What is Dermatillomania?
Dermatillomania is also known as Excoriation Disorder, Compulsive Skin Picking, and Skin Picking Disorder. Whatever name you give it, Dermatillomania is a chronic mental illness characterized by repeated picking at one’s own skin which results in skin damage and causes significant disruption in one’s life both mentally and physically. Those who struggle with Skin Picking Disorder touch, rub, scratch, pick at, or dig into their skin in an attempt to improve a real or perceived imperfection, often resulting in skin damage, discoloration, or scaring. Like Trichotillomania, those with Dermatillomania want to stop, have tried to stop, but are unable to just stop.
But what does that truly mean?
There is a great deal of unknown in why we repeatedly pick at our own skin, want to stop, try to stop, or why stopping feels impossible. Nor does the definition tell us how to control or if even control is possible. It only explains the what. This definition has no insight, direction, hope or resolution.
So let’s reset our mindset, starting with our definition of Skin Picking Disorder.
The HabitAware Definition of Dermatillomania
The hands are the gateway to the mind. When the mind is restless, it leads to "restless" hands. And those restless hands find themselves scanning our bodies for bumps and imperfections. That restlessness can also present visually - seeing something "just not right" getting lost in our own reflection seeking out flaws and imperfections. Once the real or perceived flaw is noticed the cycle to "fix" presents in the form of picking, popping, digging, scraping at our skin and anywhere on our body or scalp is far game. Some with Dermatillomania focus on only their face, while others might pick only their arms or back. Often anywhere where there's skin, there is a place to pick both targeting previously damaged and healthy skin.
Dermatillomania serves a purpose, yet the textbook definition doesn't say that.
The purpose: Dermatillomania is a coping mechanism, helping us through uncomfortable situations, from anxiety to boredom. It can be a form of perfectionism with the fallacy that if I just pick this one imperfection I will fix it and all will be well, and then after the pick, the realization that it was a mistake sets, leading to even more picking.
Dermatillomania does an excellent job of self-soothing in the moment. Those favorable side effects are temporary, like the eye of the storm. Once the calm, trance-like feeling fades, the miserable long term side effects set in and leave in its wake the physical and mental scars.
Why do we pick? The science is still unclear, but it points to and we believe the repeated soothing movement of picking helps our mind and body find emotional regulation or homeostasis.Trauma, stress, anxiety, boredom, tiredness, concentration, visual cues, tactile prompts, and other emotional states might trigger Dermatillomania as the human brain craves to be back in balance.
There might also be some perfectionist tendencies at play as a person with skin picking seeks to smooth out the bumps, pimples, scabs or other skin imperfections.
Though soothing, Dermatillomania has terrible side effects affecting the body (skin sores, lesions, scaring, infections) and mind (feelings of guilt, shame, fear, isolation, fear of being judged, depression, and anxiety).
While skin picking sounds painful, many report a sense of relief, even enjoyment, and satisfaction, making it very difficult to stop. Plus, we can’t “just stop” because Dermatillomania is a chronic health condition. But control is possible.
Let's look at other chronic medical conditions. Diabetes, asthma, and celiac disease, to name a few. What do these all have in common?
- They are persisting for a long time, or constantly recurring
- They are not our fault - we didn't choose to have a chronic condition
- There is no cure
- Control is possible
How many people have a Dermatillomania?
The TLC Foundation for Body Repetitive Behaviors (BFRBs) estimates 1 in 20 experience BFRBs, like Dermatillomania in their lifetime.
Approximately 1 in 20 people. That's a big number. That's millions.
YOU. ARE. NOT. ALONE.
There are likely people you know and love that are living with Dermatillomania, just like you. But it isn't an easy thing to know for sure. Dermatillomania is often self-reported, as such these numbers are likely higher. You might feel as if you are the only one in the world with this behavior. Trust me when I say this:
All of us with Dermatillomania feel intense shame and guilt, often hiding our condition from family and friends for fear of being judged and fear of receiving no support. The result of this secrecy?
Dermatillomania IS ONE OF THE MOST COMMON HEALTH CONDITION YOU'VE NEVER HEARD, AND NOBODY WANTS TO TALK ABOUT IT. And it only recently (2013) was considered a diagnosable condition!
Why do some people have Dermatillomania and others don't?
Dermatillomania is likely developed due to a combination of factors rather than one thing. Researchers have not discovered why or how it manifests. There is some evidence of a genetic component and a hormonal influence, as onset is usually early adolescence, coinciding with puberty. As with most disorders, there are exceptions, where children as young as six or older adults may develop Dermatillomania.
