Dallas CBT provides specialized treatment for skin picking and other body-focused repetitive behaviors in children and adults. Excoriation, or skin picking disorder, involves strong and repeated urges to pick, squeeze, or scratch at skin, often at a spot where one perceives a skin defect. Picking usually occurs on the face, hands, or arms, and results in sores, cuts or lesions. Picking is often accompanied by anxious feelings, but the urges to pick might also occur without awareness. Individuals with skin picking disorder find it very difficult to stop picking, even when they notice skin damage, and may take steps to try to hide their cuts or sores.

Potential Signs of Excoriation Disorder

  • Finding yourself picking at skin throughout the day such during class, watching TV, or falling asleep
  • Preoccupation with skin that does not feel or look “right” (for example, skin that is rough, blemished, or uneven)
  • Damage to the skin, including scabs, cuts, and sores
  • Difficulty in stopping this behavior
  • Having to find ways to cover up the skin damage cause by picking, such as with long-sleeves or other articles of clothing, makeup, or bandages


Skip picking in Excoriation (also known as Dermatillomania) is a part of an ingrained behavioral pattern that is learned and has been reinforced over time. As such, it is possible for this behavior to be changed or “un-learned,” and replaced with healthier, more desirable behaviors. Though this is often very challenging for individuals to accomplish on their own, there are effective treatment options available to assist you with this process. Therapy at Dallas CBT is based on the Comprehensive Behavioral Model (ComB), which is a modern therapeutic approach for skin picking and other repetitive body-focused behaviors based on CBT principles.

The ComB model is a short-term treatment approach that involves identifying cues or triggers for skin picking, such as certain environments, activities, or emotional states, and the unique functions that picking serves for the individual. Therapy helps clients increase awareness and understanding of their behaviors and urges, identify important factors contributing to the behavior, assess the purpose of the behavior, and establish a set of personalized strategies to minimize and replace skin picking. Therapy will also teach individuals skills to modify problematic thoughts and feelings contributing to skin picking behaviors and establish non-harmful alternative behaviors that address the functions that picking serves. For children struggling with skin picking, an important component of therapy involves assisting parents with understanding the disorder and improving their ability to help their child manage this behavior and employ new strategies developed in therapy. Over the course of treatment, urges to pick will become increasingly weaker and easier to manage.

In therapy, you can expect to:
  • Increase awareness and understanding of behaviors and urges
  • Identify important factors that influence and maintain picking behavior
  • Better understand the purpose of the behavior
  • Establish a set of personalized strategies to minimize and replace picking