The OCD Center of Los Angeles is offering a free subscription to an exclusive 52-week online program developed specifically for those suffering with Dermatillomania and Trichotillomania. Follow the link to find out more or to sign up today. I think this is something I’ll be willing to try… what have we got to lose right?
So after months and months of hiding offline due to hitting a major picking low and having a major depressive episode (I was picking to the point of suicidal ideation) I have managed to get this disorder somewhat back under control. Not many sores left but OH THE SCARS!! So my mum just finished giving me a facial using microdermabrasion products. Mum was right when she told me that as I grew older my skin wouldn’t heal itself as quickly. My scars used to fade within days, now they take months to years to disappear which does not motivate me to refrain from skin picking. I’m almost 27 now (yikes!) and one of these days I’ll stop picking…
I haven’t posted in a while. Purposefully. I guess I don’t really feel as though I have much to say. Much to share. I started this blog with the hope of encouraging myself, and others, to stop skin-picking. But I find the battle so overwhelming that I don’t know how to stop. I admit that I am in a much better place today than where I was just a few years ago. But I still pick. Daily.
I have sort of come to terms with my derma, in the sense that I now think of it and treat it as more of a physical dis-ease than a mental one. For example if one were to have diabetes, they may have it for life but they become aware of the symptoms and risks and how best to manage them. With skin-picking I am aware of the symptoms and risks (depression, suicidal ideation, open wounds, scarring) and I simply have to learn how best to manage them as I may very well have this disorder for life. Part of this disorder is having a desire to ‘perfect’ the skin when in reality we are actually destroying it. I am trying to shift my thinking to actually caring for my skin – ‘perfecting’ it in a different way. I exfoliate. I moisturise with coconut oil. I use scar treatment oil. I cover open sores with bandaids to let them heal and to remind myself not to pick. Little by little these small things are helping in their own small way but I know I could be doing a lot more.
Every year I make the New Year’s resolution to stop skin picking. Every year, I fail. This year is the first year I have not made any New Year’s resolutions although I know in the back of my mind I still want to stop picking. And the sooner the better. It’s just I can’t handle the failure anymore. I’m trying to find things to motivate myself to stop picking – less time to get ready, more confidence, be able to wear what I want, enjoy summer, date. And again whilst these desires motivate me a little, I still can’t seem to take that extra leap to actually stop.
I know I’d be a better mother if I stopped. A better daughter. A better friend. A better partner. A better lover. But at the same time my derma has made me who I am today and I guess I have to be thankful for that. My derma has made me a more compassionate and empathetic person who has the ability to look past physical appearances to the person underneath the skin. I find all people beautiful – if they are beautiful on the inside. I have never judged someone for their appearance. I give people second chances. I make people laugh. I will always listen. I will always care. I’m a better person on the inside because of my derma. I may be more scarred and a little less appealing on the eye than the ‘average’ person but perhaps that’s a compromise I have come to not only accept but also to appreciate.
I am a walking contradiction. At times I find life so difficult that I think death is the only answer but then I desperately want to live. I fear ill health and death and yet I fear my fears to the point that I see death as the only way out.
I realised tonight that mental health is just as important as physical health and deserves the same amount of recognition. I have a mental condition and I don’t think I’ll ever be cured from it, the best I can do is learn how to manage the dis-ease. I find that my mental illness also causes physical illness. I feel all kinds of things that I just don’t want to feel but the more I try not to feel the more I end up feeling.
My legs are restless. I am lying in bed but my legs feel so itchy from the inside out that I just wish I could tear them both off. I feel like I need to get up and move around but I am so tired that I just don’t want to move. I’ve just discovered I have a vitamin B12 deficiency so all my symptoms of late can be put down to that – breathlessness, faintness, dizziness, chest pains, rapid heart rate, fatigue, depression, tingling arms and legs, restless legs, etc. At first my doctor just thought I was stressed and anxious, and I could believe that, but it turns out there was an underlying condition. Apparently it can be quite serious if left untreated but I am petrified of the treatment.
You see I fear medication because I fear side effects. Even though an illness makes me ill and could even possibly kill me I never take anything I am prescribed because the medication could make me ill and even possibly kill me. Seriously how fucked is my mind? Like can you even win with me?
