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Is Skin Picking Self-Harm?

January 7, 2021 Kim Berkley

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.

Sources

  1. American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Publishing, May 2013.
  2. Mental Health America, Excoriation Disorder (Skin Picking or Dermatillomania). Accessed December 2020.

APA Reference
Kim Berkley (2021, January 7). Is Skin Picking Self-Harm?, HealthyPlace. Retrieved on 2022, December 1 from https://www.healthyplace.com/blogs/speakingoutaboutselfinjury/2021/1/is-skin-picking-self-harm



Author: Kim Berkley

Find Kim on Instagram, Facebook and her blog.

Anonymous
October, 2 2022 at 6:11 pm

Hi! I came to this article after seeing a video on the topic, and became interested because I have struggled with skin-picking as long as I can remember, and more recently had issues with SH. I think that it really depends on the case. For example, I pick my skin, and make myself bleed all the time, but it’s truly not a conscious decision that I make. I just look down at my hands and realize I must have picked too hard, and I’m bleeding. On the other hand, sometimes if I get a question wrong in class and am berating myself, I often dig my nails into my skin, and pick viciously at my cuticles. This is different for me, because I know exactly what I am doing, and do it as a form of self punishment rather than it just being habit. I honestly think it depends on the situation which category skin picking fits into. Anyway, just wanted to input my opinion on this. Have a nice day!

October, 10 2022 at 6:41 pm

Hi there,
Thanks for your insight! I agree; skin picking doesn't fit neatly into one category only. Context is definitely important to consider when trying to define it—although of course the most important question isn't which category it fits in, but whether or not it has become a problem that is interfering with your life or well-being. It sounds like this may be the case for you. I'd like to share our resources page for you, in case there's anything there you might find helpful:
https://www.healthyplace.com/other-info/resources/mental-health-hotline-numbers-and-refer…
If you have any further comments, questions, etc., feel free to reply here or elsewhere on the blog. I'll be around. :)
Sincerely,
Kim

Melon
September, 12 2022 at 3:03 pm

Well, I think that picking at skin CAN be a form of self harm. I picked/scratched at my skin before I started cutting myself, and picking at wounds as a form of self-harm was really hard for me to get over. But thank you for this article, skin picking and self harm ARE different. They serve different purposes, and different intentions when engaging in the behaviors. Just wanted to share my experiences as a side note :)

September, 20 2022 at 4:39 pm

Hi Melon,
That's absolutely true—depending on your definition and experience (of self-harm and/or skin picking), the two can overlap for sure. I think the most important thing no matter what is simply recognizing that you ARE self-harming and/or picking, and finding a way to replace those behaviors with better, healthier alternatives—which I've managed to do for self-harm, but am still working on with the skin picking. :)
Thank you so much for your comment; it's important to get different perspectives, and I want this blog to be a safe place for discussing exactly these types of topics! I hope that you were able to recover from both your self-harm and skin picking, or if not, I hope you are able to do so in the near future. Take care!
Sincerely,
Kim

Erin
July, 20 2022 at 11:56 pm

I came to this article because I've picked at myself practically my whole life, and I've often wondered if it was a form of self harm. I've been diagnosed with a form of OCD, and struggled with anxiety and depression off and on my entire adult life. You've brought up some interesting points, and as I've never cut myself, I can't say what that feels like. However, when I pick at myself, there's something about it that's incredibly soothing to me. I'm not aware of any particularly negative thoughts, but I am most usually very stressed or in an obsessive cycle of thinking. It's mentally relieving to me. So, I think you're right that they're not really the same, so far as motivation goes. But I've got scars all over my backside and thighs that would suggest that's it similar in the effect, at least.

July, 29 2022 at 11:54 am

Hi Erin,
Thanks for your comment. I also tend to pick when I'm stressed, so I agree that there's definitely some overlap, especially when it's used as an (unhealthy) method of self-soothing (as it seems like it might be in your case, conscious or not). At the same time, since you mentioned you do have OCD, I can see this still falling under the umbrella of a "compulsion." BUT, I am not a therapist or any kind of mental health professional, so take all of this with a grain of salt.
I think at the end of the day, however you label it, if your skin-picking is causing you difficulty or distress, it's an issue worth talking about and perhaps even worth reaching out for help with. I am still working to find a way to conquer my picking, myself.
In any case, thanks again for sharing your perspective. It's always good to hear different sides of an issue! I hope someday you and I both can find a way to stop picking.
Take care,
Kim

Vincent
May, 3 2022 at 9:53 pm

I guess I could argue, that on my side of the story with skin-picking, is that most of the time my intentions before and while doing it is to hurt myself. I think it might just be something thats extremely complex, so putting a label on this wouldn't describe it well enough because I will often have multiple reasons as to why I pick, at the moment though, I refer to my habits as self-harm because I intend to hurt myself each time. Another thing is that my chances of picking my skin is very low when I have gone through no stress at the moment but when I am stressed, my bathroom is the place to go. I really hope I'll be able to stop this soon, because I want to feel confident about my skin so much more.

May, 9 2022 at 10:45 am

Hi Vincent,
Thanks for your comment. Labels are definitely subjective, and I happen to agree with your perspective that if you are intentionally picking to hurt yourself, then that seems to fall under the self-harm umbrella. Regardless of the label though, it's good that you recognize (a) some reasons why you do it and (b) particular triggers, in this case, stress. I think one important step (also an obvious one, so forgive me if you've already been working on this) would be to work on stress management. It looks like we have some good tips around that on this page, if you're interested:
https://www.healthyplace.com/alternative-mental-health/treatments/managing-stress
As someone who hasn't been able to fully stop picking yet either, I can tell you that stopping is definitely a challenge. However, I do believe it is possible, and I have certainly made some progress over the years by doing things like learning to manage my stress and keeping my fingers busy—if I'm writing, for example, I'm not picking! (This isn't to say you should work all the time to avoid picking—but distractions can sometimes help!)
If you haven't yet, I would also suggest working with a professional if you can. (I personally have benefited a lot from online therapy; if you don't have time/ability to physically go to appointments, this might be a good alternative!) Here's our resources page, which can help you get started if you're interested:
https://www.healthyplace.com/other-info/resources/mental-health-hotline-numbers-and-refer…
I hope that help! If you have more questions or concerns, feel free to reply here or comment elsewhere on the blog—I'll be reading.
Sincerely,
Kim

Avery
April, 21 2022 at 11:19 pm

I’ve been picking my skin for years. I’ve tried to stop but nothing really seems to work. To make matters worse, when I was younger, my mother would actually ground me for picking at my skin. Not kidding! She actually took my computer away for 3 WEEKS when I was 14! Thankfully after I entered high school she stopped with that but she still gets on my case about the picking and I’m even thinking to myself why don’t you have me go to a doctor and get me diagnosed with ocd or something but she never did. And I can’t wear bandaids because the adhesive will cause a BAD allergic reaction. I’m getting to the point where once something starts to heal, I go and scratch at it and it just comes back open and I don’t know what to do

April, 26 2022 at 12:30 pm

Hi Avery,
I'm sorry to hear you're struggling with skin picking, and that your mom doesn't quite seem to understand it or what to do to help you with it. Have you tried sitting down to have a serious conversation with her about it? I know that can be incredibly awkward and difficult to initiate, but it might be worth a try if you haven't yet. I especially think it might be helpful to ask her to take you to a doctor, since you seem open to it. A therapist or other mental health professional would probably be ideal, but even your family doctor will do—they could help you with your skin picking AND talk to your mother about it, and about how she can help support your efforts to put skin picking behind you. Sometimes it takes a doctor's authority to get this kind of information across effectively.
As for the bandaids, that's rough about your allergy—have you tried hypoallergenic bandages? I know they're a thing, though I'm not sure how effective they will be for your particular allergy (I don't have any allergies, myself). Depending on where your wounds are, you could try wrapping them in gauze (and just tying it or taping it, making sure the adhesive only touches the gauze), though I understand this might draw some unwanted attention depending on the location. Other than that, I would suggest mainly just trying to take really good care of your wounds and scabs, both when you first get them and as they heal. Make sure you keep them clean and use antibiotic ointment as necessary to prevent infection and itching, both of which can make it extra hard not to pick. I've also heard that some people find fidget toys helpful, such as fidget spinners or even a rubber band around your wrist that you can snap whenever you feel the urge to pick. I've even seen some items that have material on them you're meant to pick off, so at least you can try and displace your need to pick while you work on finding a more permanent solution.
I hope that helps! If you have any further questions or concerns, don't hesitate to leave a comment here or elsewhere on the blog. I'll be reading.
Take care,
Kim

Paula
August, 7 2022 at 9:35 pm

I'm 68 and picked bug bites into scabs and then picked the scabs repeatedly as a child. My parents constantly yelled at me for picking and my father warned me he'd bring me to "The Scratching Lady" if I didn't stop. The SL and her son lived in a home where everything was blood-soaked due to their constant picking. I was probably around 5 years old and had many allergies . One day, the family was in the car and I picked a scab. My sister ratted on me and the next thing I know, my Dad is pulling into the driveway of the SL and pulling a hysterical me out of the backseat. After what seemed like an eternity, he relented. I really don't remember the rest. The scratching behavior ended well over 50 years ago but has recently started back up in the last year or so. Go figure.

August, 12 2022 at 11:05 am

Hi Paula,
I'm sorry to hear you had such difficulty as a child. If the scratching has started up again, you may wish to consider getting professional help this time. You can always call the lifeline (now at 988) and ask for any resources they may have, or check our resources page here:
https://www.healthyplace.com/other-info/resources/mental-health-hotline-numbers-and-refer…
I hope that helps. Take care, and good luck.
Sincerely,
Kim

Tdawg
August, 14 2022 at 8:13 pm

I pick at my fingernails, cuticles, pull on hangnails. I pick my nose. Bug bites, falling as a kid, any injury was pick territory. It still is. I'm going through a life jpheavel as I write this and just cut down my toe nails until they bled.
So, I noticed I was doing it. I came in here, and voila. I realize for myself that it is a form of fidgeting. I fidget with my hands when I'm nervous.
I learned how to knit. So I am now inspired to break it out and do some productive fidgeting.

Liz
February, 12 2022 at 12:15 pm

I'm the same, I don't really know how it's connected but just feel I'm not myself of not on the right path aligned with myself at the moment, feeling out of kilta does it make sense, I've been wondering whether to get help, I've only told a few people but because I'm not happy and il have an even worse day after I've damaged my fingers even more, and it snowballs to make me even lower.

February, 21 2022 at 4:29 pm

Hi Liz,
While I'm sure our experiences aren't exactly the same, I can definitely empathize with that feeling. It's a vicious cycle—you have a bad day, you hurt yourself to cope, and then your day gets even worse. In my experience, if you're thinking about getting help, that's usually a sign that you probably should—even if the situation isn't critical, the sooner you get help, the sooner you can begin healing. In case you haven't seen these already, below are the links to our main self-injury hub page (lots of general info there) and our resources page, which includes some hotlines and other contact info you may find helpful:
https://www.healthyplace.com/abuse/self-injury/self-injury-homepage
https://www.healthyplace.com/other-info/resources/mental-health-hotline-numbers-and-refer…
Recognizing that something doesn't feel right and that you want to change that is a vital first step. Reaching out like this via a comment on a blog is the next. I hope you do take that next step and reach out to someone for additional support, and that you can begin healing sooner rather than later. Let me know if you have any other questions, comments, or concerns—I'll be here, and I'll be reading. :)
Sincerely,
Kim

Alice
January, 21 2022 at 2:36 pm

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.

January, 31 2022 at 6:48 pm

Hi Alice,
I'm sorry for not getting back to you sooner. Thank you for your comment, and for your questions. You've made an excellent point; the labels we assign these issues should primarily be used to help us make important decisions like when to get help, and what type of help to get. I do think it would be a good idea to talk to your dermatologist if you think you would be able to do so; a medical doctor, particularly a skin doctor, would be an excellent ally and someone who would know a lot about healing the physical wounds you are dealing with right now.
However, it does sound like your skin picking is causing you distress--and I imagine undergoing skin cancer treatment may be stressful to you as well. So regardless of whether your skin picking is "just" compulsive, unconscious skin picking or transitioning to conscious, deliberate self-harm, I do think it would be wise to reach out for help. (My personal rule of thumb is that if you are already wondering if you need support, you probably could use some!) Commenting here on the blog was a great first step, but if you are ready, I think it would be a good idea to reach out to a certified therapist or counselor or, at the very least, a medical doctor.
If you haven't already, please check out our resource pages for more info and some contact information for various hotlines and resources that can help you find the support you're looking for:
https://www.healthyplace.com/abuse/self-injury/self-injury-homepage
https://www.healthyplace.com/other-info/resources/mental-health-hotline-numbers-and-refer…
If you have any more questions/comments/concerns, please feel free to keep commenting here or elsewhere on the Speaking Out About Self-Injury blog; I read all comments, and I always do my best to reply (when a reply is warranted) as soon as possible. Otherwise, I wish you the best of luck with your recovery.
Take care,
Kim

Paula
January, 17 2022 at 6:57 pm

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...

January, 19 2022 at 7:42 am

Hi Paula,
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. :)
Sincerely,
Kim

Liana
January, 12 2022 at 8:39 pm

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!

January, 17 2022 at 12:48 pm

Hi Liana,
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. :)
Sincerely,
Kim

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