Everyone picks at their skin. Perhaps you’ve popped a pesky pimple or fussed with a stubborn scab. However, there are times when this harmless picking can become more extreme. In some cases, the habit can develop into a chronic condition called skin picking disorder, or excoriation disorder.

According to Medical News Today, skin picking disorder is a body focused repetitive behavior (BFRB) that affects about 1.4% of adults in the United States.

People with excoriation disorder can experience it in a myriad of ways, all of which involve picking, pulling, or tearing at healthy skin, blisters, pimples or scabs.

“One of the ways I experience skin picking is in frequently touching, turning, or picking at my earrings in my pierced ears,” Kristen King, speaker, consultant and coach, tells Considerable.

Here are four ways that may indicate you’re dealing with excoriation disorder, and what to do about it.

1. You compulsively pick at your fingers

Picked nails, scabs on thumbs and fingers, bleeding, and lacerations around cuticles are a telltale sign of skin picking disorder.

“It is not uncommon for people with excoriation disorder to target their fingernails and cuticles as a site for picking,” says GinaMarie Guarino, Licensed Mental Health Counselor (LMHC), a therapist with a history of working with people who are in treatment for excoriation disorder.

Fingernails and cuticles tend to be a prime location, Guarino says, as the skin can sometimes flake, and nails can split, making them easy to pick at. “It is also a location that can be picked subtly, without too many people noticing the act of picking.”

2. You have sores or bruises around the hairline and neck

The fingers aren’t the only place that skin picking disorder affects. Though people with excoriation disorder will try to find discrete places to target their picking.

“Picking around the hairline can be a good place because it can be concealed with certain hairstyles and clothing,” Guarino says. Or, like King, perhaps you’re someone who targets a subtle spot like pierced ears.

3. You have recurring sores, scabs, or bleeding lacerations

Excoriation disorder often causes people to pick at their scabs. “Seeing scabs that will not heal, scars, and deep lacerations are all indicators that someone has been repeatedly picking at a certain area of their body,” Guarino tells Considerable.

4. You’re suffering from anxiety

Finally, the signs of potential skin picking disorder aren’t solely physical.

“[Excoriation disorder] often starts as a nervous habit, as many people with [it] also suffer from some form of anxiety,” explains Guarino.

Causation follows correlation: The shame and embarrassment that comes from the self-mutilating exercises can also cause anxiety, social anxiety, and isolation or withdrawal from friends and family.

Obsessive compulsive disorder (OCD), trichotillomania, and ADHD might also accompany or exacerbate skin picking disorder.

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You’re not alone

Remember, there are treatment options for skin picking disorder. These include medication and therapy, along with treating any underlying condition that may be exacerbating the urge to pick.

King says she’s learned to redirect her skin picking urges with a variety of wellness tools: meditation, deep breathing, touch-toys/fiddle toys, visualization exercises, and more.

Mindfulness can be especially effective for increased awareness and decreased anxiety. “I have a much greater urge to pick when I’m feeling anxious, overwhelmed, underfed, or overly tired,” notes King. “I find that when I’m paying close attention to my wellness overall, I have much less urge to pick and am able to redirect myself to other tools more effectively.”

Any or all of the above methods may not be 100% effective, and that’s OK: “On days when I do find I need to pick, I’ve learned strategies I can use to minimize the negative impact of picking (e.g, bleeding, scarring, scabbing, infection), which helps me minimize my sense of shame about it,” King tells Considerable.

These might include applying soothing topical ointments, such as coconut oil or aloe vera, hiding tools that are used to pick or pull at skin (such as tweezers), and avoiding mirrors that trigger the urge to pick.

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