Q: My seven-year-old, adopted as a toddler, picks her skin to the point that it bleeds. She is extremely intelligent, but can’t explain why she does this. Our pediatrician says she will “outgrow it,” but I’m worried. What could be going on? What can we do to help her?

A: Your child is not alone with this habit, which is known as compulsive skin picking. This condition is associated with anxiety, and sometimes Obsessive Compulsive Disorder (OCD). High achievers, or children who experience another source of internal stress, may be more prone to picking, although children with no underlying pressure sometimes show this disorder.

Your daughter should be seen by a psychologist or social worker who can identify possible sources of stress and treat the condition with Habit Reversal Training. She should also be screened for OCD. If she does have accompanying OCD or a high level of anxiety, medication may be needed. But, in general, I believe medication should be secondary to the behavioral, mental health work in children.

Your child’s mental health professional should screen for other possible diagnoses, such as sensory integration disorder (skin picking could be a form of sensory-seeking behavior), anemia, and kidney or liver problems.