Skin picking is not a direct diagnostic criterion for Autism Spectrum Disorder (ASD), though it can occur in individuals with autism. This article explores the nature of skin picking and its relationship with autism and other conditions.
What Is Skin Picking
Skin picking, clinically known as excoriation disorder or dermatillomania, involves repetitive picking, scratching, or digging at one’s own skin. This behavior can lead to visible tissue damage, such as sores, lesions, and bruising. Common areas affected include the face, arms, legs, and cuticles, though individuals may focus on any body part. If left unaddressed, these actions can result in infections, scarring, and chronic pain.
Individuals with excoriation disorder often spend significant time on this behavior, sometimes hours per day. Picking may be conscious or unconscious, with some not realizing they are doing it until after damage occurs. This condition is classified as a body-focused repetitive behavior (BFRB) and falls under obsessive-compulsive and related disorders.
Skin Picking in Autism
While not a diagnostic criterion for Autism Spectrum Disorder, skin picking can be a co-occurring behavior in some autistic individuals. Research indicates that BFRBs, including skin picking, may be more prevalent in autistic populations. One study found 27.5% of children with autism engaged in skin picking, compared to 7.1% of typically developing children. This suggests a notable association.
Several factors associated with autism may contribute to skin picking. Sensory processing differences are implicated, where heightened sensitivity to skin irregularities like small bumps or scabs can become overwhelming. Picking might then serve as a way to “fix” or smooth these perceived imperfections. Skin picking can also function as a self-regulatory mechanism or a form of stimming, helping individuals cope with sensory overload or understimulation.
Anxiety and stress, common in autistic individuals, can trigger or exacerbate skin picking. The behavior may provide temporary relief or a sense of control during overwhelming emotional states. Repetitive behaviors, a core characteristic of autism, can also manifest as skin picking, becoming a habitual activity.
Other Causes of Skin Picking
Skin picking is not exclusive to autism and can be associated with several other conditions. It is often linked to anxiety disorders, where picking serves as a coping mechanism for stress or negative emotions. Many individuals report feeling tension or anxiety before picking, followed by a temporary sense of relief.
It frequently co-occurs with conditions such as Obsessive-Compulsive Disorder (OCD), hair-pulling disorder (trichotillomania), and body dysmorphic disorder. Boredom can also be a trigger, leading to automatic picking. In some cases, skin picking may relate to underlying medical conditions or certain genetic syndromes.
When to Seek Support
Seeking professional guidance for skin picking is advisable when the behavior causes significant distress or interferes with daily functioning. This includes situations where picking leads to physical harm, such as open wounds, infections, or noticeable scarring. Professional support is also beneficial if the behavior results in social isolation or feelings of shame and embarrassment.
A healthcare provider can conduct a comprehensive assessment to determine underlying causes and develop an appropriate support plan. Dermatologists can address physical skin damage and rule out dermatological conditions. Mental health professionals, such as psychologists or psychiatrists, specialize in diagnosing and treating excoriation disorder. Therapies like Cognitive Behavioral Therapy (CBT), particularly Habit Reversal Training (HRT), are often effective. Medications, such as selective serotonin reuptake inhibitors (SSRIs), may also be prescribed.