And I know I don’t think rationally yet I can recognise my irrational thoughts as irrational. Like I think about ending my life over the most stupidest of things. No seriously it is ridiculous! When I was 13 years old I remember wanting to commit suicide because I thought my wrists were too thin and would snap at any given moment. Lately I’ve been wanting to end it all because I received a dodgy filling months ago and it is still causing me pain even after they were forced to redo it. Now I am too scared to have it replaced a third time so I am just putting up with the pain.
And I know there are people out there right now in excruciating pain. Mental and phsyical. And they would give anything to trade places with me. And here I am complaining. There are people battling cancer right this second. Mothers who have just lost a child. Travellers being beheaded by terrorists. And here I am in a warm comfortable bed. I had a beautiful deliciously healthy dinner and I relaxed to a movie and a new TV series tonight and yet I still can’t feel happy. I just feel… empty, lost, lonely, tired, hopeless and full of regret.
The only thing that helps me is to write. To just get it all out of me. I feel like a failure but at the same time a success. I feel lonely but at the same time I like being alone. I want to be well but at the same time I avoid everything that will make me well. I want more children but I fear I will never be able to have any more. I want to go and check that my fridge door is shut for the hundredth millionth time but I don’t want to keep giving in to my OCD. I want to not suffer with mental illness anymore but at the same time I am grateful that I am not suffering with a serious physical illness. I am so many things that I do not want to be and yet I do not do anything to change into the person that I do want to be. I am a walking contradiction. I don’t even know who I am anymore.
I understand that this blog post probably makes no sense. I haven’t bothered to censor myself. I just wanted to provide you with a snapshot of what goes on inside my head every second of every day. Dermatillomania is not my only disorder. Sometimes my anxiety, depression and OCD overwhelm me and at times like this, it is not at all related to the skin picking. Tonight is just a night for my other mental illnesses to come out and play. Anyone reading this would probably assume I was drunk or off my face on drugs. I know I sure would think so after reading such scattered thoughts. But then again I am a highly rational irrational person and I can assure you that I’m 110% sober but I maybe just maybe am a little bit crazy. Unfortunately.
If stress had a face this would be it…
I wish I knew a healthier way to cope with my stress. This disorder is slowly killing me from the inside out. Although of course it is quite possible that this disorder could kill me from the outside in. With every wound comes the risk of infection and I’m no stranger to infections.
The cause of my stress may also be the reason I go quiet on here again. I am back to working 4-5 nights a week, full-time uni goes back on Tuesday, my little man goes back to school on Wednesday, I have a 5 week teaching practicum coming up in mid-October and on top of all of this I am still trying to sort out my furniture and a home for my cats from my break up almost 2 years ago now. I know I have taken on too much. I always do. I have an extremely addictive personality and I get addicted to work and study just like I am addicted to picking at my skin. I don’t know how to slow down. I find keeping busy helps with my Dermatillomania but at the same time the pressure it puts on my heart and my brain and my body – sometimes it feels like I will have a nervous breakdown and never come back from it.
I attended an OSPA (Obsessive Skin-Pickers Anonymous) meeting online about a week ago and this helped me come to the realisation that I am powerless over my skin-picking. It is an addiction and it does have a hold on me. Unfortunately unlike drugs and alcohol I can’t simply abstain from the substance for the very addiction is me. My fingers, my nails, my hands always constantly searching my skin for the next spot, the next pimple, the next blemish, the next scar to reopen. THE NEXT FIX! How can I distance myself from myself long enough to beat this thing once and for all?
Once I came to the realisation that this disorder has more control over me than I want it to, I contacted an addiction recovery clinic here in Perth, Western Australia. I explained Dermatillomania to them and I wondered if they would be willing to take me on as a patient. Although they had never treated anyone with my specific disorder they advised me that they had successfully treated a number of patients with compulsive disorders using a drug called Naltrexone. In their words: “Naltrexone works to block the opiate receptors in the brain, but a flow on effect of this is that it reduces surges in dopamine (surges in dopamine are what gives you the pleasure and reward from doing a certain task)”. So although the drug would stop my picking from feeling good it appears that it would also stop other things from feeling good. This wouldn’t be a problem if it weren’t for my depression. However given how low my mood can currently drop I worry about how dangerously low it could get if I no longer experienced any pleasure whatsoever.
