What is it?
Definition: It is usually defined as the urge to pick at skin until damage is caused.
Dermatillomania, known also as Compulsive Skin Picking or Picking Disorder, is an Impulse Control Disorder. It displays itself as touching, rubbing, scraping, picking or squeezing skin. It is classified as a Body Focused Repititive Behaviour (BFRB).
It can vary greatly between individuals. Some people do small amounts almost constantly, while others will spend long amounts of time picking. These long sessions can be enough to disturb the social and work life of the individual. Most use their fingers, but some use tools like tweezers or pins to pick at skin.
Dermatillomania can be an unconscious or conscious action. In both cases the urge to touch the skin can be overwhelming and impossible to ignore. It is a behaviour that is incredibly hard to prevent or stop after it’s started.
It is not just picking at spots or ripping off dead skin. It can be incredibly severe and widespread. Most people focus on a specific area of the body. The most common area for picking is the face. After this is areas like the legs, arms, chest, neck and back. Some very sensitive areas such as the lips and gums are also targeted through chewing the gums or physically with fingers.
Dermatillomania is exhibited as being constant and more severe than the average persons habits.
Statistics and Facts:
There are very few facts and statistics that are completely scientific. This is because it has only recently been classified as a disorder and receives little attention. There is no page for it on the NHS site.
- Onset usually happens in teenage years or in the early twenties.
- There are more female sufferers than male- 86% Female (Source)
- 55% have only told one person or fewer (Source)
Why would you do it?
There is no fully agreed reason as to why but there are often many reasons people personally attribute it to. There are some that I will not have listed on here.
Sessions can be triggered by stress or anxiety. The behaviour is a response to calm down the mind or used as a distraction. Mood or anxiety issues often aid Dermatillomania becoming a dominant part of a lifestyle.
Perceived or real imperfections, lumps in the skin and skin rashes can also trigger sessions of picking. Dermatillomania often occurs with people who have skin problems like eczema, acne, dermatitis and skin infections. It can still happen in people who do not have these problems but believe they do.
Before picking, there is usually a feeling that they have to or need to pick at their skin. It is an urge which is hard to control.
Dermatillomania is sometime exhibited in individuals as a lone behaviour but is often linked with other disorders. It is not uncommon for a person to have several disorders.
The first is Body Dysmorphic Disorder, where a person worries constantly about their appearance and has a distorted view of it. The Skin Picking can be used to control or change their appearance or otherwise control their appearance.
A lot of information and help for Dermatillomania is grouped with help for Obsessive Compulsive Disorder (OCD). This is because a lot of professionals believe that it is a Sub type of OCD. Both OCD and Dermatillomania have similarities in both behaviours and thoughts. A quarter of people with OCD or BDD (Body Dysmorphic Disorder) have also got Dermotillomania.
A large proportion of people have both Dermatillomania and Trichtotillomania. Trichtotillomania is similar as a BFRB. In trichtotillomania the hair is being pulled out by the person in a similar pattern to dermatillomania .
What are the problems?
In the short term, the disorder obviously causes cuts and damage to the skin. This can be very severe, possibly needing hospitalisation in severe cases.
In the case of picking because of acne, whiteheads or blackheads the behaviour can lead to the increase in the number of spots. This is because the sebum clogs up more pores. This is irritating as it often provides an escalating cycle.
The behaviour also creates a lot of scars on the skin and causes long term damage to the skin. Hair follicles may be permanently damaged and there may be damage to the glands near the skins surface.
I personally have the disorder, which is focused around the top of my body. I particularly have a problem with my underarms and on rare occasions, the feet. The picking here can cause severe discomfort and restriction to movement as they are very sensitive areas.
Another problem is getting infections in the openings made by the disorder. Because they do it frequently, many sufferers do not cover any wounds. This can lead to problems like dermatitis or cellulitis.
Mental and Emotional:
On individuals with Body Dysmorphic Disorder the scars and markings caused are often distressing and worsen both problems. It also is embarrassing generally. The scars can make the person wear uncomfortable clothing just to cover up or use large amounts of make up to cover facial scars. It contributes to low self esteem and negative body image.
It also is good at excluding people. Sessions of picking that take hours are anti-social and isolating. Sufferers may feel alone and unable to find people to trust and talk to. The act itself is often misunderstood and frowned upon by people.
How to deal with it:
Preventing infections in wounds:
tw:blood, cuts, puss, gory imagery
A lot of preventative measures are fairly well known today but are often forgotten or the injuries dismissed as too small.
An easy long term preventative action is to make sure you stay up to date with vaccines. I spent a year not getting a vaccine I was supposed to I was lucky I didn’t get dirt in my cuts. Vaccines are the best way to avoid getting infections like Tetanus and are a major reason why people have higher life expectancies now than 100 years ago.
If a cut is on the hands, lower arms or feet is best to always treat and cover open cuts on skin. This is because these areas are always touching things and are prone to infection.
Small cuts may be allowed to be ignored, for example little cuts on the face or openings from picking at hair follicles. Some small cuts can be helped by a Styptic Pencil. Styptic Pencils are usually used for men’s shaving nicks and will be found in the men’s section of drugstores. They help to stop bleeding at small sites and are useful. There also may be some treatments targeted for spots which may be useful in the teenage skincare section.
