What is skin picking?
Skin picking, also known as excoriation disorder or dermatillomania, is a mental health condition that involves repeatedly picking at one’s own skin, often to the point of causing damage. It goes beyond normal grooming habits and involves obsessively picking at minor imperfections or perceived flaws in the skin, such as scabs, calluses, blemishes, or ingrown hairs.
Some common areas that are picked include the face, arms, legs, back, scalp, and feet. However, any part of the body can be affected. Skin picking may occur consciously or unconsciously and can happen during times of stress, boredom, distraction, or relaxation. It can become an automatic habit.
Skin picking of the feet specifically involves repeatedly picking at and peeling away layers of dry, callused skin on the heels and balls of the feet. This can lead to sores, infections, and bleeding if taken to extremes. The behavior tends to be chronic and very difficult to stop.
What causes skin picking?
The exact causes of skin picking disorder are not fully understood, but research suggests that it likely involves multiple factors:
– Biology: Some studies show abnormal levels of serotonin, dopamine, and other neurotransmitters may play a role. These are chemicals that regulate mood and behavior. There also appears to be a genetic component in some cases.
– Emotional regulation: Many people with skin picking use it as a way to cope with negative emotions like anxiety, stress, loneliness, boredom, or frustration. The act can provide temporary relief or distraction.
– Body-focused repetitive behaviors: Skin picking falls under the umbrella of BFRBs. These are impulse control disorders that involve damage to one’s physical appearance through repetitive, habitual behaviors. Other examples are nail biting, cheek biting, and hair pulling.
– Obsessive-compulsive disorder: Skin picking and OCD seem to overlap in some ways. The urge to pick can be obsessive, as can trying to “fix” or smooth imperfections. However, skin picking has not been established as a subset of OCD.
– Sensory processing issues: Some research points to problems with processing physical sensations and urges. This may make resisting triggers more difficult.
Why do people pick their feet specifically?
Feet are a very common target for skin picking for several reasons:
– The skin on the feet tends to build up thick layers of rough, dry, callused skin, especially around areas of friction and pressure like the heels and balls of the feet. This callused skin provides a texture and sensation that can trigger picking urges.
– Cracks, peeling skin, blisters, corns, and ingrown toenails on the feet also provide irregularities that can trigger picking.
– Feet are easily accessible to pick at anytime when wearing open shoes, sitting on the couch, or in bed. The constant access enables the habit.
– Damaged or picked-at skin on the feet is easy to conceal with socks and shoes, allowing the behavior to happen secretly and progress without intervention.
– Thoughts that the feet are less noticeable or “don’t matter” compared to visible areas like the face may mean people are less concerned about damage occurring there.
– Feet already tend to get rougher treatment and have thicker skin, so people may feel there is more leeway to pick intensely compared to delicate facial skin.
– Pickers often report getting a sense of satisfaction, relaxation, or “fixing” sensations when removing rough, dry layers of skin from their feet.
What are symptoms and signs of skin picking on feet?
Symptoms and signs that someone is excessively picking at the skin on their feet can include:
– Visible damage like open sores, scabs, wounds, redness, swelling, bleeding, bruising, or discoloration on areas of the feet.
– Thick calluses on feet that are picked down past the inner layer of skin, leaving very thin skin over the wounds.
– Peeling skin around the heels, toes, sides of the feet, underside of toes.
– Infections like cellulitis that may be oozing pus or have an odor.
– Scarring over repeatedly picked areas.
– Bandages, plasters, or socks worn all the time to conceal picking.
– Inability to stop picking behavior despite trying to stop or conceal damage.
– Urges and sensations reported before or during picking episodes.
– Picking for extended periods, losing track of time.
– Avoiding exposing bare feet around others due to embarrassment or shame over damage.
– New corns, blisters, or calluses that are “created” by the individual’s rubbing or picking.
– Preoccupation with examining and touching the feet. Frequently removing shoes or socks to pick.
– Missed days of work/school/plans due to picking episodes.
– Signs of infection like red streaking, fever, chills.
What problems are caused by picking skin on feet?