The good news is that I haven’t given up yet. I still want to beat this and I am still exploring my options. Addiction treatment and/or having my nails surgically removed are two options I am considering as last resorts. In the meantime (now that I am finally working again) I am hoping to be able to afford the regular upkeep of acrylic nails and I may even start looking for a new psychologist or hypnotherapist to work with again. This is the longest I have gone in my life without seeing a mental health professional (from the age of 8 years old I have seen one regularly). Sadly I had to finish up a 4 year relationship with my psychologist in January of this year as she was offered a job elsewhere and it was a great opportunity for her. Up until this point I have been coping but I know I’m at the stage where I need the help again.
This post was a bit ranty and maybe a bit all over the place. It’s 3:00am here and I have a splitting headache but I just needed to write and get things off my chest so that maybe just MAYBE I can sleep tonight. I have spent the last few days and nights picking sometimes until 4am in the morning and sometimes for over 3 hours straight. I know I need to start taking better care of myself but I also know I don’t have the time right now to do that. I often think of deferring uni for 6 months and really knuckling down and working on this condition but at the same time I worry that having nothing on my plate will only contribute to more picking. At the moment it seems like a lose-lose situation whichever way I turn. So for now I will leave you and myself with the serenity prayer, sometimes referred to as the AA prayer:
~ God grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference. ~
So it has been a while since I have written anything on here. My apologies! Last year I found it really hard juggling full time uni, my night job, volunteer work, a teaching prac, being a single mum as well as keeping this website updated and selling the Dermatillomania Awareness Wristbands. Something had to give because we all know what happens when we suffer from this disorder and we become stressed and overwhelmed: PICK PICK PICK!!! So I decided to leave the blog for a bit and just become more active in my Dermatillomania Support Group. It turns out that this year has been just as hectic as the last (although I have learnt to manage my time a bit better) and next semester is going to be one of the most chaotic semesters I have ever undertaken so I may or may not go quiet again on here. Please understand it is not because I have stopped raising awareness of the cause or because I have no more stories to share… quite the opposite in fact! So here’s an update on how I’ve been doing:
NOT SO GREAT!!
Any surprises there?
To be fair I was doing quite well. I managed to wear a dress to a party in January and a pair of shorts to a catch up with friends but then… that dreaded word… RELAPSE!! Made worse by the fact I am on break at the moment and when I find myself with nothing to do, well, I pick of course! Stress and boredom are two big triggers for me. Plus I suffer with depression so unless there is something motivating me to get out of bed each and every single day then chances are I will stay in bed and pick. I will also stay up all night and pick. Of course this makes me feel bad so then I pick more! But you all know this right? This vicious cycle… the never ending merry-go-round of derma, a ride we desperately want to hop off from but how?
Not only do I feel bad for myself but now I am starting to feel guilty. Guilty that this skin-picking disorder is now impacting on my son. I mean we have spent most of the school holidays inside because I am too ashamed to leave the house… I won’t even go outside to throw rubbish in the bin! Yes I am back there again! BUT if I put makeup on then I at least manage to force myself to go outside. It’s just finding the motivation to first look at my reflection in the mirror and then begin the painstaking process of trying to cover up each and every one of my self-inflicted wounds so that I at least appear somewhat ‘normal’ to the outside world. But my son brought something to my attention the other day in the roundabout innocent way that children get straight to the crux of the issue.
I was sorting laundry when I noticed certain stains on little boy’s jocks and so I teased him that boys were dirty (because let’s face it, we’ve all found those stains in grown men’s underwear too)! Little did I realise I’d get teased back!
“Ewww boys are dirty” I teased with a smile on my face.
“No you’re dirty” my little man retorted.
“How” I asked, curious as to what response he could possibly have for girls being dirty.
“You’re not clean because you have polk-a-dots” he said, pointing at my face.
“Can’t you just go and put some makeup on” he added, pouring salt into my wounds.
Well what was I supposed to say to that? I did manage to mutter a “that’s not very nice mate” but at the end of the day he was just speaking the truth. And that’s the thing about kids… they’re damn honest even when you don’t want them to be! Family, friends and even partners (as nasty as they can be sometimes when it comes to this disorder) mostly try to make you feel good about yourself placating you with comments such as: “It’s not that bad” “I can barely notice it” “You still look beautiful to me” bla bla bla. But let’s face it; my seven year old nailed it! I know I look like shit. In fact I think I look like a junkie at the moment. My hair is unbrushed and all over the place, I stay dressed in my pyjamas all day and my face and hands are covered in open wounds. Luckily it’s winter at the moment so at least my legs and arms and all the rest of me are mostly covered up!
