The urge is always there: with their jagged, bitten nails, my fingers take on a mind of their own. They dig deep into my skin, gnawing at blemishes and ripping up cuts, scabs, pimples, insect bites, and so on. My bright-red skin shouts at me to stop. But I can’t. Even if I’m bleeding, infected or scarred, I can’t stop scratching. Trust me, I’ve tried. And with the ongoing pandemic, the compulsion has only gotten worse.
Dermatillomania is a chronic skin-picking condition that is estimated to affect 1.4 per cent of the population. Beyond the discomfort of continuously picking your skin, dermatillomania can cause a whole host of other problems as picking creates scabs and, in some cases, leads to serious infections, sometimes to the point where a patient requires antibiotics. It can also leave behind scars, which can require professional treatments—including lasers—to improve, while some will never go away even with treatment. It’s taken me a long time to accept my scars.What causes people to pick their skin?
Skin picking can develop anytime during childhood, adolescence or even adulthood. It’s rarely an isolated occurrence. According to dermatologist Dr Joshua Zeichner, it’s usually common in people with acne, where patients pick pimples or skin that is healing from previous pimples. It’s also typically associated with other psychological disturbances such as anxiety whereby the picking behaviour makes you feel a temporary sense of relief.
Sometimes, people pick their skin even when there are no rashes or blemishes. “Patients may scratch at an area of skin that feels itchy or skin that feels like it has bugs crawling on it,” Dr Zeichner tells Vogue. “In many cases, patients truly believe there are bugs in their skin that they need to pick out. It is unclear whether there truly are microorganisms on the skin or whether the brain is interpreting an overfiring of the nerves as a crawling sensation.”
In some ways, skin-picking is similar to obsessive-compulsive disorder (OCD). “They both involve repetitive behaviours in response to distressing and intrusive thoughts,” says psychologist Dr Rebecca Sinclair of Brooklyn Minds mental health centre in New York. “For some, skin picking can be a ritual within OCD, but we only classify it if the behaviour of picking is in response to a thought unrelated to skin picking.”
For example, if someone picks their skin as a way of relieving distress because they worry that something terrible will happen to a loved one if they don't, that would be a compulsion, but when it's specific to the urge to pick itself, it's dermatillomania.Why do we do it?
I can’t remember not picking my skin. As soon as I had some awareness of my body as a child, I began picking at it. “You shouldn’t pick your scabs, it’ll leave scars,” the adults would say. But no one told me how to stop. No one considered why I couldn’t stop.
“The urge to pick can be not only strong but extremely unpleasant,” says Dr Sinclair. “It can feel like the alarm system of the body is going off because that bump, zit or scab is not ‘just right’ and the thoughts associated with the urges can be quite persuasive.”
Sometimes I’m conscious of the behaviour; I look at my skin, notice something out of place and so I pick at it to ‘fix it’. Sometimes the urge is so distracting that it’s actually impacted my ability to pay attention or even relax and go to sleep. But other times, I’m not aware I’m doing it. My mind goes someplace else. I don’t stop until I’m in pain. On top of this, there is a stigma that comes with skin picking. I often feel ashamed of the habit itself and because I can’t stop.
“Although 1 in 20 people may suffer from a Body-Focused Repetitive Behaviour (BFRBs), skin picking and hair pulling are less understood and often stigmatised and they can have an impact on how a person physically presents to the world,” Dr Sinclair says. According to her, feelings of shame can lead to longer and worsening impacts on mood, anxiety, and depression.How to take care of your skin
Compulsive behaviours such as dermatillomania can worsen during times of emotional stress. So for a lot of us, this pandemic has been extra detrimental. Dr Sinclair and Dr Zeichner cite boredom, too much time at home, mindless screen time, increased levels of anxiety at the state of the world and a lack of adequate ways to relieve stress, as the main COVID-induced culprits.
According to Dr Sinclair, this is when creating a skincare routine and sticking to it can be helpful. That also means not inspecting skin in the bathroom mirror in between sessions and making a conscious effort to put away the magnifying mirror.
“Stay out of the bathroom at night. People often pick their faces, and do a poor job of it as well, when they are tired,” says Dr Zeichner. He also recommends setting an alarm on your phone to limit how much time you are looking at yourself in the mirror before bed.
Beyond this, thick hand lotion and keeping your nails short and filed or having longer nails can help because it's more difficult to pick. Throwing away your tool of choice such as tweezers can remove the temptation as well. If acne is your problem, Dr Zeichner also recommends spot treatments and pimple patches.
Another thing you can do is track your picking—where you are, what tools you are using, what are your thoughts before and after you pick, as well as your emotions and what happened to trigger the picking. “Understanding the whys and the variables help figure out the next steps and builds mindfulness around the habit,” Dr Sinclair says.
Barriers such as plasters or protective clothing can help you pause before you pick, so you can step out of the compulsion and think it through more, and substitute another activity for it. “Do a sheet mask when stressed about writing emails,” advises Dr Sinclair. “Have a fidget toy handy.”When to seek professional help
While all those tools can be helpful—and indeed they’ve helped me—it’s important to know when to seek professional help. “If you are picking your skin and either the act of picking or the marks left behind are getting in the way of your everyday activities, it is important to seek the care of a therapist,” Dr Sinclair explains.
“The good news is that we have great evidence-based treatments for this condition that tend to be very effective and short-term. This isn't ‘lie on the couch therapy’ where you're there for years; the treatment is generally based on habit reversal training and is a behaviour-focused treatment to retrain your brain and behavioural responses to these urges.”
Despite the stigma and shame, chronic skin-picking is something we need to talk about more. Whether that’s to family members, teachers, friends, primary care doctors, psychiatrists or even support networks such as Picking Me Foundation or support groups on Facebook and Reddit. Skin picking can be incredibly isolating, but it’s important to realise you are not alone and that help is out there.Also read:
A pyschodermatologist's top tips on how to stop picking at your skin
How to remove every kind of scar, from acne to hyperpigmentation
The dark spots-busting skincare products, treatments and DIY masks you need to try