5 minute read
Picking apart Dermatillomania
Eve Crosbie
It can be both mentally and physically damaging so why don’t more people know about it? Eve Crosbie explores the compulsive skin-picking disorder of dermatillomania and opens up about her own struggles with it.
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The first time I realised I had a problem, I had just been to the cinema to see the film Room about a young woman who escapes after being held captive for seven years. The film had played out one of my (many) irrational fears, and as my boyfriend and I walked into the brightly lit lobby he turned to me in horror.
"What have you done to your face?" he asked.
Catching a glimpse of my reflection in my phone screen, I realised that, engrossed in the film, I had absentmindedly managed to pick away an entire layer of skin from my bottom lip, leaving it bloody and sore.
As I flashed him a reassuring, albeit painful smile, and explained that I must have gotten nervous during the film, I decided that I had to do something about my constant skin-picking. It was no longer just a bad habit, it had become an unconscious reflex, and I couldn't stop.
By that point, picking at my skin had become a daily occurrence. While reading or watching TV, I would find myself routinely plucking at my lips until they bled. As I sat in lectures, I would gnaw at the skin around my nails to the point that I found it too difficult to type out notes. Alone in the privacy of my bathroom, I would spend hours scanning my body for spots and ingrown hairs that I could poke and prod at to my heart's content. The morning after that bloody-lip incident at the cinema, when I found myself tearing away at my still-raw lips again, I grabbed my phone and tapped into Google, 'can't stop picking at my skin what to do'. I discovered two things: one, that I was not alone (there were others like me, flooding message boards and social media with posts about their skin-picking) and two, my problem had a name: dermatillomania.
"Dermatillomania, or skin picking disorder, is a Body-Focused Repetitive Behaviour Disorder (BFRB)," says Dr Tara Peris, psychiatrist and professor at the UCLA Semel Institute for Neuroscience and Human Behaviour. Along with trichotillomania (hair-pulling) and onychophagia (nail-biting), it is characterised by the urge to 'self-groom' to the point of physical injury.
"Picking at your hands, lips, face, arms or other body parts occasionally is common human behaviour but someone suffering from dermatillomania might not be able to stop once they've started, which often results in scarring, discolouration or even tissue damage," explains Dr Peris. There's also a strong link between skin-picking and Obsessive-Compulsive Disorder (OCD), Dr Peris tells me. "Similar to OCD, many people experience a compulsion-like urge beforehand and a sense of relief once that compulsion has been met". Since 2018, dermatillomania has appeared under obsessive-compulsive related disorders in the International Classification of Diseases, the healthcare manual used by medical professionals. Up until then, it was not officially recognised as a disorder.
It remains a notoriously under-researched area of mental and physical health, and precise causes have not yet been identified. "A hair-pulling or skin-picking coping mechanism could be triggered by any number of things," Dr Peris says, citing hormonal changes such as the onset of puberty, post-traumatic stress disorder or the existence of other underlying conditions as just a few of the causes of dermatillomania.
According to the Trichotillomania Learning Foundation (TLC), which has been supporting individuals with BFRBs for almost 30 years, 75% of people affected by skin-picking disorder are female. However, Dr Peris advises that the numbers may not be entirely correct. The condition is often misdiagnosed as a symptom of stress or anxiety. Men are also statistically much less likely to seek treatment than women. Likewise, research indicates that skin-picking affects 1.4% of the global population, but she suspects the number is much higher. “Picking at my skin was no longer just a bad habit, it had become an unconscious reflex and I couldn’t stop”
"There's a massive disparity between those who don't know that they're suffering from dermatillomania and those who do, which explains the underreporting," Dr Peris says. "For people who have skin-picking or hair-pulling tendencies, there's a lot of shame attached to the behaviour, which could stop someone from seeking help."
Photography: Willie B. Thomas via Getty
For me, it was something else entirely that caused me to wait almost a year to set up an appointment with my GP after I recognised I had a problem. It just didn't seem as important as other things people go to their doctor for. Like any bad habit, picking at my skin when I was bored or anxious was surely something I could and should learn to manage on my own, I thought. So instead, I trawled internet forums and found advice on how to control my urges, such as amping up my skincare routine and rewarding myself when I manage to resist picking for a day.
The impact dermatillomania can have on someone's life shouldn't be understated, Leslie Lee, Communications Director at the TLC Foundation, says. "Dermatillomania can cause significant emotional distress which could affect other areas of life. At one end of the scale, people end up avoiding social situations or activities out of embarrassment and on the other end, we've seen people lose their jobs from it."
"If it's gotten to the point where it's really affecting your ability to function – maybe you're not seeing friends, or you're afraid to date or show your partner your skin – it's advised that you seek professional help," Lee adds.
The primary treatment for dermatillomania is Cognitive Behavioural Therapy, and according to Dr Peris, it's the most evidence-based treatment for sufferers. "Your therapist will help you understand your behaviour and come up with a plan that addresses your own particular drives and triggers with alternative behaviours."
Unlearning unhealthy behaviours is never easy. Even as I write this, the temptation to pick at my skin is almost overwhelming. But through getting the help I needed, I've learnt how to resist my impulses and recognise what triggers them. Most importantly, unlike that night four years ago, I know that even if I do start picking, I can stop myself before it gets out of control.
For advice and support you can reach out to the Kingston University Wellbeing Services at health@kingston.ac.uk
