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:

• “Dermatillomania Support Group” on Facebook
• “Dermatillomania Awareness” group on Facebook
• Canadian BFRB Support Network
• Skin Picking Support
• Derma Diary
• Kicking My Dermatillomania – Help for BFRB’s
• Diary of a Skin Picker