Is skin picking linked to OCD?

It was a mild, mid-May morning in 2013 as hundreds of psychologists, psychiatrists, researchers, and journalists piled into the Moscone Convention Center in San Francisco for the 166th annual meeting of the American Psychiatric Association. Among the different talks and panels taking place over the weekend, there was one thing on everyone’s lips: The announcement of the DSM-5, the fifth version of the Diagnostic and Statistical Manual of Mental Disorders – the book that healthcare professionals use to diagnose mental health conditions.

Before 2013, skin picking had only ever been considered a symptom of other conditions, such as obsessive-compulsive disorder (OCD) or simply a bad habit. But that all changed with the introduction of the DSM-5 when – for the first time – skin picking was listed as its own condition. This was a landmark moment, as from now on, skin picking had to be taken seriously in the medical and scientific communities and not simply brushed off as a symptom or a bad habit.

It’s easy to see why for so many years, skin picking was seen as a symptom of OCD. After all, they both involve engaging in repetitive, compulsive behaviors associated with relieving anxiety. But while they may be linked and share some of the same underlying brain mechanisms, there are some important differences:

• While OCD is driven by obsessive, intrusive thoughts, skin picking is typically associated with a desire to ‘rid’ the skin of contamination or to ‘fix’ perceived imperfections.

• Engaging in OCD behaviors is not usually associated with pleasure, whereas most people who pick their skin have reported experiencing a feeling of pleasure when they pick. (This is not to say that skin picking is only associated with pleasure, as these positive feelings are often preceded or followed by negative emotions like guilt, shame, and anxiety).

• Some treatments for OCD (such as SSRIs) aren’t as effective in treating skin picking.

• While some people who pick their skin also have OCD, not everyone does, and the two conditions can exist separately.

While there is clearly some overlap between skin picking and OCD, we must continue to discuss, research, and develop treatments for skin picking in its own right – as this is the best way to help the millions of people worldwide get in control of their picking.