Some common complications and consequences that can result from chronic, excessive skin picking on the feet include:
Pain and discomfort
Open sores, damaged tissue, and infections caused by picking can be very painful. Picking can also damage nerve endings, causing chronic pain. The compulsion to keep picking typically continues despite pain.
Difficulty walking
Deep wounds, bruising, blisters, or swelling caused by foot picking may make it very painful and difficult to stand and walk normally. This can impact mobility and independence.
Infections
Bacteria can easily enter broken skin and cause infections like cellulitis, abscesses, paronychia, or foot ulcers. Infections may be mild or potentially severe if they spread to the bloodstream. Diabetics face increased infection risks.
Scarring
Repeated skin damage in the same areas can destroy collagen and elasticity in the skin, leading to thick, unsightly scarring on feet that does not heal well.
Social isolation
Embarrassment about skin damage may cause people to avoid situations where feet are exposed, such as swimming, going to the beach, or visiting the pedicurist. This social isolation worsens the skin picking habit.
Poor body image
Viewing their damaged feet as ugly, disgusting, or shameful can harm self-esteem. Feelings of low self-worth and body dysmorphia often accompany chronic skin picking.
| Area Picked | Potential Problems |
|---|---|
| Heels | Cracked, painful heels; bleeding; difficulty walking |
| Toes | Ingrown toenails; deformed toenails; infected wounds |
| Bottom of feet | Deep blisters and wounds from pressure; bleeding |
| Top of feet | Redness, bruising, swelling, blisters |
| Ankles | Scarring, bleeding, bruising, friction wounds |
When to seek help for skin picking?
It’s advisable to see your doctor or a mental health professional if:
– Skin picking is causing significant or recurrent injuries, pain, or disability
– It takes up a substantial amount of time each day
– Causes major distress or impacts quality of life
– Triggers isolation, depression, anxiety, or compulsions
– Interferes with relationships or daily activities
– Occurs alongside other concerning behaviors or symptoms
Many cases of skin picking can be successfully treated with therapy, medications, or other interventions. But the condition tends to be chronic, with improvement taking time. Early treatment leads to better long-term outcomes.
Tips for stopping foot skin picking
Some self-care tips that may help reduce chronic skin picking focused on the feet include:
– Bandage picked areas to prevent re-picking and promote healing
– Apply moisturizer regularly to soften calluses and dry skin
– Wear socks and closed shoes to limit physical access to feet
– Identify emotional triggers for picking episodes
– Find replacement habits for the hands like kneading stress balls
– Limit time spent sitting idle; stay busy and active
– Be attentive to picking urges and consciously stop as they arise
– Confide in a supportive friend or family member
– Use tools like journals, apps, or charts to record progress
– Reward successes and be encouraging rather than self-critical
Medical treatments
If self-care strategies are insufficient to control skin picking of the feet, a doctor may recommend:
– Cognitive behavioral therapy (CBT) – addresses faulty thoughts tied to the compulsion
– Habit reversal training (HRT) – teaches substitute behaviors for the picking urge
– Medications like SSRIs, NAC, or glutamate modulators
– Special bandages and patches to block picking
– Topical medications to heal wounds and prevent infection
– Evaluation and treatment of any underlying conditions
Seeking professional help
Working with qualified therapists and psychiatrists who specialize in skin picking disorder and related body-focused repetitive behaviors can increase the chances of successfully managing this condition long-term. Treatment plans are tailored to each individual but often involve both therapy and medication.
Support groups can also provide community, advice, and resources for improving foot skin picking symptoms. Help is available – sufferers simply need to take the first step in seeking it out. There is no need to continue quietly struggling with this condition alone.
The takeaway
Skin picking disorder involving the feet is a challenging condition driven by complex internal and external factors. The urge to “fix” or remove imperfections from the thick callused skin leads to harmful picking and scraping that can cause pain, infection, scarring, and emotional distress. But improvement is possible, especially when treatment is started early before the habits become entrenched. Seeking professional mental health guidance combined with consistent self-care provides the best chance for gaining control over foot skin picking urges and repairing damaged skin. There are many different pathways to healing available for those who suffer from this misunderstood disorder.