Anecdotally, we see more women than men talking about Dermatillomania on social media, attending support groups and joining the HabitAware Keen family.
Why might this be? Two words: Social Pressure. There is societal pressure for women to be beautiful. And what defines a woman’s beauty? Hair, skin, nails.
What about men? They have skin too. They might feel triggered by the bumps (think shaving), pimples or scabs too. They want to feel healthy and handsome in their own skin. Everyone, who wants to, deserves to take control.
Types of Dermatillomania
Dermatillomania is a compulsive, trance-like, behavior that falls within two types, as defined by the medical community:
- Focused means a person is goal-oriented and aware of their picking, i.e. fixated on a specific area or multiple sights where there are scabs, pimples, or bumps in the skin. This type may or may not involve tools like mirrors and tweezers. Focused episodes can last minutes to hours.
- Automatic means the person is unaware of the picking where mindlessly their finger energy takes over. This type typically occurs while doing other activities, such as watching TV, reading, studying, and driving.
While we might gravitate toward one way or the other, most experience a combination of both. The crux of the medical definition is the presence or absence of awareness of the picking behavior.
As we say at HabitAware, "You can't change what you don't know is happening." We believe Awareness is critical to change and so do clinicians. In Cognitive Behavioral Therapy (CBT), a gold standard of treatment, awareness is the first step.
You might be thinking: "Oh, I know when I'm picking, so awareness is not my issue."
I say, not so fast. Awareness is slippery. Awareness is critical, but so is control. Consider this:
Imagine you meet up with your best friend with a bag of potato chips to share. The two of you have a great time, laughing, snacking, and enjoying each other's company. As you get ready to say your goodbyes, you think that only about an hour has passed. You check the time, and in reality three hours have passed.
And those chips! You knew you were eating chips with your friend, and you thought you had eaten only a handful. But as you close the bag, you realize that the two of you devoured the whole bag!
The same goes for Skin Picking. We think we are engaging in our picking behavior for maybe 10 minutes, and in reality, it's 45+ minutes. We believe we don't pick at work or school, but without awareness, we don’t really know for certain.
It’s not just about being aware, it's about having a sense of control over the picking situation and in both focused and automatic scenarios, there is still a lack of control.
Let’s reset to how WE categorize Dermatillomania:
Passive - Picking while doing something else, such as reading, watching TV, driving, or as a passenger, working, and studying. Our hands have a mind of their own, and we are not aware until the damage is done with blood and skin cells underneath our fingernails. Even when we notice the damage and yell at ourselves to stop, our hands don’t listen. We feel Out of Control back in a repetitive loop.
Active - Picking with intention. Knowingly dropping what we are doing to achieve the goal of picking, with or without tools, like tweezers or a mirror. The picking pulls us in and we enter a trance-like state in which we lose a sense of how long it’s been. Despite the knowing, we are not in control.
Why can't someone with Dermatillomania just stop?
Dermatillomania is a chronic medical condition. As with all chronic medical conditions you can't just stop. And believe me when I say this, if just stopping was the answer, then Dermatillomania wouldn't exist.
Here's another example from Dr. Lea Lis, The Shameless Psychiatrist. She says, "telling someone to just stop is like telling someone to just stop being hungry. You can't just tell your body, stop being hungry and that hunger feeling and biological need simply stops."
Stopping hunger is just a momentary thing. You eat, the hunger is gone, but once the food digests the hunger comes back. You can't just stop being hungry.
Putting it all together:
Understanding Dermatillomania is an important step towards healing. And taking control is possible!
The medical definition tells you a partial story. We hope our explanation of Dermatillomania replaces the uncertainty with clarity. Now you know Dermatillomania is:
- a chronic health condition
- not your fault - you didn't choose to have a chronic condition
- doesn't discriminate between gender, race, or social status
- there is no cure, but control is possible
- there is passive picking and active picking
- awareness is a key to taking control
- you are not alone
- There is HOPE
Taking Control of Dermatillomania Begins with Keen AWARENESS
Taking control is possible. Tens of thousands of people all over the globe have taken control of Dermatillomania with HabitAware Keen Awareness. Keen2 is a smart bracelet - your awareness and response coach - helping YOU take control. It's a holistic system on your wrist, and in your pocket.
Now you know what Dermatillomania is and that there is hope. You can take control with the right mindset and with Keen2 Awareness and Response Coach!
