Skin picking (also dermatillomania or excoriation disorder) is a mental disorder, in which those affected pathologically scratch, squeeze or pinch their skin uncontrollably, leaving (infected) wounds and scars. Dermatillomania is classified as an impulse control disorder and is a recognized mental illness. The damaging behavior is often triggered by a scab, sunburn, a mosquito bite, a rash or a pimple in connection with individual stressful situations. Some skin-pickers act more subconsciously, for example when they are bored or under pressure while reading, watching TV or sitting infront of the computer; for others, this condition has become part of their daily routine.
The skin on the face, neck, shoulders, chest or hands is particularly often maltreated. But parts of the body that are difficult to access can also be affected. Many skin-pickers use fingernails and teeth in this form, but also tools such as tweezers, needles and scissors. Most of the time, blood flows and severe redness, ulcerated areas, open wounds and scars develop. Many know the negative consequences associated with this “destructive work”. However, if they cannot prefent this action, they often stop only because the urge subsides or because they are exhausted.
Behaviors
Working on the skin is perceived as relaxing, pleasant and stimulating in the short term, but then regret and guilt set in. The skin is then cared for and hidden until the urge to use it as an outlet for negative emotional states sets in again. Wounds that have not yet healed are torn open again, which can lead to painful complications. In addition, an excessive amount of time and attention is devoted to skin processing, so that other activities are neglected.
Added to this is shame because of the obvious injuries, which leads to withdrawing and not leaving the house for a while. They fear questions, criticism and social rejection and isolate themselves. As a result, her life is becoming increasingly restricted by the disease.
The Problem
In their environment, skin-pickers often encounter a lack of understanding, because the wounds attract attention and trigger disgust. Dermatillomania requires professional treatment.
Professional Treatment
Among other things, habit reversal training, in which the problematic behavior is replaced by other behaviors, has proven itself. The old problem behavior is more or less suppressed and unlearned in this way.
Such alternative behaviors include folding hands, clenching fists, or sitting on hands. In addition, it is helpful to practice social skills and emotion regulation techniques, strengthening self-esteem and self-acceptance.
Therapy Suggestions and Tips
- Track your picking behavior: In order to understand when and why exactly you start picking, it is very helpful to track all activities for a while and to note what feelings prevail, how long the session lasted, how intense it was and how you feel afterwards. The more mindful you are, the better you can understand yourself and help yourself. This free SkinPick App can be very helpful.
- Annette Pasternak: This woman has been a skin picker herself and gives a lot of great and helpful tips for those affected on her YouTube Channel. She has also written a highly recommended book The Freedom to Finally Stop and created this Habit Tracking Booklet.
- Recognize your triggers: Almost all skin pickers have a specific trigger that triggers the picking for them. This can be the touch of the skin or a certain recurring situation in the daily routine (the tracking app will help you to identify it, see point 1). To block certain triggers, many sufferers simply unclip their mirror or cover those nasty daylight magnifying mirrors with a cloth.
- Replace skin picking with another activity: In general, everything that is good for you is also good against skin picking because it lowers your stress level. Therefore, it can be very helpful to look for an activity that is good for you and reduces your stress level. If you have specific times when you pick, do something radically different. You can paint, craft, meditate, try a new recipe, dance etc. there are so many great options. If your fingers need something to tweak, these might help = Bubble wrap, pulling dried liquid glue from the skin, or squeezing beads out of modeling clay. Some even meticulously remove hair from their hairbrush or remove protective film from things. Stimming toys are also a very great option. You’re sure to find something..
- Try hydrocolloid patches (my PRO Tip!): These small, clear plasters are kind to the skin, speeding up wound healing and attracting pus and wound fluids. Other plus points = You can no longer fumble around in areas that have already been attacked. You see less of it too. The patches are relatively inconspicuous, some wear them in public, for example under makeup.
- Confide in your loved ones: Your loved ones can be of great help and support, depending on what works for you. They can alert you when you’re unconsciously picking at your skin and give you comfort if you’ve overdone it again.
- Find a therapy place: Habit reversal training, behavioral therapy or hypnotherapy are the most common forms of therapy for skin picking patients. If you don’t want to block/ prevent the symptom but want to find the cause, a full-on psychoanalysis could be very helpful. The theory behind it = By feeling and processing emotions in therapy, you no longer need the picking sessions as an outlet.
- You can do it! As a person you are made of completely different things – YOU are not your skin-picking! Don’t let anyone tell you that you are less valuable, lovable or attractive than other people – not even yourself.
I myself started to develop my dermatillomania already by the age of 13, and it got really, really bad when i was in my twenties. And to this day, i continue my battle with dermatillomania/ excoriation disorder – allthough, the picking has gotten way more less severe and doesn’t happen regularly or even that often anymore. It happens occasionally every so now and then, when in distress or when over-/ or understimulated. Now, at this point i can somewhat control it/ prevent it from happening most of the time..
I also developed other forms of “body-focused-repetitive-behaviors” – which i am positive – that my conditions are linked to my aspergers > as a form of stimming/ self-soothing/ sensory overload/ meltdown.
Are you on the autism spectrum and also suffer from skin picking? If so.. then let me know in the comments or e-mail me privately.
And/or what other diagnosis’ did you possibly receive which is also linked to dermatillomania? Comorbidities are relatively common amongst the BFRB’s (Body Focused Repetitive Behaviors (BFRB)).
I got left with scars from all the past picking (mainly face), but my skin has recovered well over the years as you can see in other images (despite my every so now and then “picking-attacks“). By adding the following two images (as seen below) to this article, i’m revealing and sharing a very vulnerable and intimate snapshot of myself – which were taken “back in the old days”, when my compulsive skin picking used to be severe and out of control at times. It took me a lot of courage to post these images – since i’m presenting myself “unfiltered” and “vulnerable” to the world, by showing the “ugly/naked truth”..
But i want to be real and authentic here with you guys, because i believe this is so important – especially nowadays – and offering realistic insights/ inputs whilest trying to >break-in< the so called “cycle of shame & guilt” that so many of us carry inside. To openly write/share content that disclosures the dark-, unfavorable-, unappealing- and sometimes uncomfortable aspects of yourself and your mental health.. Well, that my friend, is pure dedication for what i’m doing and what this blog stands for: In hopes to make a positive impact, or to be an inspiration for others struggeling and to help make one’s challenges in life a little easier.
The following images were taken sometime between 2015 – 2018 :
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