Understanding Skin Picking and Autism: A Parent's Guide

Sarah's mom first came to me worried about the open sores on her daughter's face. “At first, I thought she was just being a teenager with a bad habit,” she told me. I'd tell her to stop picking, try putting Band-Aids on the spots, and even reward her for keeping her hands down. Nothing worked.”

If this sounds familiar, you're not alone. These symptoms are part of a more extensive psychiatric condition known as skin-picking disorder, also known as excoriation disorder in psychiatry.  

While some people might occasionally pick at a scab or blemish, those with excoriation disorder experience an intense, recurring urge to pick at their skin, often resulting in noticeable sores or scarring. 

Skin-picking disorders frequently co-occur with:

• Depression and anxiety
• Other obsessive-compulsive disorders
• Impulsivity-related conditions

In autism, these may compound existing challenges with sensory processing and social interaction

Through years of observing skin-picking behaviors, I've seen patterns emerging like distinct personalities - each telling a unique story of how this condition manifests:

• The "sensory seeker" engaging in skin picking for stimulation
• The "unconscious engager" picking or pulling during focused activities
• The "ritual performer" incorporating skin picking into complex routines, unable to inhibit picking in daily activities 
• The "mixed presenter" shows automatic and focused behaviors; this one has a lot of impulse control challenges!
• The "Just Right" seeker picks at sores, scabs, or skin imperfections until it feels "just right."

For many parents, watching their children engage in these behaviors can be heart-wrenching. You might wonder, "Why do they do this?" "How can I help them stop?"

Remember that:

• Take a deep breath - this doesn't reflect your parenting skills. Like many mental health conditions, skin picking develops through a complex mix of factors beyond anyone's control.
• Your child is fighting an internal battle, not being defiant or difficult. They often feel frustrated and helpless about these behaviors, too, even when they want to stop.
• Hope and help are within reach! From behavioral therapy to medication, there's a growing toolkit of treatment options that can make a real difference in managing these behaviors.
• Change is possible - many people learn to better manage their skin picking over time. Small steps forward, even with occasional setbacks, are still progress worth celebrating.
• These behaviors rarely travel alone. Anxiety, OCD, and depression often walk hand-in-hand with skin picking, but here's the good news: treating one condition often helps improve the others.

Looking Forward

While these behaviors often have a chronic course, with symptoms that come and go, there's much you can do to help your child manage them. Success might look different for each family - maybe it's fewer picking episodes, better wound care, or new coping strategies.

Coming Up Next

In our next blog post, we'll dive deep into evidence-based treatments that can help manage skin-picking behaviors. We'll explore the latest medications that have shown promise, from selective serotonin reuptake inhibitors (SSRIs) to N-acetylcysteine, and discuss how specialized therapy approaches like habit reversal training and cognitive behavioral therapy can make a real difference. Whether you're just starting this journey or looking for new strategies, you'll find practical guidance on working with healthcare providers to find the right treatment combination for your child.