What is Dermatillomania (Skin Picking)?

 

Skin Picking: Dermotillomania

 

Clinical evidence shows skin picking is far more common than most people realise. Young adults and adolescents especially are more prone to this unhealthy and destructive habit. Fortunately, most people recover successfully after taking specific, concrete steps without the need for medication or hospitalisation. This article explores aspects of the phenomenon, including why some people succumb to picking their skin obsessively, and how to go about stopping and eliminating the habit.

 

 

What is Skin Picking?

Compulsive skin picking happens when a person habitually picks at the skin, and shows little or no self-control to stop it. The medical term for it is ‘dermatillomania,’ a form of unconscious self-harm; for some reason the person dislikes themselves and directs aggression against the self through consistent skin picking. People who pick their skin will use any object, including the fingers, nails, tweezers, or hairpins to prod and squeeze scabs, pimples, or even unblemished, healthy skin. Mostly, they pick the face, chest, scalp or stomach areas.

The habit usually begins during adolescence and early adulthood as a response to perceived imperfections or stressful events. Adolescents who feel awkward about their bodies or appearance might start picking their skin both as a form of self-punishment, and as a way to solve whatever the problem is: the magical or fantastical belief is that if they could “get their skin right” or perfect, their emotional pain or discomfort will disappear.

However, some people develop the habit of skin picking from observing a significant other – a parent or older sibling, for instance – doing it as a way to deal with stress or anxiety. In addition, evidence shows that most people indulge in skin picking when they are inactive, such as when watching TV, reading, or having a telephone conversation. Moreover, because they want to keep it private, people with this addiction usually give in to the urge when at home or alone in the office. For some people, it’s the very first thing they do when coming home from work; going straight to the mirror to inspect the skin and choose an area to pick.

What motivates some people to pick their skin habitually for months on end? Here are a few common reasons why the phenomenon exists.

 

Motives for Skin Picking

Available evidence points to psychological reasons behind skin picking. It is often an attempt to deal with emotional pain, offers immediate, temporary relief from anxiety, and could be symptomatic of trying to achieve some sort of perfection in appearance. Some people indulge in the habit as part of a larger personality disorder or severe emotional disorder, like Obsessive Compulsive Disorder, for example. Not all people who pick their skin are seriously psychologically troubled though, which is why most people can and do escape the habit after following one or some of the intervention strategies that will be covered in an up and coming blog. Until then, here are some of the key motivators to skin picking:

 

Unresolved Emotional Troubles: Most people who skin pick show signs of fluctuating mood disorders and go through spells of depressive episodes. Some abuse alcohol and drugs, and generally don’t feel good about themselves, lacking self-confidence and self-esteem. Many can pinpoint the time when they started the habit; usually immediately after an emotionally traumatic event like the break-up of a longstanding romantic relationship or rejection by a trusted friend. Whatever the specific reason, it usually resulted in the person feeling a massive loss of self-esteem and profound gain in self-doubt.

 

Self-Punishment: Believing they are to blame for unfair treatment by others, or that significant others reject them because they are not worthy in some way, people who skin pick direct aggression at themselves as the source for their misery. Hurting the skin, the closest and concrete part of the self, is one way of meting out the ‘deserved’ punishment for not being good enough and likeable.

 

Stress Relief: Digging into the flesh with pointy objects is distracting; for a short while the mind is preoccupied with something other than worrying. Some people who pick their skin feel it is as if all their problems disappear when they focus intensely on their appearance, scrutinising their face or arms or other areas of the skin. Such present-moment awareness, as unhealthy as it is, prevents the person from worrying about the future or dwelling on why an ex-lover dumped them, for example. Many people who pick describe the experience as going into an almost relaxing, trance-like state, in which they are oblivious to everything but their bodies.

 

Perfectionism: Cultural pressure to look well-groomed, young and sporting unblemished, healthy skin at all times affects everybody. However, people who pick their skin to compensate for psychological vulnerabilities choose to fixate on the flesh as a way of improving their appearance and self-image. While most people don’t worry about a pimple or spot on the arm or cheek, people with this condition exaggerate its significance and make it a mission to get rid of it.

 

Consequences of Skin Picking

Of course, picking the skin as an attempt to perfect some perceived blemish or avoid dealing with emotional pain doesn’t work. In fact, it actually makes matters worse; people end up with bleeding sores, unsightly, deep scratch marks, or infections. In addition, while these should be a sign to stop picking, the individual interpret these manifestations as reasons to go on picking, believing that more picking will ultimately heal the skin.

 

The original emotional causes behind the habit persist in spite of consistent picking, and the individual spirals deeper into depressive episodes, anger, self-resentment, and unhappiness. It’s not uncommon for many to end up isolating themselves and avoiding socialising, as well as living in fear of being discovered as a ‘skin picker.’

