Picking On Repeat: Life With Dermatillomania

The term dermatillomania is really just a more complicated term for Skin Picking Disorder, which falls into the category of Body-Focused Repetitive Behaviors (BFRBs). Other facets of BFRBs are trichotillomania (hair pulling), biting the insides of the cheeks, and severe nail biting. BFRBs typically piggyback on anxiety, obsessive-compulsive, and impulse control disorders, and very rarely emerge as the only mental illness diagnosis.

Among the slew of things on my “cray list,” dermatillomania joins the ranks. Fortunately, when I compare my skin picking journey with others’ accounts, mine is a relatively moderate manifestation. For which I’m grateful, because if all of the things I struggle with were in the “severe” category I would be in a lovely hermitage in the mountains—you could just call me Friar Tuck, darlings. Heck, the way we’re going I might still end up there, but I digress…

As I’ve mentioned in some of my previous posts, anxiety and depression have played a prominent role throughout my entire life. I attribute my dermatillomania, primarily, to the presence of anxiety that was tainted with some obsessive-compulsive tendencies. I chewed my hair when I was young and chewed my nails in elementary school, until my mom painted the anti-chewing, nasty tasting nail polish on them to break me of it. As the door closed on nail chewing, my propensity to pick at any bump or blemish on my body increased. I had (and still have) a very low tolerance for anything abnormal or not smooth on my skin—bumps, dry skin, whiteheads, blackheads, scabs, zits (heaven forbid), etc. I think that I categorize most of these things as appearing dirty or unkempt, which is completely unacceptable to the clean perfectionist I came out of the womb as. I know, logically, that even the pus in zits is only white blood cells that have rushed to the inflamed site to mend the area, and if I leave it alone it will all reabsorb and heal. But logic fails, as it so often does in the mental illness arena, and I just can’t handle it. The presence of a skin “abnormality” can completely distract me as I divert brain power in my attempt to not mess with whatever is, or is not, there. Often I have to stop whatever I’m doing to run to look in the mirror to see if something is actually there, or if I’m just imagining it. As hard as I try to ignore my inclination to examine and eliminate the bump, it’s like something is persistently itching in the back of my brain and I have to do something about it.

Most commonly I pick my head, followed by everywhere else on my body. This means that I always believe that there is some flake of skin or bump that needs tending to. So I scrape and dig to find and get rid of it, which often means that I will make the spot bleed and get infected, because I am so intent on getting at whatever I perceive to be there. And what happens when you make something bleed? A scab forms and then lo and behold, there is actually something there to pick at. Or I think there’s a flake of dead skin to remove from amongst my hair, so I attempt to extract it from my scalp. But in the process of rooting around, I might make my scalp bleed and/or more dead skin is dislodged which adds to the melee of perceived grievances. As you can see, it’s a vicious cycle that drives me bonkers. Welcome to the life of someone with BFRBs.

Of course there is the list of things that did not help my picking tendencies. I tried wearing a hat, but my fingers found their way around it. Gloves just annoyed the shit out of me and I couldn’t get any work done. Increased stress can really exacerbate it, and so during final exams one year I put post-it notes up all over my dorm room with the words “DO NOT PICK” on them. It didn’t help. I cut my fingernails ridiculously short, for years, to reduce the extent of damage, but became obsessed with keeping my nails very short, to the point that I was cutting into the nail bed area, and it didn’t help with the picking. People that I trusted telling me to stop when they saw me picking only made me frustrated and resentful toward them, and ashamed of this bizarre problem I struggled with.

As someone in the dermatillomania clan, I have to take some creative precautions to keep myself from giving into the urge to rip all my skin off. I have to be careful with things like exfoliants and loofah brushes because they’re socially acceptable methods for smoothing out skin. I tend to go overboard, which can really aggravate my skin and make it break out more. I have to watch the time when I’m plucking my eyebrows because I love to tweeze—it scratches that ever-present itch in the back of my brain. But if I let myself, I would start using the tweezers to pick at pores and bumps on my face, arms, back, legs—so it’s really best to rein myself in ahead of time. I have to get enough sleep, or else my hands are more prone to wander up to my scalp to dig for the flaky gold. I recently tackled the challenge of letting my nails grow out because it wasn’t helping to have them that short, and took up artfully painting my nails, which actually helped more. I try to keep my hands occupied (which also helps with my anxiety), whether by making friendship bracelets, crocheting, cross-stitching, doodling, stress balls, or just sitting on my hands. Of course, therapy and medications for the entire mess of mental illnesses residing in my brain has helped immensely, as has feeding myself appropriately.

If you struggle with skin picking or hair pulling, I want you to know that you are not alone and there are treatments that can be helpful. If you know someone who struggles with BFRBs, please don’t judge them and make them feel ashamed and dirty for the habit—it is more complicated than you could possibly imagine. By the time it’s a problem, a lot of it is practically involuntary and it takes some hard work to reroute those stubborn brain circuits, but it’s not impossible. Some days are better than others, but an overall positive trajectory can be achieved. Hold those picking and pulling fingers high, darlings!

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Do you struggle, or know someone who does struggle, with BFRBs? Tweet us @litdarling!