What is Dermatillomania?

Dermatillomania, also known as Compulsive Skin Picking (CSP), Pathological Skin Picking (PSP) and recently defined in the DSM5 as “Excoriation Disorder”, is a disorder characterised by the repeated urge to pick at one’s own skin to the extent it causes physical (tissue) damage which usually results in emotional distress. Dermatillomaniacs desire to be free of this compulsive behaviour, frequently attempting to reduce or stop their picking. Failed attempts at reducing/stopping tend to result in a greater level of emotional distress, an exacerbation of depressive symptoms and an overall sense of failure. Dermatillomania can be a symptom of drug addiction or other forms of mental illness, such as Obsessive Compulsive Disorder (OCD), Borderline Personality Disorder (BPD) and Body Dysmorphic Disorder (BDD) or it can be a separate condition in its own right.

The onset of Dermatillomania is usually in the teenage years, although in some cases the condition has developed in early childhood or has been present since birth. Many sufferers believe that there is a genetic precondition to the disorder, due to the fact a parent, child or sibling has exhibited similar behaviours and/or also suffer from Obsessive Compulsive Disorder. Other sufferers query whether there may be a direct correlation between sexual abuse and Dermatillomania, as for some an incident of sexual abuse was the onset for their Dermatillomania.

Fingernails are the main “tool” used by Dermatillomaniacs to scratch and/or pick at their skin, however numerous other “tools” are also used to engage in this behaviour including, but not limited to: tweezers, pins, needles, pliers, blades, knives, forks, teeth and toenails. Some sufferers engage in picking to “clean out” their skin while others feel as if their actions are “perfecting” their skin. The majority of sufferers do not understand their condition or why they are doing it, although some are able to recognise certain triggers such as heightened levels of emotions including stress, anxiety, anger and boredom.

A Dermatillomaniac can either be aware or unaware of their skin-picking behaviour. If aware of their behaviour they usually pick at their skin for cosmetic reasons (in order to “clean it out”, “perfect it”, make it feel “smooth”, make it look “better”) and/or for emotional reasons (to alleviate stress, anxiety, anger, boredom, etc). An inability to communicate feelings, instances of bullying, attention being brought to their skin, particularly by questions from family, friends or members of the general public, and incidences where the skin will be noticed (hot weather, wet weather, swimming, formal occasions) can all increase a sufferer’s anxiety levels to the point that they feel the need to engage in the picking behaviour.

If unaware of their behaviour, skin-picking can occur during sedentary activities (such as watching television or sitting in class) or even during sleep. A sufferer may also dissociate from themselves either before, during or after a picking session, often reporting this phenomena as feeling as though they have entered a “trance-like” state. The sufferer will usually only come out of their dissociative state when they run out of spots to pick or when the physical damage becomes noticeable either by the sight of blood or the feeling of pain. After a picking session, the sight and/or pain, of the damage they caused usually triggers extreme emotional distress with depressive symptoms. The sufferer may become angry, depressed, suicidal, experience higher levels of stress, anxiety and/or self-hatred and exhibit a low sense of self-esteem/self-worth. Picking sessions can be short and multiple in duration or they can last for hours on end.

Although Dermatillomania can range in severity the physical damage created by the picking can cause the sufferer social embarrassment, an avoidance of social activities and it can also interrupt work, study and life obligations. As well as causing tissue damage and scarring, Dermatillomania can also cause serious infections which in some instances can enter the blood stream and be life threatening. The threat to life is not only physical but also mental/emotional with many sufferers experiencing depression, suicidal ideation and, in some cases, attempted suicide.

Very little research has been done on the causes, instances and treatment of Dermatillomania. Due to this lack of research, education and awareness many Dermatillomaniacs continue to suffer in silence, feeling as though they are the only ones in the world who do this to themselves. Those who do seek treatment usually encounter professionals who have either never heard of Dermatillomania or who are inexperienced to treat it. In some cases anti-depressants may be prescribed to treat this condition as can regular sessions with a psychologist who is experienced in Cognitive Behavioural Therapy (CBT). These forms of treatment may be successful for some sufferers as can alternative therapies such as meditation and hypnotherapy.

What is important to remember:

  • Dermatillomania can also be referred to as Compulsive Skin Picking (CSP), Pathological Skin Picking (PSP), self-injurious skin picking, psychogenic or neurotic excoriation and has recently been defined in the DSM5 as “Excoriation Disorder”.
  • It can be a symptom of other conditions or it can be a separate condition in its own right, which can then cause other symptoms (such as depression and anxiety).
  • It can start at any age.
  • It affects both males and females although it is predominantly seen in females.
  • Not all sufferers are aware of their behaviour.
  • Telling a sufferer to “just stop” is unproductive and in some cases further exacerbates the condition because if a sufferer could “just stop”, they would no longer be engaged in the behaviour.

Where to go for help:

  • A Doctor (may be able to provide a diagnosis, refer you to specialists – such as psychiatrists and psychologists, and can prescribe oral or topical antibiotics for skin infections).
  • A Dermatologist (may be able to provide a diagnosis, can provide instructions on how to best care for your skin, and can examine your skin for any pre-cancerous markers).
  • A Psychologist (may be able to provide a diagnosis, can implement Cognitive Behavioural Therapy (CBT) or other behavioural techniques).
  • A Psychiatrist (may be able to provide a diagnosis, can prescribe anti-depressants and other anxiety medications).
  • A Hypnotherapist (can encourage awareness and implement strategies which may reduce the picking).
  • Trichotillomania Learning Centre is an organisation that offers numerous resources on Dermatillomania.

