"I made my decision to lead a path of self-destruction
A slow progression - killing my complexion
And I'm picking scabs off my face"

--Green Day - Geek Stink Breath--

The Clinical Picture:

The primary characteristic of Compulsive Skin Picking (CSP) is the repetitive picking at one's own skin to the extent of causing damage. This psychiatric disorder is not currently listed in the Diagnostic and Statistical Manual (DSM-IV) published by the American Psychiatric Association (APA), but some researchers believe it merits distinction as a separate diagnostic entity.

The lesions produced by patients as a result of picking are called neurotic excoriations. Many patients suffering from neurotic excoriations can engage in picking for several hours per day. The wounds can go on without healing for many months. In rarer and more severe cases the skin wounds and infections require doctor's treatment and sometimes even surgery and hospitalization. A 1978 study showed that 2% of all dermatology patients are affected with CSP.

Like nearly all psychiatric disorders stressful circumstances can exacerbate picking behaviors. Patients often report that the urge is extremely difficult to control even when trying to resist. Some patients describe the behavior as trance-like when they are picking at lesions.

Treatment options:

Many cases of CSP can be treated with some form of Cognitive-Behavioral Therapy. This is where a mental health professional (psychologist usually) teaches the patient how to become more consciously aware of situations and events that trigger skin-picking episodes. Then the patient is taught to use other less destructive behaviors in response to these situations.

As with OCD, patients with CSP often show signs of remarkable improvement upon the administration of selective serotonin reuptake inhibitors (SSRI) like Prozac,Paxil, Zoloft, Luvox,Celexa, and most recent Lexapro. A combination of behavioral therapy techniques along with drug therapy is often recommended.

Related disorders:

CSP is closely related to Obsessive Compulsive Disorder (OCD) since it is dystonic, repetitive, ritualistic, and relieves tension. (In fact, a recent study found that 23% of those with OCD also had symptoms of CSP.) Other related disorders include: nail biting, Trichotillomania, Body Dysmorphic Disorder (BDD), Tourette's Disorder, Stereotypic Movement Disorder, and Prader-Willi syndrome.

"Here I go again on my own. Goin' down the only road I've ever known."

"My shadow's shedding skin and I've been picking scabs again."
Tool - Forty-Six & 2

Hello, I take zoloft. I am so gloriously mentally ill! You will love me, yes?