 

Ultimately, this is a physically and psychologically distressing condition to live with, but there are some mental strategies that can assist people in their efforts to stop skin picking. These will appear in an up and coming blog. 

 

 



Categories: Health, Psychology

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10 replies

  1. Hi Nicola,
    I took a woman through analytical hypnotherapy for this condition. My supervisors didn’t want me to, but I was convinced I could help her. She had seven sessions, and felt lots better, so I’m glad I did. She did it because she felt ugly and old. She was infact pretty, and not old. The problem stemmed from childhood, as it always does. She had a massively traumatic time through the therpay, me too, along with her, but all was well in the end. She often comes in the shop to see me and has a laugh at how she used to feel. Makes me proud to have helped. Talk soon.xx

  2. This is a wonderful story, Sue, and gives hope to people with this condition. Good on you for taking it on!

  3. this is a great article, thanks for sharing! I will certainly have to send some of my readers this way to check this out. Great resource!

  4. I just recently turned 14 years old and I believe I have dermatillomania. Mainly on my right arm, face, fingers, and breasts. My right arm is my main target. It is covered in bloody blotches and I have bandage covering it so I can’t butcher it anymore. People find it unsightly and yell at me for doing it. I try to tell them I can’t help it, but they continue and get angry with me. My own father tells me not to do it and I always say, “Trust me; If I “could not do it” I would.” People don’t understand how I feel about it. I’ve done this since age 3. I wish I had support. My mom doesn’t think I should talk to a doctor, but I honestly think I have this disorder. Please help me.

  5. Hello Isabella, Thank you ever so much for sharing your story with us.

    Dermatillomania is such a difficult condition to live with, but I want to commend you for recognising it and reaching out for help. At 14 years old, you have detected this early, which gives huge hope for your recovery. I understand that you have been doing this since you were 3 and I am by no means saying that your age makes it easier. Recovery is tough – this is a habit, a compulsion, and a need. It gives you’ something,’ whatever that something might be. Some form of counselling, which your doctor can help you find, will assist you in finding out what you gain from this illness and what function it plays in your life. Once you know this, then you can be supported to beat it.

    It must feel very lonely recognising your problem, but not having the support of your mother in seeking help. I can’t comment on this as I don’t know your mother. It could be that she is scared of what you do and that it hurts her to see you harming yourself, and by going to the doctor it becomes even more of a reality. Whether this is the case or not, I do feel you need to trust in yourself. What can you lose from discussing this with your doctor? Maybe this is a question you could pose to your mother, if she is amenable to discussion.

    You sound like a strong girl, Isabella, with a good head on her shoulders – you will choose the right path – if not today, then another🙂

  6. It is an infomative article. I am a 37 year old man and I am living with dermatillomania from last 34 years. I want to get rid of this habit. But I do not know why? The main reason for picking my skin is Perfectionism, Stress and anxiety. Should I go for a hypnotherapy? Should I give it a try? My 4 year old son is also suffering from the Dermatillomaia.

    • Hi Charanjit. Thank you very much for sharing. So, you have been struggling with this since you were 3 years old? Do you have any idea what triggered it back then? What you say about perfectionism makes perfect sense, and yes it can also be a way to cope with stress and anxiety. Knowing the root to the picking is fantastic and a first step towards tackling it. Whether hypnotherapy works or not does depend on the individual, but if hypnotherapy can reduce your stress, anxiety and perfectionism, then maybe it would be worth a go?

  7. Thank you for making a contribution to expanding public awareness about dermatillomania, which is much more common than anyone seems to realize but rarely a part of public discussions on mental health. The primary reason for this is likely due to the embarrassment felt by those who struggle with the condition and how uncomfortable it makes us all feel, for whatever reason that is. Unfortunately, many general physicians and family doctors are not aware of DTM, and during my life the two GP’s I’ve gone to told me that “everyone has little habits, like twirling hair or biting your fingernails” when I first said something. They had never heard of the term dermotillomania.

    (Hang on to your hat if you intend on reading the rest of this essay, it get’s a bit heavy, but if you want a better understanding of mental disorders like dermatillomania then I think you will find it interesting and worth the read.)

    I would like to point out, however, that there is a significant flaw in thinking of disorders like dermatillomania as being primarily caused by psychological factors, and without proper determination of the cause, treatment of individuals who suffer will struggle to be effective. As intelligent creatures we like to believe that our actions are just the extension of our mind’s will, and it makes us uncomfortable to admit that we are only capable of making suggestions to our bodies, that the control we feel as though we have is mostly an illusion. We must understand that up until the past hundred million years or so, no living organism on Earth even had the ability for complex sensory analysis, or what we call “thought.” Except for mammals, some birds, and possibly the octopus, all other biological organisms have no ability to act based on anything but quick, direct reflex neurological activity and biochemical modulation of those unconscious circuits, which are both shaped and whose functions are shaped only by natural selection.

