It is usually around 10pm each night when I start to think about picking, and I’ll spend the next hour or so pulling at the skin on my nose and bottom lip using a large magnifying mirror. I usually keep going until I can see and taste blood – which jolts me out of the trance.
My struggle with dermatillomania, or skin-picking disorder as it’s more commonly known, started with squeezing blackheads on my nose with tweezers and picking my bottom lip when it was dry. For some reason just squeezing the spot wasn’t enough though; I felt some kind of need to remove all the skin surrounding it as well, and I think this tendency to go too far is something which characterises sufferers.
I now have a permanent split lip which refuses to heal, and my nose is always a mess. Any sign of healing is simply a sign to start picking again, and so the cycle repeats.
It’s been exacerbated by living under lockdown conditions with a constant low-level fear overshadowing each day. Seeing the physical evidence of the condition, and other people commenting on my damaged skin, has contributed to the erosion of my self-esteem and self-image. It’s a vicious cycle between skin picking and the idea of beauty; I pick due to anxiety but then feel more anxious when I see the state of my skin. I know I’m not alone.
Dermatillomania under lockdown
Dermatillomania, or skin picking disorder, is characterised by the inability to to stop picking at your skin, even to the point where doing so leads to cuts and bruises. I often suffer the next day with sore open wounds on my nose, which is a constant reminder of the damage I’ve done.
Dr Marla W. Deibler is the Executive Director of The Center for Emotional Health which specialises in supporting those with obsessive compulsive and related disorders, including excoriation (skin picking) disorder. She tells me that triggers for skin picking vary, but include experiencing intense emotions, specific beliefs around how one’s skin should look and feel, physical sensations such as feeling a bump in the skin, and feeling displeased by one’s appearance due to noticing something like a blemish.
It appears that dermatillomania sufferers have been struggling even more during the pandemic.
Leslie Lee, the Programs and Communications Director of The TLC Foundation for Body-Focused Repetitive Behaviors, tells me that the foundation has seen a 500% increase in the number of people seeking help for the disorder since the pandemic began.
This research study on skin picking and hair pulling during the pandemic found that 67% of sufferers surveyed reported increased symptoms during COVID-19. Of the participants receiving active treatment for this disorder, almost 38% experienced interruption in their therapy due to COVID-19.
So why might skin picking disorder be thriving under lockdown? I recently joined a Facebook group for dermatillomania sufferers and have seen how the pandemic has adversely affected the community, both exacerbating existing symptoms and prompting new cases of the disorder.
Reasons for this include heightened stress and anxiety caused by lockdown conditions, along with people looking at their faces more in mirrors due to being at home a lot or on frequent Zoom calls. Conversely, not being looked at as much by others can remove some of the shame associated with people noticing damaged skin, thus lessening any sense of accountability which normally helps limit picking.
Self-image and mental health
Living with dermatillomania can have a significant impact on sufferers’ self-image and mental health, whilst in itself being a mental health condition. It can also impact people’s perception of beauty. I feel ugly after a picking session, damaged even. The irony is that picking is often an attempt to achieve some kind of perfection, to eradicate what you see as blemished skin.
Lauren McKeaney, 34, runs the Picking Me Foundation, an online support group for dermatillomania sufferers. She has been living with the condition for 28 years, and at one point almost lost her leg to it after picking an abscess led to her contracting MRSA.
“Growing up, society taught me that clear skin was good skin,” she says.”This idea of good versus bad skin is something I still struggle with.” Being bullied as a child contributed to a sense of shame around the condition which Lauren felt the need to mask at all times. She would make sure there was a concealer in every bag, drawer and room so she could quickly cover up her damaged skin.
Over time Lauren has found ways to cope with the condition, and starting her nonprofit has helped with her mental health. “This disorder may define my skin with its scars and divots, but it does not define me,” she says. “The scars polka-dotted on my body are just punctuation marks in my story.”
The Picking Me Foundation is dedicated to raising awareness and encouraging acceptance around dermatillomania. Lauren speaks at mental health conferences and recommends treatments such as hydrocolloid patches which help heal and block picking. She also sends out fiddle packs to sufferers to use as distractions from picking. Lauren has sent out more of these packs than ever in recent months – in fact, there’s been a 250% increase during the pandemic. Think about the rhetoric from health professionals about not touching your face during the pandemic. This is particularly hard for sufferers. “The rest of the world has got to experience how hard not touching your face is,” she says, “now imagine you have a mental illness instructing you to do just that?”
In terms of beauty, Lauren highlights the closure of nail salons as something which she’s found difficult, as having acrylic nails helps to prevent her picking because they aren’t as sharp as her real nails.
Konrad, 33, also used to enjoy manicures but, irrespective of the pandemic, he now feels too self-conscious about the damaged skin on his fingers where he picks to go to a nail salon.He tells me that, ironically, his picking started when he wanted to make his hands look better by picking at dry spots. Konrad confirms that his symptoms have worsened under lockdown conditions due to being at home more, and that it’s triggered by anxiety. “The skin picking has made me question myself more and has affected my self-esteem,” he says, “so besides the actual skin damage, it’s negative for my mental health as well.” Konrad’s experience highlights the vicious cycle that often characterises skin picking, where negative self-image can be both a trigger and a product of the disorder.
Dr Deibler confirms that living with dermatillomania often has a significant impact on self-image, resulting in feelings of shame and embarrassment. This in turn can lead to avoidance of social situations and medical care. Talking of society’s attitudes toward beauty in relation to dermatillomania, she says: “There is often a great deal of effort put forth to hide or conceal damaged skin. The emotional toll and physical scarring of this disorder are reflected in the unrealistic ideals of unblemished beauty.”
Support for sufferers
Dr Sreedar Krishna, a NHS consultant dermatologist who runs an online dermatology portal, confirms that she has seen more patients with skin picking disorder during the pandemic.
Dr Krishna recommends visiting a dermatology clinic to get appropriate advice and treatment, even if appointments are currently being held online. Treatment will be multi-pronged and involve talking therapies, and some dermatologists can also prescribe antidepressants to help with the condition. In addition, Habit Reversal Training (HRT) is a form of Cognitive Behavioural Therapy which is currently the ‘gold-standard’ evidence-based treatment for dermatillomania, according to Dr Deibler. Again, HRT sessions may be taking place online, but the support is still there.
Aside from treating the physical and mental aspects of skin picking disorder, sufferers also need peer support. The TLC Foundation has launched a series of online programs, including monthly online support group meetings.
I’ve never sought help from anyone for my picking. Until recently, I didn’t even know there were others out there who tear at their skin until it bleeds. But, I’m relieved to find that there is actually a lot of support available for sufferers, and I intend to make good use of it.