If you suspect a loved one is picking at their skin, it can be frustrating to sit back and watch. Often, I receive e-mails from people who are upset due to a friend, family member, or romantic partner’s picking- including questions on how to communicate with their concerns with them. The following includes practices I have used in my personal life and continue to promote due to their effectiveness in creating an open conversation about skin picking in any close relationship.
1. “I see my partner skin picking and even trying to hide it from me. What do I do?”
There are many ways to approach your partner without distressing her. Due to the sensitivity of compulsive skin picking and on how many levels it may be affecting her, you must allow her to feel in control of the conversation. In the past, she may have been bullied, rejected by professionals, scolded by parents, or mistreated by past partners.
Try talking to her when she’s in a better mood, asking her if it’s okay to sit down without electronic distractions (computer, tv, cell phone) because you are concerned about her. Once you have her full attention, you can bring up that you’ve noticed that she’s been picking at her skin and ask her what her opinion on it is. It is important to tell her that you don’t judge her and understand that there are people who struggle with picking at their skin, which doesn’t make them any less of a person. From there, she will hopefully open up to you and discuss her feelings on the situation. Assure her it’s something she doesn’t have to be ashamed or embarrassed about and you accept her 100%.
Don’t belittle your partner, tell her that it’s making her skin worse, tell her to “just stop”, or slap her hand. All will result in her trusting you less and she will further isolate herself, feel less loved/ accepted, and it will shut down communication.
2. “He doesn’t want to talk about his picking. He just pushes me away and I don’t know how to talk to him about it.”
While the above question addresses how to go about communicating with him, he may not feel comfortable talking about it for various reasons; he may be in denial, feel like no one could possibly understand, not be aware that there are others with this condition, or is afraid of being rejected (to name a few). It may take small steps for him to open up to full disclosure about his struggle.
You must respect that he does not want the conversation to continue. However, you can leave him with a few thoughts that may make him more apt to discussing it in the future:
- Tell him you love him no matter what and are there for him
- Tell him that you care for him and do not judge him
- Educate him about the resources available for support and treatment
- Reach out by letting him know you’re willing to listen whenever he’s ready
- Provide him with information to online forums if he would rather talk to others who have this condition before opening up in his personal life.
Don’t push your partner into talking to you about this private matter; he may have never even told anyone about this disorder before or may have faced ridicule or discrimination because of the condition of his skin. By forcing him to open up he may feel that you don’t have his best interest in mind, you’re only concerned about how the behavior makes you feel, you don’t recognize how it affects him emotionally, or his relationship to you could be in jeopardy. Never give an ultimatum of “picking or me” or “talk about it or I’ll leave” because that furthers the feelings of being misunderstood, pressured, and rejected.
3. “How do I get them to stop?”
The truth of the matter is that you can’t, for the long term, if they have excoriation disorder. When you see them picking, there are many things you can do, but shouldn’t until you have spoken to them with your concern. Then, boundaries can be set regarding what their comfort level is in discussing this issue. They may not be in a place of wanting to stop picking or they could be feeling hopeless about their situation, so checking in with them to see what you can do to emotionally support them is best.
Ask them if they would like you to touch their hand when they’re picking subconsciously while so that they are made aware that they’re doing it. If they’re in the washroom for too long, ask them if it’s okay to knock on the door to remind them that they’ve been in there for “x” number of minutes. Building respect with someone who has issues surrounding skin picking is key to gaining trust from the sufferer, but recognizing their lead is important in empowering them to feel better about themselves.
Don’t yell, intimidate, or withhold affection as a punishment if they picks. Do not alienate them as “strange”, “a freak”, or “different” or tease the appearance of their skin. They need loved ones who can accept them as they are, without judgment or feeling like a burden.
4. “That sounds fine, but I don’t want to enable the behavior. How do I get him help or convince him that he needs it?”
The tricky part about body-focused repetitive behaviors is that help is not always readily available. While psychologists are great at helping clients with a multitude of mental health afflictions, BFRBs are not high on that list due to a lack of information, minimal research, and a lack of adequate training that can help a professional practice evidence- based approaches specifically for these disorders. If he cannot stop picking and has tried various methods to stop, he probably knows that he needs outside sources to supplement his efforts in stopping or reducing the behavior but may not be optimistic that it will help.
The choice is his whether to seek out psychological counseling for his picking. There are many combined components of therapy that can effectively treat dermatillomania. Although BFRB- trained professionals aren’t available to all communities around the world, therapy could still be beneficial in treating other elements in life that may have caused him to begin picking or even help him with how to cope living with the disorder.
Regarding the fear of being an enabler, there are no treatment programs for family members to abide by when it comes to supporting a skin picker. When a disorder that has so little in supports, research, understanding, and treatment providers, the best thing you can do is respect his wishes in how he wants to approach his picking, and support his overall well-being.
Check out BFRB specialist Dr. Fred Penzel‘s article for significant others.