Stigma, referring to negative social judgement to a perceived difference, is commonly experienced by those with mental health conditions (read Pattie and Mallory’s Mental Elf blogs to learn more). Often stigma is discussed in the context of conditions where it cannot easily be seen, but what if your mental health condition was visible for all the world to see and judge? How would this affect stigma and your experience of it?
This is something that individuals with skin-picking disorder regularly encounter. Skin picking disorder, also known as excoriation disorder or dermatillomania, is the pathological picking of one’s skin, leading to tissue damage and impairment (Farhat et al., 2023; Grant et al., 2012). This often leads to distress despite attempts to stop. Skin picking disorder has an estimated prevalence rate of around 3% and is more commonly reported among women than men (Farhat et al., 2023; Grant & Chamberlain, 2020).
Skin picking disorder is regularly associated with shame, secrecy and social withdrawal (Anderson et al., 2023; Isibor & Sagan, 2023). Despite its impact, many delay or avoid seeking help and disclosing their condition to healthcare professionals (Isibor & Sagan, 2023; Montali & Garnieri, 2024). The presence of scabs, scars, or bleeding skin can invite scrutiny and assumptions from others, shaped by wider cultural narratives about beauty and accepted forms of suffering. Despite the role appearance stigma may play in these experiences, it has rarely been researched, which is what this study by Isibor (2026) addresses.
Methods
Isibor (2026) undertook a secondary analysis of an existing qualitative dataset using interpretative phenomenological analysis (IPA) to explore how people living with skin picking disorder make sense of appearance, visibility and social judgement. The study used appearance stigma as an analytic lens, situating experiences such as shame, avoidance and secrecy within a wider social context.
The data consisted of seven adults who self-identified as experiencing recurrent skin picking with distress or impairment. They were recruited via online support communities and social media platforms focused on body-focused repetitive behaviours (BFRBs).
The original data were collected through face-to-face semi-structured interviews. For this study, the transcripts were revisited, following the six stages of IPA outlined by Smith et al. (2009).
Results
Analysis identified three domains through which participants made sense of skin picking in relation to appearance and social evaluation:
- Visibility and management of being seen
- Moralisation, disgust, and the self-inflicted body
- Beauty norms, legitimacy, and conditional acceptability.
For the first domain, participants noted the unique burden of skin picking due to its visibility, particularly if it involved the face or hands. Unlike many other mental health conditions, skin picking is physically visible and announces itself to others without the consent of the individual. This adds to the distress of the condition; not only are skin pickers dealing with the condition itself, but they also have to manage the visibility of their condition, involving constant monitoring and concealing their skin in everyday interactions. Participants felt there was also an added moral judgement and lack of understanding from society, that their skin picking was seen as a personal failure rather than a legitimate mental health condition.
If I’ve picked my face, I actively don’t do things that I usually would … I’ll hide behind my laptop so people don’t see me.
In the second domain, participants described how skin picking was framed through disgust, confusion and disbelief. This moral framing was imposed externally but also became part of individuals’ internal narratives, shaping their self-concept and sense of legitimacy. A central theme of the domain was disgust, not only from others but also from themselves, with the self-inflicted nature of visible damage intensifying disgust. Skin picking was seen as unlike other conditions and not fitting into socially recognisable categories of mental and physical health, further adding to the stigma. Skin picking was easily noticed and visible but conceptually not understood and thus also invisible.
Scabs are seen as quite a gross thing anyway… people would be weirded out.
The third domain related to beauty norms and the idea of socially acceptable skin. Participants felt that one’s skin is closely connected to one’s identity, worth and social credibility; thus, having damage to one’s skin disrupted how they wished to be seen, leading to conditional engagement with others. Legitimacy was a concern for participants, who often felt like their distress from skin picking wasn’t ‘serious enough’, especially in healthcare settings. “Participants anticipated judgement or dismissal from healthcare professionals, which contributed to avoidance of help-seeking and reinforced self-silencing.”
I don’t feel entitled to call myself someone with mental health issues.
Conclusions
Isibor (2026) concluded that,
Skin picking disorder is experienced not only as a compulsive behaviour or emotional regulation difficulty, but as a socially exposed condition shaped by cultural expectations about appearance, control, and legitimacy. Visibility transforms the body into a site of judgement, while the self-inflicted framing of damage undermines recognition and support.
Strengths and limitations
A key strength of this paper stems from its ability to gain a deeper understanding of a poorly understood and under-researched mental health condition. By foregrounding appearance stigma, the author moves beyond treating shame, avoidance and secrecy as purely internal states, instead exploring how they are shaped by the social meanings attached to appearance and anticipation of others’ judgement. This has practical relevance, suggesting that support may need to address stigma and social understanding alongside individual symptoms.
A second strength is the use of interpretative phenomenological analysis (IPA), which allowed participants’ lived experiences to be explored in depth and gave weight to their own accounts. This suits a condition that has received so little research attention, and the small, fairly homogeneous sample is consistent with the aims of the method.