    The problem we as mammals, but especially as even more intelligent great-apes, face is that the part of the brain which gives us the rare ability to internally analyze our world and the ability for awareness, the neocortex, is still just a very thin layer of recently developed neural networks (a few 100 million years) which has no direct control over the body. Our thoughts and intentions are relayed to older regions of the brain which are more like calculators, simple input/ouput (relatively speaking), and while most of the time we are the ones giving the orders to these unconscious systems, it is important that we remember that these systems have been functioning for billions of years totally independent of conscious input. Essentially, we just don’t have the kind of power it feels like we do when it comes to our actions. Multiple different kinds of psychological and neurological studies over the past few decades have shown that often the reasons we give for doing something are entirely fabricated retroactively, because we have the urge to explain every action we take in terms of our own thoughts or intentions even if they were not the cause.

    A person who compulsively/obsessively picks at their skin might say and truly believe that it is because they want to fix the imperfections or they want to harm themselves because they feel worthless, but in reality what they are stating are merely justifications in an attempt to make the most sense of why they are harming themselves. Now, all of this is not to imply that purely psychological behaviors do not exist, but that when trying to explain a widespread human behavior, we should first examine the role of non-psychological factors since they are much less complex and hence more likely to be ubiquitous. If anything, the psychological reasons given as to why some people pick are not actually the source of the behavior, but rather were just the trigger for the underlying neurological problem.

    While someone may see a small skin imperfection and want to fix it by picking it, the person without dermatillomania stops after having “fixed” it whereas someone with dermatillomania experiences an intense compulsion to just “pick one more.” When pickers give an account of their picking behavior, one of the things these stories share is diminished awareness and control; it is most commonly described as being in a “trance,” on “autopilot,” or turning into a “zombie.” This suggests that although a conscious intent might have been the initial trigger for the first few picks, the problematic behavior (inability to stop when most people would) is due to a lack of inhibitory control in the orbitofrontal cortex. The orbitofrontal cortex is the part of our cognitive processing which assesses what the expected outcomes and rewards of certain actions are, and plays a large role in inhibiting behavior which might be harmful. It is the primary culprit in addiction, ADHD, and other impulse control disorders. In fact, another common element to dermatillomania stories is the explicit knowledge that their behavior is harmful to themselves and that they are able to control the picking for days or weeks sometimes, but eventually they relapse, making dermatillomania stories read much like drug addiction stories. In some ways it is worse than a drug addiction because not only is the drug free and easily taken throughout the day, it can never be thrown away nor can you distance yourself from it. An alcoholic trying to stay sober knows to avoid the liquor store and it is still an extremely difficult struggle to do so, but ask an alcoholic to imagine staying sober with a liquor store being at arms reach at any time. Also, with alcoholics it is generally understood that the reason that someone may have started drinking heavily is not the ongoing reason a person continues to have the addiction, but the underlying neurological dysfunction which fails to regulate behavior.

    The bottom line to all of this is that dermatillomania isn’t something we are going to be able to develop a an effective and reliable treatment strategy for unless we recognize what is driving it. Sitting down and working through someone’s insecurity issues is good, but they have been picking for years already, then the compulsion has already been established and will remain a problem even if some underlying trigger is resolved. By far the most frustrating issue is that cognitive and mental health research are not widely pursued despite the fact that our current understanding of the human brain and the technology at our disposal is sufficient to formulate working models of exactly how these conditions work. With a good understanding of exactly what is causing the problem and how the involved neural circuits are responsible, effective treatments and medications can be developed. The problem is that there is little profit in mental health research investment, unlike the highly commercialized cancer foundation industry, since cancers are concrete problems which are easily framed with timelines which lead directly to marketable drugs. To understand how many mental illnesses work, a more comprehensive theoretical understanding of how neural networks work together to generate the conscious thoughts and behaviors that are affected, and there is virtually no large scale research in theoretical cognitive neuroscience because a medical research group would have no marketable product to offer investors. The majority of neuroscientists are funneled into doing research which is “safe,” working at the neural biochemistry level, because it can offer a drug in the foreseeable future. We need a public push to fund research to gain this understanding, because it isn’t going to happen anytime soon if we have to rely on the stagnate, greed fueled system we have now.

  8. hi everyone
    I want to discuss that I am also suffering from this type of disorder I bite my index finger mostly and also other fingers but mostly index and I feel that I harmed my self and I can’t stop it by my own it surely about my depressed mind but I always worried about my carrier study and I am 18 year old only it’s start when I am just 9 or 10 year old but I can’t stop it I noticed that I picked my skin near my exam or when some thing was going wrong but I can’t stop it so plz tell something and help me to out of this everyone in my family tell me that why u do this or what the matter that u not share with anyone but and I tell them truth but it does not work so help me I want stop it now plz plz plz it’s only my depressed about my study or some time my persnal issues and my thoughts are also negative but I can’t fight with them and then I feel depressed so plz help me u do great job for awareness about this disorder thank you

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