 Where to go for support:

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  1. Hello, I was sexually abused at the age of 10, and that’s when I started skin picking. It is proven that skin picking is related to sexual abuse? I hate the scars it leaves on my body yet I like picking, am I going nuts? Why is this happening? why do I enjoy it?

    • Hi Rita,

      I too was sexually abused at the age of eight however my skin picking started when I was four. For some people there is a direct correlation between sexual abuse and skin picking, for me I guess there was another trigger. I am sorry to hear that you have experienced abuse and that you are still suffering today with the skin picking. I can assure you that you are not going nuts (although I know it can feel that way sometimes). Whilst picking doesn’t make an awful lot of sense it does release endorphins (feel-good hormones) into the body which is what makes picking so addictive and so enjoyable. As of last year skin-picking has finally been recognised in the mental health circle and is listed under ‘Excoriation Disorder’ in the DSM-5. Just know that you are not alone and there are plenty of places you can turn to for help – especially online. If you’re on Facebook please connect to my online support group – Dermatillomania Support Group. Wishing you all the best!

  2. Hello love, thank you so much for replying to me, unfortunately I don’t go on Facebook anymore, but can you direct me to someone who can help with this problem?

    Thanks hon,

    Rita

    • Hi Rita,

      Sorry it took me so long to reply. It had been a while since I tended to my blog. Depending on where you live you can find support here: http://trich.org/ It’s based in the US but offers help worldwide. Or here for Canada: http://www.canadianbfrb.org/

      Otherwise you can mention ‘Excoriation Disorder’ to your doctor or a psychologist and see if they can help you further. This disorder is classified under Obsessive Compulsive Disorders so you may be able to seek out places that offer treatment for OCD.

      Other than that there are some simple things you can do daily to help ease the skin picking and they can be found underneath the tabs on my blog: ‘How To Stop Picking at Your Skin’ and ‘Things to do Instead of Picking’.

      Let me know if you need any more help with anything!

      Samantha 🙂

  3. Oh. Oh my gosh. This, this is a real thing? There’s a reason? I’m not the only one? I, I had no clue…this is so exactly me and I always thought it was just a nervous habit that became a regular old habit. But then of course I discovered I have anxiety and that’s why I almost always feel nervous so I went back to thinking it was just a nervous habit. But, but it’s real, it’s a real thing. There’s a reason for this. I’m not alone? This isn’t new? I can get help?!

    • Hi Lynn. Yes this is a very real thing… also finally recognised in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as excoriation disorder. You sound exactly like I did when I first discovered this was a real thing and there were others out there just like me. And depending on where you live there is help and support groups available. The best known worldwide provider is trich.org otherwise you should be able to mention this disorder to a doctor or psychologist and see what they can recommend. In the meantime, I run a Facebook group called Dermatillomania Support Group which can link you up with other sufferers. Glad you discovered you’re not alone in this!

  4. Thanks. Just thanks, I am so happy right now, that there are words for my suffer. Although I don’t know which doctor I should go to, because the dermatologist, who said I had bad acne, just told me to stop picking my skin. I don’t think he understood what’s going on with me, and so did I because I found out today, that this is an actual illness, mainly through a shortfilm, named “She’s lost control”, which is about a dermatillomaniac. But still thank you, because of all this Information, that makes me feel strong to somehow defeat this disorder. Thank you. 🙂

    • Thank you for writing in! I am glad you’ve found out that there is a name for your suffering. Our disorder is also listed in the DSM-V as Excoriation Disorder which you can mention to a doctor or psychologist when seeking treatment. I hope you find someone who can help you overcome this disorder. Stay strong and keep fighting! 🙂

  5. Now I Know I have this but I also Know that if I tell my mom she’s not going to take me seriously ¿how can I tell her so she believes me? I want to get help, I don’t want this to continue. I need an advice. Please!

  6. I haven’t had this for long – I suppose my OCD used to manifest in checking, cleaning etc. I was sexually abused 3 years ago and since I have started to consider that it might have actually been real, my picking has started – especially the more I talk/think about the trauma. I have PTSD and the dermatillomania seems very much linked to that, but it also reinforces my eating disorder. Today for the first time I wasn’t present when I was picking my skin. I guess normally it’s a way of me NOT dissociating when faced with a trigger, but today happened to be both at the time, which made me come on here and look into it – didn’t realise it happened to other people that they weren’t aware they were doing it until it was too late! It’s reassuring, but I’m sorry to find others who are struggling to fight this too.

  7. oh my GAWD. I’m almost 48 years old and I just thought I was this isolated weirdo too lazy to actually graduate to being a cutter and just eating myself…My fingers take the damage most, followed by the obsession that I have visible facial hair…I carry a 15x magnification mirror and tweezers in my purse, also in my drawer at work and in my make up case plus a smattering of tweezers found throughout the house. I just discovered a coworker having the same issue just in general conversation. my fingers are often so embarrassing I walk with a paper towel or napkin wrapped around the cuticles of a freshly picked to bleeding state…

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