What are the barriers to successful treatment for Skin Picking Disorder (excoriation)?

There are several barriers that can impede the treatment of skin picking disorder (excoriation disorder). These barriers can vary from individual to individual but commonly include:

Skin Picking Disorder
  1. Lack of Awareness and Understanding: Skin picking disorder is not as widely recognized or understood compared to other mental health conditions. Many individuals and even some healthcare professionals may not be aware of the disorder, which can delay accurate diagnosis and appropriate treatment.

  2. Stigma and Shame: People with skin picking disorder may feel embarrassed by the behaviors and have a lot of secrecy around their habits. This can make it challenging for them to seek help or disclose their symptoms to others, including healthcare providers.

  3. Misdiagnosis or Underdiagnosis: Skin picking disorder may be misdiagnosed or underdiagnosed, as its symptoms can overlap with other conditions like OCD, BDD, or impulse control disorders. The lack of specialized training or knowledge about the disorder among healthcare professionals can contribute to inaccurate diagnoses or overlooking the specific needs of individuals with excoriation disorder. (Per our knowledge, Kairos Wellness Collective is the only center in Boulder with specific training in skin picking).  

  4. Limited Treatment Options: While treatment approaches like cognitive-behavioral therapy (CBT), the COMB technique, and habit reversal training (HRT) have shown promise, access to qualified providers who specialize in treating skin picking disorder may be limited. Clinicians must be focused and committed to supporting their clients through recovery.  Often inexperienced clinicians ignore the skin picking and choose to focus sessions on easier-to-treat mental health issues.  

  5. Self-Perception and Motivation: Some individuals with skin picking disorder may not perceive their behavior as problematic or may believe they can overcome it on their own. Lack of motivation or ambivalence towards treatment can hinder the initiation or continuation of therapeutic interventions.  Some people experience their skin picking as pleasurable, and only regret when it goes too far (infection, bleeding, scarring).  

  6. Relapse and Treatment Resistance: Skin picking disorder can be chronic and resistant to treatment in some cases. Individuals may experience periods of remission followed by relapse, which can be discouraging and demotivating. Persistent symptoms or relapses can make individuals lose hope and discontinue treatment prematurely.


Overcoming these barriers often requires a multi-faceted approach. Raising awareness about skin picking disorder, reducing stigma, improving education among healthcare professionals, and expanding access to specialized treatment options can all contribute to better outcomes for individuals with excoriation disorder. Supportive and non-judgmental environments, both in clinical settings and within communities, can also play a crucial role in addressing the barriers and providing effective treatment options for those affected by skin picking disorder.


Please contact Kairos Wellness Collective today to learn about how our therapists can support you.

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