Dermatillomania: More Than Just a Bad Habit

Let’s be honest – every single one of us has picked a scab or a hangnail at some point in our lives. It’s not unusual to be curious and pick at something on your skin. But have you ever had a moment where you stopped and realized that you had been picking at your skin or nails for an extended period of time without even knowing it? Even after noticing it, have you ever not been able to stop?

Last spring, my friend and I were digging through the DSM-V. We had reached the part where it discusses Obsessive-Compulsive and Related Disorders, including body-focused repetitive behaviors. She started reading about a mental disorder characterized by repetitive, compulsive picking of the skin. As she described it, I started to recognize many of the behaviors as things that I had been doing for years – behaviors that caused me so much distress, because I could never understand why I did them and why I couldn’t seem to stop. In the DSM-V, the disorder is called dermatillomania, or excoriation (skin-picking) disorder. Different from trichotillomania (a similar disorder characterized by hair pulling), excoriation disorder is somewhat rare. It is thought to affect up to 1.4 percent of the total population, with almost 75 percent of cases being females (Psychology Today). The International OCD Foundation suggests that as many as one in every 20 people engage in chronic skin picking.

So, what is dermatillomania? Even Microsoft Word doesn’t recognize it as a word! The DSM-V, however, uses the following criteria to determine whether or not skin picking is related to excoriation disorder:

-       Recurrent skin picking resulting in skin lesions.

-       Repeated attempts to decrease or stop skin picking.

-       The skin picking causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

-       The skin picking is not attributable to the physiological effects of a substance (e.g., cocaine) or another condition (e.g., scabies).

-       The skin picking is not better explained by symptoms of another mental disorder (e.g., delusions or tactile hallucinations in a psychotic disorder, attempts to improve a perceived defect or flaw in body dysmorphic disorder, stereotypies in stereotypic movement disorder, or intention to harm oneself in nonsuicidal self-injury).

But what does this “chronic skin picking” actually look like? It’s different for everyone, because excoriation disorder covers just about every area of the body. It sounds pretty gross, and it can be, but repetitive skin picking isn’t just picking. Psychology Today writes that it “extends to pulling, squeezing, scraping, lancing, and even biting both healthy and damaged skin,” often targeting areas of the face, hands, fingers, arms, and legs. The picking can result in skin damage and disfigurement, including lesions, discoloration, open wounds, scars, and infections. It also causes a great deal of psychological distress as someone may spend hours trying to resist the urge before giving in. And once you give in, there’s no going back. Waves of anxiety, depression, embarrassment, shame, guilt, and fear creep in and take over the mind.

For some people, dermatillomania extends from OCD. Mine, however, seems to stem from my anxiety or boredom. I was in high school when I first noticed that I had a problem. I’ve bitten and picked at my nails for most of my life, but I started regularly picking at my scalp around sophomore year. I often didn’t notice that I was doing anything harmful, because it felt like I was just scratching an itch; it offered a level of relief. That is, until places on my scalp started to become sore, blood would show up under my nails, and scabs would begin to form beneath my hair and around my fingers. I know – gross. But for 1.4 percent of the population (and possibly more!), this is a very real look into our very real issues – issues that we are too embarrassed to talk about because “it’s not hard to stop picking.”

But if you’re like me, or the girl who sits in front of the class tapping her pencil to avoid picking her fingers, or the guy who is afraid to change in front of his teammates because of the sores covering his chest, then you probably know that it’s much more than a bad habit we want to stop. It’s uncontrollable, debilitating, and severely distressing. Hours upon hours of our lives are lost to this nasty habit – hours spent picking at our skin, participating in post-picking cleansing rituals and cancelling plans to hide our sores and lesions from the world. 

It wasn’t until my sophomore year of college that I even heard of dermatillomania. In high school, no one seemed to know. But when I mentioned it to a psychiatrist last summer, everything changed – not physically, but mentally. I finally had answers and a place to find resources, accountability and community. And I felt much less crazy! Someone had confirmed that it really wasn’t as simple as being able to “just quit” when my mom said so.

Although I am so much more aware of my skin picking now, it is still an everyday battle. I think it always will be to some extent. The behaviors associated with dermatillomania are chronic, and treatment requires a mix of therapy, some medications, and self-help strategies (Psychology Today). There is no “cure”, and picking for hours each day won’t suddenly turn to none. Within the last month, I can’t recall the number of times I’ve found myself staring in the mirror or at my computer while picking my scalp, lips, face, or cuticles (I’m even doing it right now). But I can tell you that the more I know, the better I can try to manage it.

So, there it is. The ugly, sometimes bloody and not at all enviable truth of someone living with excoriation disorder. For so long, I was embarrassed about my picking because “other people don’t do this” – or so I thought. So, if you or anyone you know is struggling with chronic skin picking, all I have left to say is, “Hey, friend. You are seen. You are known. And you are not alone.”

Find more information about dermatillomania (including resources) at https://mhanational.org, https://www.psychologytoday.com, https://pickingme.org, https://skinpick.com, and https://stopskinpickingcoach.com.  

Find other first-hand accounts of excoriation disorder here: https://www.nami.org/Personal-Stories/Body-Focused-Repetitive-Behaviors, https://www.bfrb.org/component/content/article/39-black-girls-with-bfrbs/543-my-dermatillomania-story-by-blackdermatillomaniac, and https://www.theguardian.com/lifeandstyle/2019/feb/04/dermatillomania-meet-the-people-who-cant-stop-skin-picking.