The methods and areas individuals pick at vary from person to person. Some individuals have many sores or scarred areas. Other individuals have only a few scars or sores. The areas individuals pick at may change over time.
Some individuals pick at their skin somewhat automatically, without thinking about it. Others are more conscious of the activity.
Individuals do not pick at their skin because they are concerned about their appearance. However, they may feel tense or anxious just before they do it, and skin picking may relieve that feeling. Afterwards, they often feel gratified.
Many activities (rituals) may accompany skin picking.
- Individuals may painstakingly search for a particular kind of scab to pick at.
- They may pull the scab off in a particular way, for example, using their fingers or an implement such as tweezers.
- They may bite or swallow the scab once it is pulled off.
Most individuals with skin-picking disorder also repeatedly pull out their hair, bite their nails, chew their cheek, or do other repetitive body-focused activities. Some individuals pick at the skin of others.
Individuals may feel embarrassed by or ashamed of the way they look or of their inability to control their behaviour. Consequently, they may avoid situations in which others may see the skin damage.
They typically do not pick in front of others, except for family members. Many individuals try to camouflage the skin damage with clothing or make-up.
Individuals may also be distressed by their loss of control and repeatedly try to stop picking at their skin.
Individuals with skin-picking disorder typically try to stop picking their skin or to do it less often, but they cannot.
If done excessively, skin picking can cause scarring, infections, excessive bleeding, and even a serious infection of the bloodstream (septicemia).
Many individuals with skin-picking disorder also have other mental health disorders, such as obsessive-compulsive disorder, hair-pulling disorder, and depression.
Symptoms typically vary in intensity but may continue throughout life.