I admit I sometimes criticise people (only in my head of course) for their dress and body art choices after they’ve become a parent. Not that I have anything against people’s choices when it comes to their own appearance but sometimes becoming a parent means a bit of conservativeness wouldn’t go astray. I often wonder if these children will be embarrassed of the way their parents’ look; however never once did I stop to think how my son must feel about the way I look. I will put on clothes and makeup to cover up this disorder to everyone else (family, friends, partners, work colleagues, etc.) but not my son. Never my son. Maybe I thought because he had only ever known me this way that he wouldn’t even notice it. But he has. And I know that now. And I feel awful that he has to look at me every single day and stomach what this disorder has and still is doing to my appearance. I have a good kid! In fact I think he is fantastic and he’s usually super sensitive to other people’s feelings. But maybe just maybe I needed to hear in a roundabout way what MY disorder is doing to HIM. Part of being a good parent is protecting our children, especially from pain and suffering, but how can I do that when I keep exposing him to my own pain and suffering? This is not his battle. This is mine. It is not fair that he has to suffer because I am suffering. I have always wanted to stop picking but now I want to stop for him. I just wish I knew how…
I felt like my last post may have come off as a bit of a “my skin picking is more severe than yours” rant which was not my intention at all because regardless of whether you suffer mildly or severely, you are still suffering and you can still have this disorder, so I felt the need to write this follow up post just to clarify a few things. Over the years I have noticed two things: 1. Those who are suffering quite mildly (in their own words) and therefore don’t feel like they fit into the derma community because they only pick certain areas, at certain spots and as such they feel like they fail at having this disorder; and 2. Those who are suffering quite severely (in their own words and as evident in their photographs and stories) and therefore don’t feel like they fit into the derma community because everyone seems to have it so much more under control than they do and as such they feel like they too fail at having this disorder. This is why I made the point in my last article that “In order for no one person to feel isolated about living with a condition such as Dermatillomania, it is important that there are different ways to describe the severity of the disorder, ones that are backed up by thorough medical and psychological research”. It was never meant to be a competition about who had it worse, it was just another viewpoint that I felt was important enough to be added to the conversation. Also when I spoke about severe dermatillomania, I gave an example from my own personal life. As someone who has suffered from this disorder for 21 plus years now I have experienced the highs and lows of Dermatillomania and have experienced stages where I would consider my suffering quite mild and at other times quite severe. Part of the reason I want a sliding scale for derma to come into existence is because if we can’t categorise derma then how can we even begin to evaluate our own progress or relapses? Or in my case how can I even begin to explain how I used to look and feel a few years ago compared to how I look and feel now? This is not about singling people out; this is about finding ways to make people feel included!
Sliding scale of severity set aside, the reason I wrote my last post was because I wanted to raise the point that while self-diagnosis can be helpful as a starting point (as it was for me) it does not always guarantee an accurate diagnosis and that is why it is worthwhile to have a discussion with a medically qualified health provider about the information you have found online. The second point I wanted to bring up was that there is a difference between having a bad habit, suffering from tendencies of a disorder or suffering from the full blown disorder itself. The third point I wanted to raise was that when it comes to Dermatillomania there are varying degrees of severity, just as there is with most other mental and physical illnesses and I think this needs to be acknowledged by medical professionals and other sufferers as well – not because it is a competition but because treatment options may vary and our ability to relate to other sufferers may differ depending on our own personal struggles with this disorder. And the final point I wanted to make was that the symptoms of Dermatillomania are very similar to those of Body Dysmorphic Disorder which is why it might be helpful to seek a clinical diagnosis after self-diagnosing simply to ensure that the information you are accessing online will actually be beneficial to you.
I think Dr. Phil hit the nail on the head last year with the two segments he aired that related to skin picking. The first “Distorted Beauty” featured a guest by the name of April who sought help for Dermatillomania but was perceived to be suffering from Body Dysmorphic Disorder instead. Many viewers agreed with Dr. Phil because for those of us covered in marks/scars/open wounds April’s skin appeared flawless. Even in her photographs she appeared flawless. And this was backed up by Dr. Phil’s own words referring to April’s skin after she had removed her makeup: “It’s flawless. You are stunning!” It is hard to make judgements on this without seeing her in person though because she could have made a concerted effort to clear her skin up for the show and she was wearing long pants and sleeves in the segment however given the information I was being presented with I found myself in support of Dr. Phil’s diagnosis.
Fast forward a few months and “Obsessed and Over It” features a guest by the name of Samantha and her little sister Rachel who both engage in skin picking. The marks/scars/open wounds were highly visible not only in her photographs but also when she was asked to remove her makeup. We were even able to see video footage of Samantha and her younger sister engaged in the skin picking behaviour and I couldn’t help but think “FINALLY”! Finally Dr. Phil has featured someone on his show clearly suffering from Dermatillomania and he even went as far as to mention the DSM-5 and the diagnosis of “Excoriation Disorder”. What a relief!
Whilst I was glad that a professional with a widespread public audience had made the distinction between Dermatillomania and BDD clear there were still some things bothering me and so I felt compelled to write about self-diagnosis because it was paining me to see:
- People seeing a list of mental illnesses and/or body focused repetitive behaviours and saying “Oh I have EVERY single one of those” without seeking out a clinical diagnosis to find out if they actually DO suffer from every single mental disorder/BFRB listed. Again there is a difference between sharing symptoms from a multitude of disorders or each symptom/behaviour being severe enough on its own to warrant the diagnosis of multiple separate disorders.
- “Supposed” sufferers bullying other sufferers online, leaving remarks such as “Why can’t you just stop”, “Why would you pick where people can see it” “Why would you post such a disgusting picture” … boy does it hurt me to see other sufferers subjected to this kind of bullying by people who are not only meant to understand the disorder but also be suffering from it themselves?
- People saying “Oh I pop pimples too” and then assuming that means they also have the disorder and therefore understand a Dermatillomaniac’s innermost struggles.
- People who say they have Dermatillomania and then don’t understand why I don’t socialise, why I don’t have many friends, why I’m too embarrassed to go out after a picking session, why I HAVE to put makeup on before I let anyone see me, why I have to wear long sleeves and long pants in summer, why I don’t want to get naked in front of anyone, why I don’t want a relationship and the list goes on and on and on. If you have the disorder like you claim you do… wouldn’t you to some extent, understand what it is I’m going through?
- And lastly those who again supposedly have Dermatillomania and then call me vain because of my preoccupation with my skin. Facepalm right there.
For the most part I have had overwhelmingly positive interactions with people online and there have also been some positive experiences in face-to-face interactions as well. But then I have also witnessed and/or experienced all of the above. Now I am extremely understanding about the varying degrees of suffering that a Dermatillomaniac can experience and I totally get that this disorder comes about in a multitude of ways and therefore presents itself in a multitude of ways which is why I have never turned away a sufferer seeking help or advice. My aim here is not to take away from other’s struggles or win some kind of imaginary competition about “who has it worse”; it is about educating people, raising awareness of this disorder and encouraging those who are unsure whether or not they may be suffering from this disorder to seek a diagnosis.
And if you don’t have this disorder but you want to reach out or try and relate to what it is we go through, I will leave you with the most positive interaction I have ever experienced between a non-sufferer and myself when my picking was in a pretty severe state:
When I was around 19-20 years old I decided to take a holiday to visit my best friend, her fiancé and their daughter and stay with them in their home for over a week. It was the first holiday I had taken away from the comfort zone of my own home as an adult sufferer of Dermatillomania. I had packed all the necessities: Makeup and Tweezers. I would sit with the urges to pick ALL day until everyone went to bed, then I would grab my toiletries bag and rush into the bathroom only to spend the next few hours picking in front of the mirror. One night smack bang right in the middle of a gloriously successful picking session my best friends fiancé walked into the bathroom and caught me leaning in close to the mirror, tweezers in hand, covered in fresh open sores with blood spotted all over my face. I tried my best to cover up what I’d been doing and I was that shocked by his presence I didn’t even know how to begin to explain to him this sight he was witnessing. Instead of recoiling in horror or making some disgusting comment he simply walked over to the wall-length mirror, inspected his face and then said something along the lines of “I pop pimples and pick at imperfections on my skin too. I could easily get absorbed in it and be here all day except the only difference is I know when to stop and walk away.” That moment and that comment have always stayed with me as a positive interaction. Here was a man who despite our differences could provide a totally empathetic response that both made me feel normal by admitting he picked/popped too while recognising the severity of what I was going through by acknowledging I didn’t know when to stop. Had he walked into the bathroom and said oh I sometimes pop/pick too so I know how you feel, it probably wouldn’t have come off as such a positive experience for me. Instead here was someone who totally got it, without having to be a derma sufferer himself. Still to this day I don’t think he knows how much that interaction had an overwhelmingly positive effect on me but if he happens to stumble across this post one day … THANK YOU!
