With the DSM 5 now officially released, it is imperative that we eliminate all misconceptions about Dermatillomania (aka, “Excoriation Disorder”) and spread the word before these ideas become the majority thought. Many of us have already heard many of the myths listed below, so we need to make sure that these reflections don’t become accepted views on what Dermatillomania is and how it affects us.
1. MYTH: Skin pickers can just stop at any time.
TRUTH: If this were the case, we would have already stopped because it causes us emotional distress having to deal with the aftermath of marks on our bodies. Our brains are activated by a reward system that reduces anxiety once we get a “good pick”, which can make us feel accomplished thus making us continue the behavior. By the time we get a diagnosis, we will already have the behavior ingrained in our daily rituals, making it much more difficult to reverse the behavior and find other coping mechanisms. We pick at our skin to reduce anxiety but then become anxious because of the visible marks we make, which heightens our anxiety, then we engage in the behavior again as a way to reduce that anxiety, creating a vicious cycle.
2. MYTH: All skin pickers have an underlying skin disorder causing the need to pick.
TRUTH: While many people start picking at their skin due to skin disorders (ie. Acne, Eczema), not all have one to start with. Having one can trigger the onset of Dermatillomania, but many of us have started with picking at perceived flaws such as multiple pimples/ blackheads causing the compulsive behavior. Some skin pickers, mostly those who are prone to Body Dysmorphic Disorder, never had a skin disorder but found imperfections to pick at.
3. MYTH: Picking at your skin is the same as “cutting”/ burning.
TRUTH: This is the one that aggravates all of us pickers. There’s nothing as dismissive as when someone tries to relate to you by saying, “Oh, I know what you’re going through… I used to cut myself”. Yes, people are trying to relate but that lack of knowledge about what Dermatillomania is drives us mad! Some people with Dermatillomania engage in other self-harming behaviors, but it’s not a prerequisite to having the disorder nor is there a direct attachment between the two. A person who cuts (even if it’s compulsively) does so to feel the physical pain in order to release endorphins making him/her feel better as a distraction to not have to cope with emotional turmoil. Many skin pickers have a cognitive distortion that justifies them in picking, so they get on a “mission” and can dissociatively ignore most of the physical pain in order to achieve what they’re set out to “accomplish”.
4. MYTH: Everybody pops some zits… does that mean everyone has Dermatillomania to some degree?
TRUTH: Dermatillomania isn’t as simple as popping some pimples. There is an obsessive nature behind the urge, which is why it’s been classified under OCD and Impulse Control Disorders. There is a repetitive nature behind picking at your skin whether it’s a conscious decision to place yourself in front of a mirror and ‘search’, an action that begins without you noticing while you watch TV, or something you do while you sleep. Skin picking becomes a disorder when you are unable to stop yourself in the moment, can’t control when you’re doing it/ how often you do it, and it affects your day-to-day living while affecting your self-esteem.
5. MYTH: To be a compulsive skin picker means that you do so because you hate yourself a LOT.
TRUTH: Many people with Dermatillomania start off with low self-esteem and feel like they want to fix something that is wrong with them and use skin picking as a socially acceptable way of making themselves feel better (it’s acceptable because it’s not noticeable until it becomes a disorder). For all of us, self esteem issues arise or are exasperated by this disorder because we feel alone, can’t control our urges, and blame ourselves; it also prevents us from feeling accepted, makes us feel judged (if the truth came out), not understood, and stops us from even anywhere remotely close to “normal”. The stigma of the disorder and the judgments regarding the marks on our faces/ bodies are what drive us to further feelings of isolation and self-loathing.
6. MYTH: People who pick at their skin, leaving marks, do it for attention.
TRUTH: Quite the opposite, actually. We spend much of our time trying to cover up the damage we inflict with makeup or clothing so that we can face the world without anyone noticing our scars because a high majority of us are ashamed of the marks- not just because they irritate our skin, but because the action that caused it was at our own doing and continues to be. We try to hide the fact that we have this disorder because it isn’t well-known to the public and the stereotypes attached to it are damaging.
7. MYTH: Picking at your skin to the extent that it causes noticeable damage on a daily basis means that you are under the influence of illegal narcotics (ie. Meth).
TRUTH: Methamphetamine is a stimulant that can result in skin picking from hallucinations of something under the skin, which falls under an amphetamine psychosis. It is also a stimulant that increases focus and speeds up thought processes, which can stimulate obsessive behavior. Once the drug is removed from the body, the user’s behavior is more than likely to disappear because it is the source that induced the Dermatillomania. Those of us who don’t do drugs have different root causes for our skin picking (see next MYTH).
