Dermatillomania in Teens and Young Adults

Skin picking disorder often begins during adolescence. The combination of puberty, acne, heightened self-consciousness, and increasing academic and social pressure creates a perfect environment for the behavior to take root. Yet it's also the age when people are least likely to ask for help, and when the people around them are most likely to dismiss it as "just a phase."

If you're a teen or young adult struggling with skin picking, or a parent who's noticed the signs, this guide is for you.

Why Does Skin Picking Often Start During Adolescence?

The Acne Connection

Puberty brings hormonal changes that produce acne for the majority of teenagers. For some, the presence of pimples, blackheads, and rough skin creates a powerful trigger for picking. What starts as popping a single pimple can escalate into a compulsive pattern, especially when combined with perfectionism about appearance.

The progression often looks like this: a blemish appears → the urge to "fix" it feels irresistible → picking provides momentary satisfaction → the damage looks worse than the original blemish → shame and frustration → more picking to "fix" the damage.

Emotional Regulation Is Still Developing

The prefrontal cortex, the brain region responsible for impulse control and decision-making, doesn't fully mature until the mid-twenties (National Institute of Mental Health). Teenagers are dealing with increasingly complex emotions with a brain that's still building the hardware to manage them.

Skin picking can emerge as an emotion regulation strategy during this gap: a way to cope with anxiety, boredom, frustration, or overwhelming feelings when healthier coping mechanisms haven't been developed yet.

Social Pressure and Appearance Anxiety

Adolescence brings intense awareness of how others perceive you. Social media amplifies this with filtered images that set impossible standards for skin appearance. For teens already prone to perfectionism, the gap between their skin and the flawless faces they see online can fuel obsessive examining and picking.

Increasing Stress Without Established Coping Skills

Academic demands, social dynamics, identity formation, family conflict, romantic relationships. The stress load during adolescence is real and growing, but most teens haven't yet developed a mature toolkit for managing it. Picking fills the gap.

How Skin Picking Affects Teens Specifically

Social Withdrawal

Visible picking damage on the face can lead to:

• Avoiding social events, parties, or gatherings
• Skipping school on days when skin looks particularly bad
• Withdrawing from extracurricular activities
• Avoiding eye contact or turning away in conversations

Academic Impact

Picking sessions can consume significant time, particularly at night, leading to sleep deprivation that affects concentration and academic performance. The emotional toll (shame, anxiety, low self-esteem) further impairs the ability to focus and engage at school.

Identity and Self-Worth

During a period when identity is actively forming, the shame of skin picking can become woven into a teen's self-concept. "I'm the one with bad skin," "there's something wrong with me," "I'm disgusting." These beliefs, formed during a vulnerable period, can persist into adulthood.

Secrecy and Isolation

Most teens with skin picking disorder hide it completely. They may not realize the behavior has a name, let alone that millions of others share it. The secrecy reinforces the belief that they're the only one, which deepens the shame.

How Parents and Loved Ones Can Help

If you've noticed a teen in your life picking at their skin, how you respond matters enormously. The wrong approach can deepen shame and secrecy. The right approach can open the door to help.

What to Do

Educate yourself first. Learn about skin picking disorder and BFRBs before starting the conversation. Understanding that it's a recognized condition, not a choice, changes everything about how you approach it.

Start with empathy, not correction. "I've noticed you've been picking at your skin, and I want you to know I'm not upset. I've been reading about it, and it's more common than you'd think. Do you want to talk about it?" is far more effective than "Stop picking your face, you're making it worse."

Normalize seeking help. Frame therapy as a tool for managing a specific challenge, not as evidence that something is wrong with them. "There are therapists who specialize in exactly this" is less loaded than "I think you need therapy."

Don't monitor or police the behavior. Constant surveillance ("Are you picking again?") increases shame and anxiety, which increase picking. Instead, ask how you can support them and let them guide the level of involvement.

Provide practical support. Help with environmental modifications: better lighting, covering mirrors, providing fidget alternatives, supporting a gentle skincare routine.

What to Avoid

• "Just stop doing it": If they could, they would. This response communicates that you don't understand the problem.
• Drawing attention to their skin in public: Comments about skin appearance in front of others are deeply damaging.
• Expressing disgust or frustration: Even well-meaning frustration ("I just don't understand why you keep doing this") reinforces shame.
• Punishing or restricting: Taking away privileges or punishing picking treats a neurological behavior pattern as a disciplinary issue.

Getting Help

Talk to Someone

Whether it's a parent, school counselor, doctor, or trusted adult, breaking the silence is the most important step. If the idea of an in-person conversation feels too difficult, many teens start by writing a note or preparing what they want to say in advance.

Professional Support

Therapists trained in habit reversal training (HRT) and CBT for BFRBs can be highly effective with teens. The TLC Foundation for BFRBs maintains a directory of trained providers.

Self-Help Tools

Building awareness of picking patterns is a practical first step that doesn't require a therapist. Untouched can help teens notice automatic picking during computer use by detecting when hands move toward the face and providing gentle alerts.

It Gets Better

Adolescence is temporary. The brain continues developing impulse control capacity into your twenties. Many people who develop skin picking during their teen years see significant improvement as they develop better emotional regulation skills, gain access to effective strategies, and reduce the shame that fuels the cycle.

Starting earlier makes a difference. The sooner the behavior is acknowledged and addressed, the less entrenched the neural pathways become.

If you'd like to start with building awareness of picking patterns during computer use, Untouched is free to try and runs locally on your Mac, with no video ever leaving your device.

This article is for informational purposes only and is not a substitute for professional medical or mental health advice. If you're struggling with skin picking, consider reaching out to a qualified mental health professional or visiting the TLC Foundation for BFRBs for resources and support.