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:

1. 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.
2. “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?
3. 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.
4. 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?
5. 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!