8. MYTH: Skin pickers see things on or under their skin that isn’t there; they are experiencing a psychosis.
TRUTH: A smaller percentage of skin pickers do experience psychosis, but there isn’t a direct correlation between skin picking and psychosis; the most common co-morbid disorders to go along with Dermatillomania are Obsessive-Compulsive Disorder (OCD), Body Dysmorphic Disorder (BDD), Anxiety Disorders, Trichotillomania, Depression, and Personality Disorders. In the cases of a psychosis being the main cause of the skin picking, the behavior will discontinue when the psychosis is treated; keep in mind, there are a smaller number of individuals with psychosis who have Dermatillomania as a separate issue- it is a disorder, not a symptom, for these individuals.
9. MYTH: Dermatillomania is a made-up disorder made to enhance the DSM- if it were a real disorder, it would’ve already been in there.
TRUTH: Why would someone make something like this up- what is there to gain from it? Trichotillomania (hair pulling disorder) was added in the DSM III- R while skin picking remained a symptom of other disorders, such as Borderline Personality Disorder, falling under the conventional self-harm category. It was considered to be self-injurious (since causing harm to your skin creates marks) but it wasn’t further explored as a stand-alone disorder until later May of 2013. This is one reason why co-morbidity is so high with other mental illnesses. The other reason is that Dermatillomania affects much more of a person’s life that by the time it’s recognized, it’s already created problems in other areas of functioning which attributes to other mental illnesses.
10. MYTH: Picking at your skin is just a bad habit.
TRUTH: While the behavior of skin picking can be considered habitual in nature, dumbing it down to “habit” is hurtful to us; when we hear of a “bad habit” we can’t help but think of instances such as it being a bad habit for a male to never put the toilet seat down in a predominantly female household despite reminders, cutting your toenails and not throwing away the clippings on a regular basis, or consistently not wiping crumbs off of a counter after fixing yourself a sandwich when being told to a million times. It is better classified as obsessive-compulsive or even a behavioral addiction.
11. MYTH: Skin picking isn’t a serious issue- it’s superficial because it only hurts someone’s appearance.
TRUTH: The simple act of a person popping a few zits is harmless, but the disorder Dermatillomania IS a serious issue that affects all facets of life. Social and physical isolation, suicidal ideations, embarrassment, a lack of control that starts to trickle into work/ school/ other thoughts (depression and/or obsessive), and anxiety over a lack of control, being seen with marks, social anxiety, or generalized anxiety. This is just a short list of how it hits us emotionally, but it isn’t the only way we are affected.
Physically we are prone to infections, even if we keep our “picking tools” (clippers, tweezers, pins, etc.) and picking areas clean. There are life-threatening bacteria out there that are resistant to anti-biotics and all it takes it one wrong one to enter a wound before there’s nothing you can do about it. Of course these are more rare circumstances, but there’s a reason why our guardians had a ritual for us when we scraped our knee that included cleansing, Polysporin (or rubbing alcohol), and a bandage- imagine having to do that to every wound all the time! From entering the “trance-like state” where we dissociate and don’t feel the full effects of the pain we’re inflicting, we can (and it’s documented) tear into muscle or veins/ arteries that need immediate medical attention.
It may seem superficial to many, but when you have a malformation that you can say was done by your own hands, the shame and guilt is enough to consume a person.
12. MYTH: There is no treatment for Dermatillomania.
TRUTH: Here is the good news- there are treatments to this disorder and recovery IS possible. While Dermatillomania is highly resistant to treatment, there are methods that are known to help the sufferer. The most common treatments are Cognitive Behavioral Therapy (CBT) which includes Habit Reversal Therapy and Stimulus Control and/ or SSRI’s (anti-depressants) to try to lessen the severity of the urges. A combination of CBT and Acceptance and Commitment Therapy is what helped me. Other methods include, but are not limited to, meditation, yoga, support groups, or online BFRB classes. Also, barriers are effective in preventing skin pickers from engaging in the behavior, or in helping to notice that they are, while fiddle toys can keep anxious hands busy.
Research has been done on a supplement called N- Acetyl Cysteine which increases levels of gluthione in the body, seen in a study to reduce the urges of hair pulling when taken in higher dosages. It has not yet been looked into for long term use past 3 months, so it isn’t an approved method but shows promise for people with BFRB’s.
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