Never use a needle to pick at your skin. It practically guarantees infection, especially if you get puncture wounds.
Medium injuries should be covered. Medium Injuries may be larger picking sessions, for example when a bit of dying skin around a scar has been picked off. Medium injuries are about the size of one to two of your fingers if irregular or no more than 4cm if straight. They are not deep.
Medium injuries on the soft or sensitive parts of the body should be covered, places like the thighs, stomach, breasts, chest, neck. Use the appropriate plaster. A useful thing to buy is plaster tapes or Zinc Oxide tape. These give you a lot of plaster for your money and are very useful for wrapping around a whole arm or foot. For the heels and toes, blister patches and toe plasters are better at staying on.
If you go swimming or have a shower, replace your plasters. Some swimming pools and beaches are very coarse and hard on feet and legs. On holiday you can find plastic shoes to wear on the beach locally as people have them to avoid jellyfish. To avoid reopening the scabs cover your feet with swimming socks or shoes. These are often found at beach or sports shops. Also throw away old plasters in bins as soon as possible, don’t leave them lying around.
Before covering they should be washed.
Wash the cut as soon as you can. Vary the amount needed depending on the size and depth. You will probably not need alcohol. If you can, try to remove any dead skin around the site.
These injuries will usually stop bleeding themselves if you do not have issues with blood clotting. It is usually best to allow some blood through as it will allow it to clot the site.
Some injuries may need medical attention. Your injury will need attention if:
- It is very deep
- It is a large cut on the face or neck
- It is deep or large and is near important blood vessels i.e.: Wrists, Thigh, Neck
- You have gotten dirt, faeces or chemicals into the wound
- It is a deep puncture wound- i.e. from a needle
- You can see fat, muscle or below the upper layer of skin
- Your cut is infected severely, resulting in redness, puss, swelling
- You have picked at an Insect, Spider or animal bite and it is infected
- You won’t stop bleeding
- Other severe pain or injury reasons
Long term treatments:
It is common for people to think there is no cure for Dermatillomania. This is because it is hard to just get rid of. Very few people successfully stop picking but that doesn’t mean you can’t reduce it.
Simply trying to stop does not fully work. You can discourage yourself each time you try but it is nearly impossible to have willpower that strong. Just remember each time you don’t pick is a success.
There may be support groups available to you to help you with Dermatillomania. You also may find it beneficial to find someone with the disorder to talk to. Habit Reversal Training is also used to change the way you act and change your behaviour.
Other treatments include Cognitive Behaviour Therapy. This is especially useful if there are other disorders and issues involved. Cognitive Behaviour Therapy tries to get you to approach your problems differently by focusing on your present.
In some cases prescribed drugs may be a way to medicate the condition. This is usually when the problem is caused by Depression, OCD or some other mental health issue.
The best way to identify your needs is to see your GP or Doctor. If this is too embarrassing, don’t worry about it. They’ve heard about all sorts of things over the years and you’re probably not the first mentioning this.
If you are unable to access healthcare, self help and care may be needed if you want. The internet is a good resource for finding the right methods for you.
Here are a few tips to help avoid sessions of picking
- Using your hands for something else, for example, Cat’s Cradle, drawing, colouring, craft activities
- Using Exfoliant on the body and face to reduce lumps in skin
- Using cleanser to Avoid spots on face
- Having chewing gum as a distraction
- Using sport or an activity as a physical removal from thoughts, Skipping is quite good if you can do it
- Not having tweezers, pins or sharp objects in your possession
- Avoiding mirrors if it triggers you
- Having fake nails or shorter (Yes, short nails) nails so you can’t pick as successfully
- Moisturising instead of picking
- Peeling vegetables- Especially carrots
How to help others you know:
If you know someone who you think that Dermatillomania, do not ridicule or pester them about it. It is not there for attention and a lot of people are ashamed and guilty about it. A lot of sufferers have told no one or very few people about their problem. Try to be accepting and sensitive about the subject as you would be about any other health issue.
Try not to dismiss it if it is clearly a problem. As soon as a person believes it is a big enough problem to tell you, it is a big enough problem. A lot of people do not get treatment because they dismiss it as a bad habit.
If a person is putting themselves at serious risk through Dermatillomania take action by talking to the person about it, their family members or talking to their parents/guardians if they are children.
Links to Resources: (All Open in New Page)
General Information about the disorder, particularly useful when talking about OCD and some tips.
Links to various pages about help, causes and symptoms.
Band Back Together
Information as well as some links at the end of the writing about related subjects like Anxiety and Impulse Control Disorders
Information, Self Diagnosis and Phone Number for becoming a member of Anxiety UK.
Lots of articles and information, area specific symptoms and also source for a lot of the statistics
Medical view of Dermatillomania
12 Dermatillomania Myths Dispelled
Kicking My Dermatillomania
A tumblr specifically about Dermotillomania (This one is not)
NHS Choices Links: (No pages on SPD/Derma but on other mentioned subjects)
Cognitive Behavioural Therapy
Obsessive Compulsive Disorder
Cuts and Grazes
Apologies and Afternotes after cut: