What Is Dermatillomania: The Skin Picking Disorder? 

What is dermatillomania, the skin picking disorder? Everyone has bad habits — those pesky little behaviors like nail-biting or foot-tapping — that they would all like to cease. I have a particularly bad, “shameful” habit of picking at my fingers, which doesn’t sound too bad, does it? But the deceptive colloquialism of the term “bad habit” belies some of the weight behind these behaviors. What started as nail-biting for me, eventually turned into an obsessive relationship over the skin on and around my cuticles.

On good days, I can easily ignore the skin on my fingers; on bad days I often find myself absentmindedly picking until blood gushes and my fingers pulse with pain. Like most people with dermatillomania, I tend to pick when I am stressed, anxious, or bored, though often it is a subconscious behavior so ingrained that I can’t say that I make a conscious decision to pick.

The first time I saw the phrase “dermatillomania”, I had angrily typed “picking at fingers” into Google after a particularly painful picking session. The sense of relief that coursed through my body as I read about it suddenly put my world into a clear, bright focus. For years, I was ashamed of my fingers, keeping a stash of bandages in my locker and backpack in case I had an impromptu picking spree in class. When people asked me about my bandaged fingers, I would blame it on a vegetable-chopping accident or an unintentional brush with the hot stove.

Dermatillomania + Stress

I soon realized I was not alone, and that has made all the difference. Dermatillomania is also known as excoriation disorder, which is classified as a type of body-focused repetitive behavior (BFRB). The disorder is characterized by individuals who pick repeatedly at their own skin, causing lesions and wounds because there are imperfections, real or perceived, that they must eliminate. The picking can be debilitating, often interfering with and limiting daily activities. Picking can occur on healthy skin, acne, lesions, or blemishes. Most dermatillomania cases begin with the onset of puberty when adolescents are more likely to pick at their acne. The compulsion to pick can still remain, even after the acne has long vanished. A stressful event, such as financial instability or the loss of a loved one, can also trigger its onset in young children and older adults.

I began picking in elementary school, though the compulsions definitely worsened as I developed acne during puberty. The most commonly targeted area is the face, though the arms, legs, back, lips, stomach, chest, and shoulders are also commonly picked at. The fingernails, cuticles, and toenails are other common areas. While most picking is done with fingers, some people use tools, like tweezers or scissors, to aid in their picking. Though research on this disorder is lacking, it is estimated that up to 4% of the population suffers from it.

People have reported that picking relieves stress, as well as brings them some level of pleasure, even when they are unaware that they are doing it. However, the relief and pleasure is short-lived, replaced instead with guilt and regret. I tend to mentally berate myself after picking, repeatedly wondering how I could do something so damaging to myself. The effects of dermatillomania can be devastating — fingers can be so raw that it hurts to type or write; some people pick through the first layer of skin, causing tissue damage and putting themselves at risk for infection.

Skin Picking Disorder: It’s Not Self-Harm

Excoriation and skin picking are not the same thing as self-harm. It is associated with obsessive thoughts and compulsive behaviors. Many people who suffer from it also have anxiety and depression. However, picking is not typically classified as a self-harm behavior. The intent behind self-harm and picking are fundamentally different, though both can inflict severe damage. Those who pick feel the compulsion to eliminate certain blemishes on their body, and that compulsion is so strong they will pick through the pain and bleeding.

The purpose of self-harm is to injure intentionally in order to escape from negative feelings and find relief. Though people with dermatillomania also pick to relieve stress and negative emotion, it is the act of correcting imperfections, not the actual harm, that helps them. I feel better because I managed to address the flaws on my fingers, even though the method was painful.

Treatment For The Skin Picking Disorder

People should understand that stopping is not easy. In fact, it has been incredibly difficult, frustrating, and embarrassing for me to attempt to stop. I have been asked if I ever “get tired” of wearing bandages, of bleeding, of being in pain. They ask me why I do it, with a look of disgust, fear, and incomprehension on their faces. The thing is, I do get tired of wearing bandages and being in pain. I get tired of constantly trying to hide my fingers from view. But I can’t help it.

Some days I feel out of control as if my overwhelming compulsion embodies and defines me.  Some days I sit, immobile until either I am satisfied with the imperfections I have cleared up or I am in too much pain to continue. As much as I would love to stop, it is not easy.

Few people seek professional treatment for this skin picking disorder because of the paucity of research and the stigma associated with it. However, treatment options do exist — there are medicines that can be prescribed, as well as behavioral therapies. Some therapists will prescribe medications as part of the treatment plan. However, there are no medications designed specifically to treat this condition. Research suggests that some SSRIs (selective serotonin reuptake inhibitors) may be useful. Cognitive-behavioral therapy and habit-reversal training can also be successful. Due to the stigma and shame associated with dermatillomania, many individuals often do not seek the treatment they need.

Here are also some tips and tricks that I have tried (to varying degrees of success):

• Keep your nails cut short, so picking will be difficult
  
• Wear gloves as often as possible (more feasible in colder weather)
  
• If you catch yourself picking, stop immediately and put something else in your hands (a stress ball, a rubber band, etc) or chew some gum (as a distraction tactic)
  
• Wear a hair tie or bracelet around your wrist, so that when you recognize the compulsion, make a conscious effort to play with the bracelet first

If you see yourself or someone you know reflected in the lines of this article, just know that it is okay. Dermatillomania should not be a shameful secret. Those who suffer should no longer have to deal with the fear of being stigmatized and misunderstood. I was afraid of speaking out because I believed my behavior was irrational and illogical. Now, I’m presenting it within my own frame. I hope that it encourages others to start conversations about their own struggles and to seek the help that they need.