When you cannot stop picking your face

Once upon a time nine years ago, there was a princess patient who would not stop picking at a (perceived) black-head on her chin. She persisted with her squeezing and picking until she literally reached the bone.

There was another patient who would set a vibrating-alarm on her phone to wake her up in the middle of the night (purposely at that time because everyone else was asleep then) in order to spend hours picking at her face in front of her magnifying mirror, without her husband or kids interrupting or knowing.

Then there was the adorable, bubbly Millennial with the fresh-to-death fashion sense and Pantene-worthy hair. With a rapidly approaching wedding, it actually got to the point where she forced her fiance to be on “picking-patrol” and begged him to to physically slap her hands away from herself when he saw her start to absent-mindedly pick and claw at her face. Fortunately her style demanded short nails, otherwise… I shudder to imagine what she would have done to her face if her fingers had long nails attached to the ends.

Yes, these patients all had some clogged pores. However the damage they did to their skin trying to correct this was a million times worse than anything a black-head, whitehead, or monster pimple could have caused. Their skin was ultimately able to be fixed and look normal again (although getting rid of Chin Bone’s scar was quite a feat) but the required fixing-treatments were for issues that should have never existed in the first place.

Similar to someone suffering with anorexia looking in the mirror and seeing an overweight body reflecting back,, there is another kind of body dysmorphia that causes a person to destroy their skin in an ongoing effort to make it look better. People suffering with Dermatillomania cannot control their urge to pick, dig, and ultimately damage their skin, ironically worsening the problems they are driven to correct.

If you, or someone you know, is suffering from this, please be reassured that you are not alone, and there is help.

We’re Only Human…

We tell every single acne patients to do everything within their power to NOT pop, pick or attempt extractions on themselves. All too often we see the complicated after-mess that occurs from well-intentioned at-home doctoring, and it’s never worth it.

Popping a big, juicy pimple can sometimes be too hard to resist, and it is normal for people to occasionally pluck, pick and squeeze their skin.

But for some people this behavior is indicative of a mental issue, and the excessive picking begins to cause scarring, infection, disfigurement… and worst of all, excess shame and humiliation.

For anyone with this problem, the embarrassment and emotional pain their skin causes them can be overwhelming. It may force them to avoid socializing or becoming intimate. People with this disorder tend to try to hide the effects of their picking and are often extremely sensitive to comments or questions about their hair, makeup or skin.

If you or someone you know has this disorder, please know that Dermatillomania is not just a bad habit, but a real mental illness.

If you are suffering Dermatillomania, the first thing you must know is that you are not alone. There are thousands (perhaps millions) of people out there who suffer in silence; wearing hats, makeup, long sleeves and pants in the summer to hide what they are doing to themselves because they cannot stop.

Although Dermatillomania is not often discussed (those afflicted with this know what they are doing is considered wrong and undesirable) there are professionals who can help, along with support groups, medications, supplements, and therapies. There are numerous methods designed to enable you to control yourself, but the first step is ultimately seeking help to begin with.

What is Dermatillomania?

Dermatillomania or Compulsive Skin Picking (CSP) is the urge to rub, pick, scratch, squeeze or dig into the skin, often to remove some perceived irregularity or flaw such as a flake of dry skin, pimple or scab.

The action may be performed with the fingers, nails, tweezers, needles, or any other instrument.

How do you know if you (or someone you love) has Dermatillomania/CSP versus just the occasional lapse in skin-judgment?

The picking that occurs with Dermatillomania usually follows this criteria:

  • Picking happens on any part of the body or in a combination of places.
  • Picking is usually preceded by an intense urge to fix the spot. The urge becomes the focus of attention until relief is found by acting on the urge.
  • The picking often happens in a trance-like state and in severe cases, a person can spend several hours a day performing the actions associated with trying to smooth out or remove all the problem spots.
  • The picking is almost always followed by a feeling of guilt, shame and regret about the damage done to the skin. (Sufferers often are also diagnosed with social anxiety disorder and depression.)
  • The picker cannot help themselves from continuing this destructive behaviour.
  • It is almost impossible for the picker to be satisfied with the appearance of their skin.

Many people do not realize that Dermatillomania/CSP is a real illness and do not report it or seek treatment.

Your friend with the bad skin might not just have bad skin. The crusted red sores on their face could actually be indicative of a skin-picking problem.

A relatively new disorder (20 years ago no one had ever heard of Dermatillomania) the ins-and-outs are not yet fully understood. Some experts label it as an impulse control disorder (grouped with things like kleptomania and pyromania) as the sufferer cannot fight their ongoing, pervasive desires to act a certain way. Other therapists consider it to be a subtype of Obsessive-Compulsive Disorder, because a large percentage of people with OCD also pick their skin. (Many of the emotional and psychological processes resemble those of Trichotillomania (Compulsive Hair Pulling) and the treatments for Trichotillomania can be helpful, as well.)

Dermatillomania has a much higher incidence in women than in men.

CSP is not the same as self-injuring or self-harming behaviors (like cutting or burning). Dermatillomania sufferers are not purposely trying to inflict damage upon them-selves. Instead, people with CSP are trying to correct some perceived flaw in an effort to be perfect, and have more control over their lives.

Is skin picking a self-injurious behavior, like cutting or burning yourself?

No, and it is important to distinguish between these two types of behaviors. People with CSP do not wish to cause themselves pain in order to relieve a sense of numbness.

While people who pick their skin may find pleasure in the act picking and squeezing, the aftermath is actually one of distress and shame.

What causes Dermatillomania?

Some experts believe Dermatillomania is a natural grooming instinct gone haywire. These people theorize that there is a genetic or biological component.

Others think it is a self-soothing mechanism or emotional outlet because many sufferers report being zoned out or in a trance-like state while picking.

According to brainphysics.com, a quarter of people who have Obsessive-Compulsive Disorder also suffer from Dermatillomania. A quarter of people with Body Dysmorphic Disorder also suffer from CSP.

Before a diagnosis can be made, a doctor must rule out other physical illnesses which may be causing the urge, such as a skin infection or allergic reaction.

It is hard to tell when picking crosses into Compulsive Skin Picking, but generally, when the time spent picking or the damage done by the picking begins to affect one?s life, it has become a problem. If a person avoids certain activities (like going to the beach or intimacy), calls out from work, or misses other events due to picking, or is unable to effectively to hide the picking, it is time to seek help.

What is the recommended treatment for Dermatillomania?

There are lots of promising options for this on the horizon.

Treatments include:

  • Medication: SSRIs (antidepressants) are often subscribed for those suffering Dermatillomania. Many Dermatillomania sufferers also suffer from anxiety, depression and Obsessive-Compulsive Disorder; antidepressant treatment is almost always explored as an option.
  • Natural Remedies: Some Dermatillomania sufferers benefit from the B-vitamin inositol, which seems to reduce the urge to pull or pick. It is broken down by the body into two neurotransmitters that enhance the activity of serotonin in the brain. Serotonin is a brain transmitter that may be implicated in Obsessive-Compulsive Disorder. Inositol must be taken in large quantities, but will not build up to toxic levels because it is a water soluble vitamin.
  • Cognitive-behavior therapy has been studied as a means of treating Dermatillomania and related disorders. Therapy may involve several different techniques, such as Habit Reversal Training, Self-Monitoring, Stimulus Control and Competing Response.
  • Online Dermatillomania Support Groups. Some of these support groups use the 12-step Alcoholics Anonymous program to help people to quit picking.