Skin Deep:
A Firsthand Account of Dermatillomania
By: Sophia Upshaw
Have you ever picked a scab? Perhaps just out of curiosity, maybe just when you were a child.
Many people do the occasional grooming of their skin or face acne, but did you know that there’s a group of disorders called body-focused repetitive behaviors (BFRBs)? These include hair pulling, nail-biting, and, my weapon of choice, skin-picking.
Dermatillomania. Excoriation Disorder. Skin-picking. These terms are used interchangeably to describe the repetitive and compulsive picking of one’s own skin. Some common locations of picking include acne on the face, bumps, scabs, or even seemingly smooth skin on the arms, hands or legs. One can use their fingers to pick their skin or even resort to using tweezers or other sharp tools to aid them.
Here are some common behaviors that characterize dermatillomania (supported by DSM-5):
Your skin picking has created lesions or deep scarring
You’ve attempted to stop this behavior multiple times with no success
Your behaviors cause you distress or impair your daily life
Your skin picking isn’t caused by medicines, drugs, or dermatological conditions
Your behaviors don’t fall under another disorder
These episodes have been observed to be triggered by a variety of emotions or situations. With stress and anxiety being the most common, there’s also instances where a person may pick to relieve boredom or cope with frustration. A typical skin-picking episode lasts from minutes to several hours, but the impact can last a lifetime. With most sufferers developing this disorder sometime throughout their adolescence, their obsessive skin picking can result in alienation from peers, lowered self-esteem, fear of others knowing, and attempts to hide their damaged skin.
Personally, I’ve lived with this tricky disorder since before I aged double digits. I distinctly remember getting a large wound from scraping my thigh while on a field trip. For the weeks that followed, I would spend a few minutes throughout the day crouched on the toilet, my leg propped up on the bathtub’s edge and my fingernails dug into my skin.
When my parents first noticed, they just thought it was a bad habit. They noticed me messing with my skin and would sternly warn me of my increased likelihood of infection if I continued. But to someone with dermatillomania, these warnings do little to halt such behavior. Minutes turn into hours, clothes become stained with red, and soon after finishing what I’d set out to do, I’d feel an immense cloud of shame looming over me.
To clear up some myths and misunderstandings:
Although BFRBs are characterized as being compulsive and repetitive, they are not the same as obsessive compulsive disorder (OCD). They are closely related disorders but the presence of one doesn’t indicate the other!
BFRBs are not a form of self-harm. Even if the behaviors result in pain, the purpose behind hair pulling or skin picking is not to produce pain, but to soothe the individual.
The development of BFRBs hasn’t been shown to correlate with any sort of traumatic event in one’s past. However, there is some evidence to point to it being inherited and co-occurring with other mental illnesses such as depression and anxiety.
During the summer, I’d avoid wearing shorts so the scars on my legs weren’t visible. In the winter, I’d bring a jacket to school with me to cover up fresh-appearing wounds on my forearms. One day, in the sixth grade, a classmate walked up to me and asked about a mark on my upper shoulder that was actively bleeding through my shirt. Although the comment was made out of concern, I felt wholly exposed, as if a deep dark secret had been spoken out loud.
It wasn’t until this past year, being a few years into my adult life, that I finally confronted my skin-picking for what it was: not a “bad habit” but a body-focused repetitive behavior. From all the years I had spent hiding this from others, it was hard to come to terms with the severity of this disorder. Amidst all the interventions I’d tried, from applying Band-Aids to cutting my nails short, none seemed to stick.
Currently, as I’m walking through Comprehensive Behavioral (ComB) self-treatment, I’m learning what my triggers are, what locations I pick my skin the most, and which combinations of interventions work best for my disorder. So far, waterproof Band-Aids, fuzzy socks, and smoothing skin oil are interventions that can help keep my dermatillomania at a manageable level.
Some encouragement for those who struggle:
Tell at least one important person in your life. Someone who doesn’t judge you for your behavior, will hold you accountable, and support you through ups and downs.
Pursue therapy or medication as an option. Many sufferers of dermatillomania find benefit in trying cognitive behavioral therapy (CBT), habit reversal training (HRT) or antidepressants.
After a compulsive episode, choose self-care over shame. Instead of engaging in negative self-talk, take a few minutes to apply ointment, lotion, or a gentle cleaning soap to your skin to encourage healing.
Some tips for those who have loved ones with BFRBs:
Do your own independent research on your loved one’s disorder.
Although it can be hard to fully understand their experience, make an effort to listen and validate.
Offer to be an accountability partner that supports them after a picking episode. Support may look like offering band aids, soothing ointment, or comfortable clothing that doesn’t irritate the skin.
Like several mental health disorders, I’m aware that I may never reach the point of being “cured”. In the way that the ups and downs of life occur, the intensity of a mental health disorder can wax and wane throughout the years. While I fully expect that I’ll struggle with dermatillomania for a majority of my life, I’m fighting to increase awareness of it so that no one else has to struggle in silence.
About the Author
Sophia Upshaw is work-from-home technical consultant and runs a personalized success blog called The Good Graduate. Currently located in Atlanta, GA, she’s dedicated to empowering young adults to define their own definition of a successful life. In her free time, she loves to binge true crime podcast episodes, build websites, and do photography. Check out her Patreon to find out how you can support the blog.
Stock photo credit:
Photo by Julia M Cameron from Pexels
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