What is finger picking?
Finger picking, also known as skin picking disorder or excoriation disorder, is a mental health condition characterized by the repetitive picking and pulling of skin on various parts of the body, most commonly the face, arms, and fingers. It is an impulse control disorder that can lead to significant tissue damage and emotional distress. Finger picking specifically refers to skin picking focused on the fingers and hands.
Some common signs and symptoms of finger picking include:
- Repeatedly picking at minor skin irregularities or perceived imperfections on the fingers, such as hangnails, calluses, or scabs
- Picking at healthy skin on the fingers out of habit or boredom
- Feeling tension or anxiety before picking, and relief or satisfaction during the act
- Wounds, scabs, scarring, or bleeding due to excessive picking
- Trying to conceal picked areas with clothing or makeup
- Feeling embarrassed, ashamed, or depressed about the effects of chronic picking
Finger picking can occur across all age groups but often begins in adolescence. It is more common in females than males. The fingers are a convenient and easily accessible area for picking behaviors.
What causes someone to pick their fingers repetitively?
The exact cause of finger or skin picking disorder is not known, but it appears to result from a combination of biological, psychological, and environmental factors, such as:
- Genetics – a family history of OCD or BFRBs increases risk
- Brain differences – abnormalities in brain pathways involving serotonin may contribute
- Psychological issues – anxiety, depression, obsessive thoughts, stress, or trauma can trigger picking
- Body-focused repetitive behaviors (BFRBs) – chronic nail biting, lip biting, and hair pulling are associated with skin picking
- Perfectionism or compulsiveness
- Substance use disorders
- Boredom or habits
- Sensory issues – hypersensitivity to touch or texture may lead to picking
For some individuals, finger picking starts with a minor skin imperfection that triggers the urge to pick. For others, it is an unconscious habit. Stress and anxiety can worsen picking behaviors.
Why is it hard to stop picking your fingers?
Finger picking can be extremely difficult to stop for several reasons:
- Brain reward response – Picking triggers the release of endorphins which provide temporary relief or pleasure. This makes the behavior highly reinforcing and addictive.
- Habit – Finger picking often becomes an automatic habit over many years, making it hard to break.
- Underlying anxiety/OCD – Skin picking may be a maladaptive coping mechanism for anxiety. The urge to pick may be overpowering.
- Perfectionism – A constant need to smooth imperfections can fuel chronic picking.
- Lack of awareness – Many people pick subconsciously while doing other tasks.
- Accessibility – Fingers provide constant access to pickable areas.
- Triggers – Things like blemishes, scabs, hangnails, boredom, or being alone can trigger strong urges to pick.
- Shame – Embarrassment about picked skin leads to concealment and isolation, making change harder.
The “itch-scratch cycle” in finger picking can be self-perpetuating – picking causes minor damage, leading to inflammation and itching, triggering more picking. Stopping this cycle requires understanding the underlying factors driving the behavior.
What physical and mental health problems can result from chronic finger picking?
Persistent finger picking over months or years can lead to various physical and mental health issues:
Physical health problems:
- Scarring, calluses, and discoloration of fingers
- Open sores and wounds vulnerable to infection
- Pain or reduced mobility of fingers
- Nerve damage
- Potential need for skin grafts or surgery in severe cases
Mental health problems:
- Distress, embarrassment, isolation, and low self-esteem due to appearance of fingers
- Anxiety, depression, stress related to uncontrolled picking
- Impaired daily functioning and activities
- Obsessive-compulsive disorder
- Body dysmorphic disorder
Chronic finger picking is associated with reduced quality of life comparable to other psychiatric disorders. Seeking treatment early is important to prevent significant tissue damage and emotional consequences.
How is finger or skin picking disorder diagnosed?
Finger picking falls under the diagnostic category of body-focused repetitive behavior disorders (BFRBDs) in the DSM-5 psychiatric manual. To be diagnosed with excoriation disorder (skin picking), the following criteria must be met:
- Recurrent picking of skin resulting in skin lesions
- Attempts to reduce or stop picking
- Picking causes significant distress or impairment
- Picking is not caused by a medical condition or skin problem
- The picking is not better explained by mental disorders like delusions or intoxication
A mental health provider such as a psychologist or psychiatrist would perform an evaluation involving:
- Physical exam of picked areas
- Discussion of symptoms, triggers, and history
- Psychiatric assessment and potential screening tools
- Assessment for other mental health conditions
- Ruling out medical conditions causing skin lesions
Keeping a picking diary to identify patterns can help with diagnosis and treatment. Providers may classify picking as mild, moderate or severe based on related distress and impairment.
What are some treatment options for chronic finger picking?
Treatment for chronic finger or skin picking involves a combination of therapy, medical strategies, and self-care:
Psychotherapy
- Cognitive behavioral therapy (CBT) to modify thoughts and behaviors
- Dialectical behavior therapy (DBT) for emotion regulation skills
- Habit reversal training (HRT) to increase awareness and substitute habits
- Acceptance and commitment therapy (ACT) for acceptance
- Support groups to reduce isolation and shame
Medical approaches
- Medications like SSRIs, N-acetylcysteine, or glutamatergic agents
- Botox injections to reduce picking urges
Self-care strategies
- Using bandages or dressings to prevent picking
- Keeping hands busy with fidget items
- Identifying and avoiding triggers
- Tracking picking urges, episodes, and triggers
- Redirecting focus when urges arise
Treatment is tailored to each individual. Those with underlying OCD or anxiety may require more extensive management. Multidisciplinary care involving therapists, psychiatrists, and primary doctors yields the best outcomes.
What tips can help someone stop picking their fingers?
Here are some proactive tips to help stop chronic finger picking:
- Get evaluated – See a doctor or mental health professional for assessment and diagnosis.
- Identify triggers – Increase self-awareness of situations, emotions, and skin flaws that trigger picking.
- Avoid triggers – Limit access to triggers through tools like bandages, gloves, or fidget items.
- Manage stress – Try relaxation techniques, exercise, or self-care activities to reduce anxiety.
- Substitute habits – Replace picking with less harmful habits like rubbing smooth stones.
- Keep hands busy – Engage hands in activities like squeezing stress balls when urges arise.
- Reduce perfectionism – Challenge thoughts about the need to fix every skin flaw.
- Find accountability – Enlist support from loved ones to intervene if picking occurs.
- Try psychotherapy – Habit reversal or CBT can equip you with coping skills.
- Consider medication – Certain drugs can reduce irresistible urges to pick.
With professional help, consistency, and time, chronic finger picking can be overcome. The key is committing to regular techniques to short-circuit the picking cycle. Support groups can also provide validation and assistance.
Conclusion
Finger picking is a challenging condition driven by multiple factors like genetics, brain biology, emotions, and habitual patterns. The urge to pick can feel uncontrollable. But recovery is possible through professional treatment, lifestyle changes, and diligent habit reversal efforts.
With a combination of therapy, medication (if needed), alternative coping habits, trigger avoidance, and self-compassion, finger picking compulsions can be reduced. It requires patience and dedication, but a life free of chronic picking is achievable. Support groups and therapists provide guidance for this difficult process.
The first step is seeking help without judgment or shame. Finger picking does not define someone’s worth. Understanding this disorder empowers individuals to take control and find healthy ways to overcome ingrained picking habits. Consistent hard work focused on healing thoughts, emotions, and behaviors can steadily minimize picking urges and achieve lasting change.