I've been dealing with this for over 20 years...I've tried (and failed) many times to stop on my own. I finally got up the courage to ask my first therapist for help...she couldn't. I asked my second therapist for help...no luck there either. FINALLY, I got up the courage to try one more time, and asked my current therapist for help. I'm making progress...it's slow, but it's progress. The biggest factors in my success so far have been mindfulness, learning how to handle anxiety, learning what my triggers are, learning what works to keep myself from picking, and talking about it with my T. My T has incorporated some small aspects of DBT in to my treatment as well. She has me fill out a diary card just one day a week, detailing what my emotional triggers were, how strong of an urge it produced and what action I took. I've found that helpful in finding my triggers and in finding ways to deal with those triggers.

For me, skin picking is a complex behavior, because it's not strictly a compulsive behavior. Sometimes, it's a direct result of anxiety or some other strong emotion, and it's a way to ground myself. Sometimes, it's a way to punish myself. And, sometimes, it's a compulsive behavior, where, like you, I feel like I need to smooth out my skin, make it "perfect" remove any "flaws." Yes, when I look at it logically, I can see the flaw in my thinking...picking makes my skin worse, not better, but compulsive behaviors usually aren't logical.

Some immediate things that have worked for me, and that you might try are - wearing jewelry that I can play with instead of picking (I always wear a ring that I can take off and play with when I need to do something with my hands). Playing with silly putty when I'm sitting around, reading or watching TV (again, so that my hands are busy). Mindfulness exercises before getting ready in the morning and at night (my most likely time to pick, as I'm washing my face or showering or whatever). Writing in my journal when my emotions are extremely high and I have a high urge to pick. The biggest thing, though, has been talking with my T about it, and having her accept the behavior for what it is and working at my pace to try and change it.

I can tell it's working, because I can actually write this post. Even a month ago, I still felt too much shame around the behavior to even be willing to talk about it here.