Editor’s Note: This article is for educational purposes only. If you or someone you know is experiencing behavioral health distress, please call the SAMSHA National Helpline, 1-800-662-4357, or consult with a medical professional.
It happened again: What was once a pesky blemish has turned into another small laceration on the outer side of my bicep, joining a small constellation of scars across my arm. Picking your skin is the equivalent of treason in the world of beauty editors, but once I get that urge, no part of my body is safe until I remove every irritating ingrown, pimple, or scab. This inevitable urge to pick at my body with tweezers isn’t just a weird quirk of mine: It’s a serious condition with many names, but it’s most commonly known as dermatillomania, or excoriation disorder.
As Dr. Sam Von Reiche, clinical psychologist and author of Rethink Your Shrink: The Best Alternatives to Talk Therapy and Meds, explains, “Dermatillomania is a mental health disorder that manifests as repetitive, compulsive skin picking. It is considered an impulse control disorder and is one of several body-focused repetitive behaviors that are part of Obsessive-Compulsive Disorder (OCD).”
Here’s everything you need to know about it, straight from mental health professionals — plus experts tips for how to deal with lingering scars.
Dermatillomania: The Basics
If you find yourself experiencing a recurring urge to pick at your skin, you’re not alone. According to Mental Health America, approximately 1.4% of American adults experience this body-focused repetitive behavior (BFRB), and Dr. Von Reiche reveals that approximately 75% of those affected are female. The MHA also notes that this condition most commonly begins during adolescence, but can become an issue at any point in your life (like, say, during a worldwide pandemic).
According to The TLC Foundation for Body-Focused Repetitive Behaviors, there are a variety of physical and mental factors that trigger chronic skin picking. Causes range anywhere from dermatological and autoimmune disorders to body dysmorphia, obsessive-compulsive disorder (OCD), substance abuse use and/or withdrawal, and more.
“It reflects a mental disorder when the behavior is chronic, results in tissue damage, and causes the individual significant dysfunction and suffering,” Dr. Von Reiche says. She further explains that dermatillomania is more than just the picking itself According to the Diagnostic and Statistical Manual of Mental Disorders, the symptoms also include repeated unsuccessful attempts to decrease or stop skin-picking and feelings of distress, loss of self-control, shame, and even impairment in functioning during your daily life.
This isn’t to say that ripping off the occasional hangnail means you have a chronic condition. “People with this severe disorder not only disfigure themselves with either their hands or various implements, but they also spend hours obsessing about whether or not to pick, or attempting to resist the urge,” says Dr. Von Reiche. “This cycle of anxiety, picking, remorse, shame, and struggling with the impulse is reflective of a classic OCD picture.”
The mental anguish of this recurring skin-picking isn’t the only issue that arises. According to cosmetic dermatologist Dr. Michele Green, chronic trauma to your skin could also lead to some physical health issues.
“Open wounds from picking at the skin can lead to infections, discoloration, scars, and even disfigurement,” she says. And then there is the added emotional trauma that can accompany these physical and mental symptoms. Says Dr. Green, “Individuals may find themselves isolating after intensely picking at the skin — this can be draining emotionally, making it difficult to seek help.”
Dermatillomania: Healing The Damage
The good news for those of you dealing with chronic skin picking is that you can treat the disorder with the help of a licensed mental health professional — not to mention, they can help you diagnose it in the first place.
If you believe you are experiencing dermatillomania, Dr. Von Reiche says your first step is to seek professional help. She also advises looking for a licensed mental health worker with experience in treating OCD disorders, such as a cognitive-behavioral therapist.
“Generally, a cognitive-behavioral approach is used targeting both behavior modification as well as the thinking behind this condition,” she says. “Increasing serotonin levels is also part and parcel of treating any OCD-related condition. The supplement known as 5HTP is excellent for OCD, but take it before bed because it can cause daytime drowsiness. You can take up to 400 mg of 5HTP safely.”
Of course, taking care of your mental health should be the top priority when dealing with dermatillomania. But once you have addressed the root cause of your skin picking, you can begin to address the physical damage. Dr. Lily Talakoub, board-certified dermatologist and founder of McLean Dermatology and Skincare Center and Derm to Door, suggests using a combination of topical scar creams and in-office dermatology treatments depending on the severity.
If you have minor scarring or red scars, Dr. Talakoub recommends grabbing a topical scar cream from your local drugstore or grabbing a prescription topical from your trusted dermatologist. However, deeper scarring may require more intensive in-office procedures, such as intense pulsed light (IPL), chemical peels, or fractional lasers.
“It all depends on the types of scars you can get,” Dr. Talakoub says. “There are brown, red, thickened, and white scars. In-office laser procedures such as IPL (intense pulsed light) and the fractional laser can blend the scar with the surrounding skin. Chemical peels can also help resurface the skin and lighten hyperpigmented or brown scars.”
With all that being said, dealing with dermatillomania is much more than just a skin-picking habit—for many of us, such as myself, it can be a subconscious form of releasing stress and mental anguish. But no matter how severe your case may be, know that you are not alone. If you’re seeking help for yourself or a family member that’s developed dermatillomania, you can head to The TLC Foundation for Body-Focused Repetitive Behaviors, which has resources for you to find therapists, support groups, and even salons that are experienced in BFRBs.