Self-diagnosis. We are all familiar with it and we have probably all engaged in it at least once or twice. But how does self-diagnosis impact on those who have either been diagnosed with or are clearly suffering from a mental health disorder, such as Dermatillomania? This is a topic I feel compelled to write about, it is a controversial one none the less but I feel that someone has to give this topic a voice.
As a Dermatillomania awareness advocate I come across and converse with many derma sufferers on a daily basis. Mostly what I see is upsetting – people caught in the grips of an illness that is literally tearing their lives and skin apart, then there is the occasional hopeful story – those who say they used to suffer from the illness but now have it beat (I always wish there was photographic proof for these stories though as I am a bit of a sceptic); and finally there are times when what I see confuses and deeply upsets me. By this I mean those who say they are suffering from Dermatillomania and yet I can’t see any scars or marks on them. Then I find myself wishing that my derma could be that mild [edit: as physically mild as theirs] so I too could experience what it’s like to wear tank tops, shorts, go without makeup, or even wear a bikini! In fact I don’t even own said swimwear. The last time I went swimming was 11 years ago when I was 14 years old. I lived in a very hot and humid coastal town, so avoiding the water was near impossible, it just came with a sideline of questions and bullying.
Now as a Dermatillomania sufferer I am well aware of the tips and tricks one can take advantage of to hide the damage we do to our bodies, including Photoshop, taking photographs from certain angles, experimenting with different kinds of lighting, wearing certain types of clothing and picking only in certain areas. I am also well aware that Dermatillomania is a condition similar to physical illness, in that the sufferer can go through periods of remission, a word most commonly associated with cancer but it refers to the period of time during a serious illness when the patient’s health improves. I experienced remission when I was 17 years old to the point I almost considered myself recovered, although I did still pick every day even if it was only at a handful of hidden spots. Then I went through similar incidences of remission again when I was 22 and 24 although I relapsed in both instances within a matter of months. My skin-picking also decreases during winter when I have less opportunity to pick at my skin due to the fact it is always comfortably covered by jeans, jumpers, scarves, etc. And because I am not standing out as the only person wearing pants and long sleeves (as I do in the warmer months of spring and summer) I find that I fit in to the wider community a lot more which lessens my stress, depression and anxiety which in turn decreases how often I pick. So keeping all of this in mind I understand that I may be making judgements on people who are in remission; however if this is the case then it is helpful to state that you are in remission when discussing Dermatillomania with other sufferers so they don’t feel upset or confused by how flawless your skin looks in comparison to theirs. This is something that I learnt when I was in remission interacting with other sufferers and I found myself having to explain that I really did know how it felt to have severe Dermatillomania.
When I was 19-21 years old, my Dermatillomania reached its most severe point and thankfully it hasn’t been back there since. I was that disabled by my condition that I NEVER left my house without assistance and only then it was to force myself to do the grocery shopping in order for me to feed my son. I could not even walk to my letterbox, I could not put my bins out on the verge, I could not even open my front door to put rubbish in the bin, I would not open my front door to anyone and I would not even hang the washing out in my own backyard for fear of being spotted by a neighbour. My curtains and blinds were always drawn shut – I lived in complete darkness for more months than I can count! My only regular interaction with others was with mental health professionals, social workers and family support workers. I was that disabled by Dermatillomania I needed encouragement to walk outside of my own house because I felt as though my legs were going to collapse underneath me from the anxiety of it all; and if someone did manage to convince me to leave my house I would walk with my head faced firmly down, eyes fixated on the pavement, struggling to breathe, on the brink of tears and completely lost for words. During this time of my life I would engage in 7 hour long picking sessions most nights, where I would gouge at my skin with tweezers to the point I felt physically ill. I hardly ever slept, I was constantly infected and I was inundated by suicidal thoughts. I started planning my own death and writing goodbye letters. The next day I ended up as an outpatient at my nearest mental health hospital. This is severe Dermatillomania.
