Eating disorders and skin picking
Updated: Feb 12
Eating disorders and skin picking are separate but related conditions that often co-occur.
Skin picking, (also known as dermatillomania or excoriation disorder), is a body-focused repetitive behaviour (BFRB). characterized by the recurrent picking of one's own skin, resulting in tissue damage. Other BFRBs include hair pulling disorder, nail biting and nail picking , and other self-grooming related behaviours.
BFRBs are among the most poorly understood, underdiagnosed and untreated group of mental health disorders. BFRBs aren't self-harm. Research suggests that causes of BFRBs include improving or correcting a perceived imperfection in physical appearance, in addition to attempted self-regulation of intense emotions.
The severity of BFRBs vary and is often an unconscious action. Studies have found that individuals with eating disorders are at an increased risk of developing skin picking behaviours. Research has also shown that skin picking behaviours are more common in individuals with bulimia nervosa and binge eating disorder than in those with anorexia nervosa.
It can quickly become a comorbid condition with eating disorders, as well as OCD, body dysmorphic disorder and anxiety disorders
In some cases, skin picking may be a manifestation of compulsions and obsessions commonly seen in eating disorders, such as an obsession with having perfect skin or a compulsion to remove perceived flaws or imperfections. Additionally, both conditions are thought to be related to difficulties in regulating emotions and may share common underlying psychological and neural mechanisms, such as impulsivity and compulsivity.
In some cases, skin picking may be used as a form of 'purging', similar to vomiting or laxative abuse, to cope with feelings of guilt and shame associated with binge eating.
It is important to note that the relationship between eating disorders and skin picking is complex and typically involves multiple factors, including genetic, environmental, and psychological factors. Further research is needed to fully understand the links between these conditions and develop more effective treatments.
CBT is currently the treatment of choice for BFRBs, with existing studies suggesting that CBT is superior to medication in treatment outcomes. Some individuals may need medication initially or in conjunction with CBT.
As is true with successful treatment of eating disorders, an emphasis should be placed on matching the treatment to the individual. There are a number of treatment approaches that fall under the umbrella of CBT, including Habit Reversal Training and Comprehensive Behaviour Treatment.
Acceptance and Commitment Therapy and Dialectical Behavioural Therapy are approaches that help tolerate distress and regulate emotions, and so can successfully bolster the effectiveness of other cognitive behavioural therapies with both eating disorders and BFRBs. Addressing an eating disorder and BFRB concurrently using a combination of these techniques has been shown to have very positive outcomes.
If you are struggling, or you've noticed your loved one picking their skin or exhibiting signs of an eating disorder, reach out for help and support.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Arlington, VA: American Psychiatric Association.
Eshkevari, E., & Corstorphine, E. (2017). The comorbidity of eating disorders and excoriation (skin-picking) disorder. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 22(2), 287-292.
Grant, J. E., & Kim, S. W. (2002). Impulse control disorders in adult psychiatric inpatients. The American Journal of Psychiatry, 159(12), 2008-2011.
Veale, D., Gournay, K., Dryden, W., Boorman, R., Shah, F., Willson, R., ... & Walburn, J. (1996). Body dysmorphic disorder: a cognitive behavioural model and pilot randomised controlled trial. Behaviour Research and Therapy, 34(8), 717-729.
The TLC Foundation for BFRBs