A further strength is the author’s transparency about their own position. IPA recognises that analysis is shaped by the researcher’s interpretative lens, and the author addresses this openly, noting both their academic expertise in BFRBs (body-focused repetitive behaviours) and their experiential engagement. Reflexivity was built into the analysis through analytic memos and revisiting interpretations to check they stayed grounded in participants’ accounts. However, this closeness to the topic may also have shaped the interpretation, and while openly acknowledged, it cannot be fully removed.
A limitation of this study is its design as a secondary analysis of interview data. Although secondary IPA is an acceptable approach, the original interviews were not designed to explore appearance stigma, meaning relevant questions may not have been explored in sufficient depth. As such, the data may not capture the full complexity of participants’ experiences. Further research specifically exploring appearance stigma could gather richer, more focused data.
Another potential limitation is the lack of diversity within the sample, which consisted of six women and one man (all aged 20 to 32, all living in Scotland). This homogeneity is appropriate for IPA, which requires a fairly uniform sample so that shared experiences can be explored in depth. However, it means the findings may not transfer well to other contexts, such as men with skin picking disorder, or people of different ages, cultural backgrounds or ethnicities. This is especially relevant given the third domain, as beauty norms and cultural expectations around skin may differ across genders and cultures. Future research could recruit a more demographically varied sample to explore these differences.
Implications for practice
Although shame is widely documented in skin picking, and indeed all body-focused repetitive behaviours, this study suggests that it is shaped not only by the behaviour itself, but also by its social consequences. Participants described hiding visible skin damage, withdrawing from activities, and worrying about how their appearance would be perceived by others. Clinicians may therefore want to take a holistic approach to assessment and treatment, accounting for stigma, feelings of legitimacy and appearance-based judgement alongside the behaviour itself. Validating these experiences may help individuals feel more comfortable discussing their skin picking and seeking support.
This concern about being judged or dismissed also highlights a need for greater awareness of skin picking disorder across healthcare settings. Inclusion-oriented awareness messages could go beyond simple symptom descriptions and instead challenge judgement-based interpretations of visible skin damage. It is also important to normalise disclosure in everyday health settings, embedding awareness of skin picking disorder and associated appearance stigma across services, from GPs to dermatologists and community mental health teams. However, further research is needed to establish whether these approaches can improve disclosure and engagement with support services.
When mental health difficulties cannot be hidden, stigma can become quite literally written on the body. Isibor’s (2026) study provides a powerful reminder that the impact of skin picking disorder extends far beyond skin damage, affecting identity, relationships and access to support. By drawing attention to the social consequences of appearance-related stigma, this research challenges clinicians, researchers and wider society to look beyond visible scars and recognise the distress beneath them. Perhaps the most important message is that understanding and acceptance, rather than judgement and scrutiny, may help people with skin picking disorder feel safer seeking support.
Statement of interests
Courtney Taylor Browne Luka knows the author of the research, but has not been involved in this study or worked with them on any other project. She has no other conflicting interests to declare.
Edited by
Dr Nina Higson-Sweeney.
Links
Primary paper
Marta Isibor (2026). Beyond skin deep: appearance, visibility, and social stigma in skin picking disorder. Mental Health and Social Inclusion, 1-13. https://doi.org/10.1108/MHSI-02-2026-0043
Other references
Anderson, S., Clarke, V., & Thomas, Z. (2023). The problem with picking: Permittance, escape and shame in problematic skin picking. Psychology and Psychotherapy: Theory, Research and Practice, 96(1), 83–100. https://doi.org/10.1111/papt.12427
Farhat, L. C., Reid, M., Bloch, M. H., & Olfson, E. (2023). Prevalence and gender distribution of excoriation (skin-picking) disorder: A systematic review and meta-analysis. Journal of Psychiatric Research, 161, 412–418. https://doi.org/10.1016/j.jpsychires.2023.03.034
Gonsalves, P. (2023). Self-stigma for people with depression: systematic review presents global prevalence data, risk factors and protective factors. The Mental Elf.
Grant, J. E., & Chamberlain, S. R. (2020). Prevalence of skin picking (excoriation) disorder. Journal of Psychiatric Research, 130, 57–60. https://doi.org/10.1016/j.jpsychires.2020.06.033
Grant, J. E., Odlaug, B. L., Chamberlain, S. R., Keuthen, N. J., Lochner, C., & Stein, D. J. (2012). Skin Picking Disorder. American Journal of Psychiatry, 169, 1143–1149. https://doi.org/10.1176/appi.ajp.2012.12040508
Isibor, M., & Sagan, O. (2023). “You get good at becoming secretive, at hiding it.” Shame and Loneliness: The Mental Health Impacts of Skin Picking Disorder. https://eresearch.qmu.ac.uk/handle/20.500.12289/13509
Moore, M. (2025). The inescapable role of stigma in driving depression and distress. The Mental Elf.
Montali, L., & Garnieri, S. (2024). Feeling uncomfortable in your own skin: A qualitative study of problematic skin picking in Italian women. Current Psychology, 43(14), 12870–12881. https://doi.org/10.1007/s12144-023-05377-4