In the DSM-5 it states that: “Excoriation (skin-picking) disorder is characterized by recurrent skin picking resulting in skin lesions. Individuals with excoriation disorder must have made repeated attempts to decrease or stop the skin picking, which must cause clinically significant distress or impairment in social, occupational or other important areas of functioning. The symptoms must not be better explained by symptoms of another mental disorder”.
Apart from the name Excoriation Disorder, I feel that the DSM-5 has it fairly spot on so far. To be diagnosed with the condition one must have skin lesions present on their body, there must have been some desire to want to stop, it must cause clinically significant distress and/or it must cause impairment in social or occupational functioning. It also must not be better explained by symptoms of another mental disorder and I think this is the most important signifier. In some instances there seems to be a fine line between Dermatillomania and Body Dysmorphic Disorder. I say this because if one has flawless skin but believes they have imperfections on their body that are not observable or appear slight to others, then this more accurately fits BDD. With Dermatillomania there is no doubt to oneself or others that the condition very much exists physically! This is backed up in the DSM-5 under the Body Dysmorphic Disorder Diagnostic Criteria which states that a BDD sufferer has a “preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others. At some point during the course of the disorder, the individual has performed repetitive behaviours (e.g., mirror checking, excessive grooming, skin picking) in response to the appearance concerns”. The DSM-5 then goes on to state under the Excoriation Disorder section that although “skin picking may occur in individuals with body dysmorphic disorder who pick their skin solely because of appearance concerns; in such cases, excoriation disorder should not be diagnosed”.
This brings me to my next point however and that is that the DSM-5 should include an assessment criterion which diagnoses Dermatillomania on a sliding scale as it does with depression. When my derma was at its worst I was also diagnosed with severe depression however I can go through stages now where my depression is quite mild. Then there are days when I am just sad. Sadness and depression are two different things as are skin picking and Dermatillomania. One has to be severe enough to negatively impact the sufferer’s mental health and/or their ability to function in social situations in order to be classed as a disorder. Hopefully with more research and more awareness into this disorder a sliding scale for derma might come into existence, one where it can be assessed as mild, moderate or severe. I feel this is important because some people only focus on one area (and it may be an area that one can hide) whereas other sufferers can’t help but pick at numerous areas and in places that can only be hidden when the sufferer takes great extents to do so (e.g. by wearing long sleeves and pants in summer). Also some derma sufferers are still able to maintain friendships, relationships and hold down employment whereas others are unable to function in any social situation. In order for no one person to feel isolated about living with a condition such as Dermatillomania, it is important that there are different ways to describe the severity of the disorder, ones that are backed up by thorough medical and psychological research.
In a world where Dermatillomania is only just starting to be recognised in the medical and psychological field, I understand that many sufferers self-diagnose because they feel that there is no other option for them. I self-diagnosed 5 years ago when I first found information online about this disorder but I then brought that information to my doctor and the psychologist I was seeing at the time in order to receive a proper documented diagnosis – albeit they have spelt Dermatillomania wrong on my file! Whilst self-diagnosis can be helpful, it is only a stepping stone in a greater journey towards clinical diagnosis, treatment and then hopefully recovery. The reason being is that when self-diagnosing ourselves with disorders or illnesses, whether they be physical or mental, we can sometimes get it wrong or be quick to label a habit something more serious than it actually is. To put this in perspective: I often pluck my eyebrows, sometimes I over pluck them in my desire to shape them perfectly, I will also pull stray hairs from my chin or upper lip, and if my hair is done up in a style and I notice some are out of place I will pull them too. I occasionally pull hair but I do not have Trichotillomania or Trich. My hair pulling is nothing out of the ordinary and does not cause me any distress or social embarrassment. Everyone picks at their skin. This is normal. Many people even take pleasure in popping pimples or satisfying an itch. This is also normal. What is not normal is when you do not know how to stop and when you keep going to a point that it causes you significant distress and/or impacts on your ability to function socially. So please keep this in mind when self-diagnosing, as a wrong diagnosis can have a detrimental effect on both yourself and those suffering from the mental health disorder in question. I don’t want Dermatillomania to be misunderstood more than it already is or to be made out less serious than it actually is – this disorder has the potential to put a sufferer in a life threatening situation and this is why I am so passionate about spreading awareness, however controversial it may be.
