Scalp picking is a common human behavior, ranging from an occasional habit to a more persistent action. While many touch their scalp intermittently, for some, this behavior becomes frequent and difficult to control. This article explores the characteristics of scalp picking and its classification within mental health.
Understanding Scalp Picking
Scalp picking involves repetitive touching, scratching, or digging at the skin on the head. Individuals often focus on specific areas, targeting perceived imperfections like bumps, scabs, or rough patches. The behavior can be automatic or a more focused act. Before picking, a person might experience tension, anxiety, or stress. The act of picking can then lead to temporary relief, satisfaction, or pleasure. This cycle reinforces the behavior, making it challenging to stop despite a desire to do so.
Excoriation Disorder and Its Classification
When scalp picking becomes recurrent and causes significant distress or impairment, it may indicate Excoriation Disorder, also known as dermatillomania or skin-picking disorder. This condition involves repeated skin picking that results in tissue damage or lesions. Individuals often make multiple unsuccessful attempts to reduce or stop the behavior.
Excoriation Disorder is classified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), as a Body-Focused Repetitive Behavior (BFRB). BFRBs are self-grooming behaviors that cause unintentional physical damage. In the DSM-5, Excoriation Disorder is placed under “Obsessive-Compulsive and Related Disorders,” alongside conditions like Obsessive-Compulsive Disorder (OCD) and trichotillomania (hair-pulling disorder). This classification acknowledges shared features with OCD, though they remain distinct conditions.
Distinguishing From Obsessive-Compulsive Disorder
Excoriation Disorder is a distinct condition from Obsessive-Compulsive Disorder (OCD), despite its categorization within “Obsessive-Compulsive and Related Disorders” in the DSM-5. OCD is defined by obsessions (intrusive thoughts, urges, or images) and compulsions (repetitive behaviors performed to reduce distress or prevent a feared outcome). For example, someone with OCD might repeatedly check locks due to an obsessive fear of burglary.
Excoriation Disorder is characterized by repetitive picking, often driven by urges or a desire for sensory stimulation or tension relief. Unlike OCD, picking in Excoriation Disorder is rarely motivated by specific obsessive thoughts, such such as preventing harm or contamination. The primary internal experience is the urge to pick and subsequent relief or satisfaction, rather than the anxiety-driven cycle seen in OCD.
When to Seek Support
Scalp picking warrants professional attention when it moves beyond an occasional habit and causes significant problems. Signs indicating a need for support include physical harm, such as skin lesions, open wounds, infections, or scarring on the scalp. Persistent picking can also lead to folliculitis or permanent hair loss.
The behavior may also cause emotional distress, including shame, guilt, or embarrassment. If scalp picking interferes with daily life, such as avoiding social situations due to visible damage, or if attempts to stop are repeatedly unsuccessful, seeking help is advisable. A healthcare professional, such as a dermatologist for physical symptoms or a therapist or psychiatrist for mental health aspects, can provide diagnosis and guidance.