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Self-Diagnosis: Harmless or Harmful?

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.

What I would have looked like if I wore a bikini – 2009.

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.

In remission – year 12 school ball 2006.

In remission – 2006.

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.

My Dermatillomania at its worst – 2009.

Relapsing right before a wedding – 2011.

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”.

November 2013.

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.

Getting better – December 2013.

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Fading Scars

So when my sores start to vanish I start to notice my scars a lot more. This photo doesn’t really do the scars justice but you can still make them out – they are the purple spots on my arm/hand. The colder it gets or the colder I feel the more pronounced these scars become. And I have them ALL over my body. Legs, arms, face, back, stomach… bottom… you name a body part and I can guarantee you it is covered in scars. It gets me down. I know I shouldn’t let it get me down but it does. Even if I stop the picking I still won’t be able to enjoy my skin because I have essentially wrecked it. However I have heard somewhere (not sure where) that skin renews itself every 7 years. So I’m going to hold onto the hope that I won’t always be scarred… or at least they won’t always be so noticeable. In the meantime I am using this:

It is Palmer’s Cocoa Butter Formula (with Vitamin E) Skin Therapy Oil. It has replaced Bio-Oil as my new favourite scar treatment. I found Bio-Oil quite greasy, you couldn’t put it on open sores and I didn’t overly enjoy the smell. This stuff, on the other hand, smells FANTASTIC (rosehip fragrance), is light & non-greasy, it doesn’t mention anything on its packaging about it not being suitable for use on open sores AND it’s gentle enough to be used on the face! WINNING! And as an added bonus not only is this stuff available for sale in the US and UK but also Australia and a few other countries! I’ll keep you updated on how well it goes on improving the appearance of my scars; in the meantime they have a website you can check out: http://www.palmers.com/

Self Portrait – Keeping My Hands Busy

Self Portrait - Keeping My Hands Busy

Just a little update…

Got about 5 quotes so far for the wristbands 🙂 and am getting some samples sent out in the post next week! Told the guy on the phone all about Dermatillomania & Trichotillomania….AWKWARD!!! Haha raising awareness in Australia one person at a time 😛

Also enquired at the post office and it will cost $2.60 (Australian Dollars – AUD) to post a band to the US/UK in a regular envelope via airmail (should take approximately 10 working days to arrive). It was the most affordable option they could offer so I hope that’s not too expensive for everyone – I think it works out less for US & UK buyers though due to the exchange rate at the moment.

Next step will be working out the cost of the band and this will depend on how much they cost to make. TLC sell their awareness bracelets for $4.00 and there was one recently being sold on ebay for $10 with 10% of the sale price going towards TLC. I was going to try and sell the derma ones for $4 or less with 50% of proceeds (the money left after expenses) going towards TLC and the other 50% going towards raising awareness in Australia. Does this sound acceptable to everyone?

Sunshine and Scarring

Sunshine and Scarring

It’s Winter here in Perth, Western Australia but you wouldn’t know it! The sun is still shining and there’s hardly a chill in the air so yesterday I decided to catch a bit of the sun’s rays while they’re still hanging around.

I decided to take pictures so you could see the different types of scarring I have on my body. There’s the white lumpy scars on my belly. The dark purply brown scars on my legs. And then of course as soon as my skin is exposed a bit of picking is bound to happen. In that photo, not only can you see the freshly picked spots but also the white and brown scars. If I tan, the brown scars fade but the white ones stand out and if I remain pale the white scars aren’t noticeable but the brown ones are. So I can’t win either way really!

Minor Relapse plus Genetic Precondition?

Sooo I’d finally managed to get my face clear and then last night while I was reading a book I started to pick at it again. I attacked the spots that were almost healed (they were dry and flaky) and I don’t know if subconsciously I did it because I still wanted there to be something to pick at on my face. :/ So now I can not wait for my fidgets to arrive! TLC sent me shipping confirmation today so I am excitedly waiting for my parcel!

On a different note while I’m sitting here writing this my 6 year old son is picking at his lip. He’s a lip picker but ONLY when there is dry skin there to actually be picked off. I’m telling him to stop because it will hurt if he rips it off and he gives me a cheeky smile like he knows that’s what’s going to happen but he wants it off anyway. So far I’ve kept his hands busy with a drawing & writing activity and I’ve told him to drink water to hopefully rehydrate his lips but I guarantee you he’ll pick at them later when I’m not looking. I also went to visit my nan last night with my mother and while I was sitting there picking at a spot on my back, my mum was sitting there scratching at her face. Genetic much?

Dermatillomania – My old skin care routine

Video 3 is live! Titled “Dermatillomania – My old skin care routine” it was filmed back in 2009 & I was demonstrating the routine I used to follow for my skin. At the time I was using The Body Shop’s Vitamin E range but switched a couple of years ago to their Seaweed range which is super light on the skin which means no breakouts for me yay!! I’d also forgotten about the Aloe Vera gel for the open wounds… I now use Bactroban cream, prescribed by my doctor, if I get an infection. Last year I was getting LOTS of them thanks to the huge amount of stress I was under. Thankfully this year has seen improvements all round ♥

Dermatillomania Awareness Wristband

Ok so here’s what I’ve come up with so far for the awareness bands:

I’ve chosen these colours because I feel both sexes would be comfortable wearing them as would both sufferers and non-sufferers.

I like black because I think it represents the depression/isolation that comes with derma (also I don’t notice many black bands around) and white is for hope (plus it stands out quite nicely).

I like blue because it is associated with mental health awareness and it’s also the colour that represents Trichotillomania (although there’s is a lighter blue) and again white for hope.

Also by choosing to fill the words in with white it means it stands out… I can opt to not fill the words in with colour, so they will still be there but they will only be indented into the band.

So far this is just an idea… I would have to figure out a cost-effective way of being able to post the wristbands worldwide first. Will enquire about this at the post office within the next couple of days.

So my questions are what do people prefer:

Black or blue?

Indented words only or indented and filled in with white?

Educating the Uneducated

Why are people so damn naïve? And why do people keep saying “God can help you”? *facepalm* -_- I suppose this is what I get for jumping on the Dr. Phil bandwagon haha! For those who have no idea what I’m talking about:

Dr. Phil featured a fellow skin picker April on his show not long ago and reran the segment yesterday… unfortunately he portrayed April as having Body Dysmorphic Disorder (BDD) instead of Dermatillomania. This has upset a lot of derma sufferers because it has made our condition look as though it is all “made up in our heads” despite it finally being recognised in the DSM5 as a condition in its own right. Soooo I decided to comment on his Facebook page underneath the post “Could YOU be suffering from body dysmorphic disorder” and of course the ignorant comments are now flowing in.

Here’s a link to his Facebook page where the above mentioned post is featured:

Dr. Phil’s Facebook Page

And here is a link to Angela Hartlin’s article where she interviews Dr. Phil’s guest April about her experiences with Dermatillomania:

Angie Asks: April, Guest on Dr. Phil

Dermatillomania – It has a name!

Video Number Two: This was made at the beginning of 2009, a few weeks after I found out that my illness had a name: Dermatillomania. By this stage I’m getting pretty desperate for help… it’s very hard for me to watch back over these but I’m uploading them again in the hope that they will help other sufferers realise that they are not alone in this. Much love to you if you are feeling or have ever felt like I did in this video. x

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