Dermatillomania is the big red elephant in the room when it comes to intimacy in relationships. How does one navigate the world of dating, which is tricky enough on its own without having the added complication of living with this condition? How do you even begin to describe to someone who barely knows you that you have Dermatillomania? The obvious answer to me has always been to avoid situations like this. Quite simply: don’t date. However that is unrealistic because at one stage or another we are bound to desire the intimacy of being with another human being – mentally and emotionally as well as physically. For someone with Dermatillomania all three of these connections can pose a serious problem.
Whether we like it or not there is still a great deal of stigma surrounding mental health issues which is why I usually lie and tell people I have a skin disorder. This makes the condition sound physical – almost out of my control – without me having to explicitly state that I am suffering from a mental condition. However it’s only a matter of time before it becomes obvious that Dermatillomania is more than just a physical affliction and that there is something else going on underneath the surface. But how can you explain a condition to someone when you don’t fully understand it yourself; when you know that what you’re doing makes no logical sense whatsoever and yet you still can’t seem to find a way to stop. It really does make one sound a little bit crazy, or in other words it definitely puts the mania in Dermatillomania.
Then emotionally it’s very hard to connect with others when you are suffering from a condition like this. The saying “You have to learn to love yourself first before you can expect others to love you” comes to my mind when I think of what it feels like living with this condition. How can I expect another person to love or accept me physically, emotionally and mentally when I can’t even love or accept myself the way I am? It seems like a pretty big ask to me and because I fail to see how someone else could accept me as a Dermatillomaniac, anyone’s genuine attempts at showing me love or affection is lost on me. I have lived 21 out of 25 years with Dermatillomania and the way I have been treated because of this condition and the insults and bullying that have come my way, has affected me to the point that I struggle to believe someone even when they compliment me. I shake my head and don’t know what to say because they couldn’t possibly be talking about me or if they are then they must certainly be lying just to try and make me feel better about myself.
And finally this brings me to physical intimacy, the most problematic connection one can experience when living with Dermatillomania. If I am physically disgusted by my own appearance, how can I expect someone else to be able to look at my skin and still feel an attraction towards me? In the past I have dealt with this by only getting undressed or being intimate with someone in the dark – the very very dark! But even then I spend that much time worrying about the makeup running off my face or the feel of my skin underneath their hands, that I can’t relax enough to fully enjoy the experience. And because your mind is racing with worries instead of feel-good feelings towards the other person, the chance to emotionally connect with someone is once again lost and sex becomes a chore or an act instead of the fun, loving, bonding, intimate experience it’s supposed to be.
So how does a Dermatillomania sufferer navigate the complicated world of dating especially when we live in a society that is obsessed with body image and where we are inundated by images of flawless skin on a daily basis? For me, I don’t think I will ever allow myself to experience a truly intimate relationship, one that involves experiencing all three connections (mental, emotional, physical) simultaneously with someone until I first learn how to accept and love myself just the way I am. However I understand this isn’t for everyone so what I can say with confidence is this: There are some truly loving genuine people out there who are accepting and understanding and will not treat you any differently for being a Dermatillomaniac. Find those people and hold onto them with both hands. Anyone else, especially those who treat you differently or make you feel bad for having Dermatillomania, are not worth your time and they should be shown the door immediately. Just because we have this condition, does not mean we don’t deserve the very best – a lesson I am still learning today!
I’m so sad that while I’m working, you’re still so busy growing.
Yet I still remember how I felt when I first started showing.
This little miracle inside of me just waiting to be born,
And now that you are here, between work and parenthood I’m torn.
I was there for your first word and I was there for your first step;
I even held you in my arms and rocked you while you slept.
I’d tiptoe around the house not wanting to disturb you,
But now it’s you who’s quiet so study I can work through.
Sometimes you sit and stare and a tear runs down your cheek,
And even though I work so hard for both of us, I’ve never felt so weak.
I’m always in a rush, especially before and after school.
The sadness in your eyes makes me feel like such a fool.
Time is precious and it’s always going to pass,
That’s why we should be playing so I can hear that gorgeous laugh.
I want to bake with you and chase you around the yard.
Why does work and parenthood have to be so hard?
I want to teach you how to ride a bike and take you to the park,
Do anything I can, to recapture your kind and giving heart.
I promise from now on that you are my number one,
And I will do everything I can to make your childhood fun!
(Not exactly derma related but many precious moments with my son were lost when I was busy picking. Now his attention is competing not only with my disorder but also with my work and study. In this picture I am covering the damage I had done to my chin at the time.)