Over the last few weeks, I’ve seen plenty of the “No-Make-Up Selfie” posts around my various social media websites. While I certainly don’t mind the effort that was put into creating awareness for breast cancer (even if, in some ways, the trend has become more of a fad and less of humanitarian endeavor), I can’t help but feel that there are other illnesses that could spare to be recognized amongst the masses.
Mental illness in particular seems to get the short end of the stick when it comes to awareness and public involvement. And while I don’t deny that someone who has cancer or any other serious physical ailment deserves encouragement, support, and love (and of course a cure), those with serious psychiatric illnesses are often left in the dark.
Back in 2012, The American Psychiatric Association released the Diagnostic and Statistical Manual 5 (DSM 5) that included a particular mental disorder that, unfortunately, I (and around 4% of college students) suffer from: Excoriation Disorder, or more commonly known as dermatillomania: chronic and compulsive skin picking.
It’s likely that I’ve had this disorder from the time I was a child, since I have distinct memories of picking my skin as far back as elementary school, but my parents never looked into it as a serious problem. As dermatillomania is a relatively new illness to make its way into the realm of psychiatric disorders, it’s not surprising that they thought very little of it. Even now, as more and more people are beginning to realize that this is more than just a bad habit, there are still many out there that are not aware of how this disorder works.
So in the interest of informing the general public, I’d like to clarify a few misconceptions that surround this illness and hopefully educate those of you out there who may know someone with dermatillomania or possibly have it yourself.
Skin picking is just a nasty habit. In some contexts, it can be. It’s normal for people to pick at their skin every once in a while, such as when they see a pimple or dry patches during the winter. What separates dermatillomania from just a habit is the fact that it is constant and takes place over a length of time, eventually causing damage such as discoloration, infection, scarring, and, in severe cases, a need for skin grafting. Dermatillomania is classified as a Body-Focused Repetitive Behavior, meaning that the person’s habitual actions have the potential to cause harm to their body or physical appearance. It shares similar attributes to Obsessive Compulsive Disorder (OCD)—sufferers take part in ritualistic, repetitive behavior, often brought on by a need or urge to do so. The difference between the two is that people with a skin picking disorder find pleasure in their actions and those with OCD don’t. Dermatillomania is also very closely linked to another disorder known as trichotillomania, or compulsive hair pulling. People can pick just about anywhere on their body—face, hands, scalp, back, legs, fingers, feet, cuticles, etc. While there is usually one place that someone with SPD focuses their energy on, if that area becomes too sore or damaged, they will migrate to another part of the body until their main spot has healed. While the default tool for picking is the fingernails, sufferers will also use tools like tweezers and scissors.
Regardless of where or how someone picks, it’s important to remember that dermatillomania is a disorder—it’s not something that the sufferer can help or control.
Skin picking is similar to/another form of cutting/burning. While there may be compulsive tendencies in someone who cuts themselves or burns their skin, the difference is that they want to feel the pain inflicted on them in order to take away emotional trauma. Skin pickers disassociate themselves with the pain in order to complete the “mission” that their brain has fixated on. It isn’t about the pain—it’s about satisfying the urge. For some pickers, looking down at their hands and seeing blood without even realizing they’ve been picking is a common occurrence. This is why pickers can often tear, gnaw, scratch, and dig at a spot for long periods of time, causing bleeding or serious pain, and not stop. Their brain has decided that it’s far more important to finish the “mission” and satisfy the urge than to stop on account of the pain or blood.
People who have an SPD are on drugs. Nope. While the effects of usage for drugs like meth may involve picking away at imaginary bugs or other supposed invaders, their need to do so disappears once the effort of the drug wears off. SPD sufferers do not lose their urge. Their need to pick can come from various other sources, but a set cause is unknown. Most people have an underlying anxiety or depression disorder—as is the case with me—but not all. For some people, it’s a compulsion that has come about from outside stressors or is the result of someone who is unable to cope with things in their life, such as big changes. During times of stress, strong emotion, or boredom, pickers are more prone to dive into their habit. But this is not the result of a drug problem.
People who pick their skin and leave marks do it for attention. Just as with any other mental or emotional illness, there are people out there who seek to gain attention or affirmation by exploiting such disorders. But for the vast majority of us, there is nothing glamorous about dermatillomania. I would personally love to have all of my toenails and long thumbnails, be able to go to sleep without getting caught up in picking, and wash my hands without discomfort. It’s not about the resulting disfiguring that makes us pick—it’s all about that urge. In the moment, it doesn’t matter that we’re bleeding or the area is already scarred. Even if our actions didn’t result in disfigurement, we would still pick.
Not to mention that people’s general reaction to seeing the site of a picking episode is something along the lines of, “Oh my gosh, what happened to your face/hands/back/arms/etc??? It looks awful!” This draws attention to ourselves and makes us feel an incredible amount of shame and guilt because we know that the inflicted damage has been done by our own hands. It isn’t pleasant and it isn’t fun.
People with an SPD can stop whenever they want. No! As I mentioned before, dermatillomania is a disorder and not something the sufferer can control. It isn’t about breaking a habit. The worst thing you can do for someone with an SPD is to yell at them to stop or try to inhibit their picking session. Calling them out brings attention to their actions and makes them feel ashamed, while not allowing them to pick increases their levels of anxiety because you’re preventing them from satisfying that urge. Both of these things only make the problem worse (not to mention they may resent you after the fact for it), and could result in a more rigorous and damaging picking session later on. The best thing you can do for an SPD sufferer is to just love them as they are. Be their friend, support them if they are feeling down, and encourage them to seek treatment.
There’s no treatment for an SPD. The good news is that there are ways to treat and cope with dermatillomania, the most common and effective one being Cognitive Behavioral Therapy which includes Habit Reversal Therapy and Stimulus Control. Anti-depressant medications can also be used to help lessen the severity of the urges. There are even support groups dedicated to helping and supporting sufferers. TLC has a program called Hands-Down-A-Thon that those who pick their skin and pull their hair can take part in.
Those are some of the big ones. Hopefully now people will grow to have a greater understanding of what it means to have this disorder and, if they have loved ones or friends that suffer from it, they will continue to love and encourage them despite the daily battle.