing. (As far as I know, there's no "official" classification one way or the other. And you have every right to choose the labels with which to describe your own experiences.) I think the important thing to remember is that, regardless of what we label it, skin-picking does hurt us, and is something to work on healing—one day at a time.
I hope we both can find a good way to stop, or at least reduce, our picking, someday soon. :)
Hi Kim. Fellow HP blogger here. I suffer from skin picking as well. I just read what you wrote about your mom. Mine too! And you wrote it almost as I thought it about my own mom.
With the distinctions you've made, I agree. Skin picking and self-harm seem to be different. I've never self-harmed but I always thought my skin picking was a form of self-harm. Thank you for laying out the differences so plainly.
I'm the same as you insomuch as I've always done it. It's a compulsion. I'm trying to understand the triggers. The last couple of days I've been struggling with self-trust and body image. This evening, I picked my thumb and did damage. Connected? Not sure.
Anyway. Sorry for the long comment. Great post!
Nice to meet a fellow HP writer! I'm glad you found my post relatable and—more importantly—helpful. Of course, other people see it differently—I have read many instances in which people decide that they are the same thing, and I can see their point, but for me, as I wrote in the post, I just don't experience the two in the same ways. They feel completely different to me.
That's not to say that skin-picking isn't serious or isn't something that should be addressed, of course. I sometimes struggle with my own body image—for a number of reasons, but one of them is the state of my hands. The worst thing is when I damage my fingers to the point that they are super sore and/or require bandaging, because then I'm reminded of my "bad habit" every time I put hands on a keyboard—which, being a writer, is a lot of the time.
I'm still trying to understand my triggers, too. When I'm stressed, I pick. When I'm bored, I pick. Those instances, at least, make sense to me. But sometimes I'll have a pretty darn good day and still catch myself at it. I think part of the problem is that, having done it for so long, the habit of scanning my fingers (touching one finger unconsciously to others, looking for blemishes, rough spots, and other pickable places) has become so ingrained that I don't even notice I'm doing it most of the time until I'm already picking.
It's interesting that we share the same experience with our moms! I wonder if there's some sort of genetic component at work, or if it is more of a learned compulsion. Or something in between?
Anyway, thank you so much for your comment. I hope we both figure out a way to heal our poor fingers (and whatever's at the root of these compulsions of ours) one of these days. Until then, keep the bandages and the antiseptics handy, just in case. :)