Everything You Need to Know About Dermatillomania
Whether you're searching for the latest strand-saving solution, tricks for scoring sounder sleep, or cleaning hacks to spruce up your space, there's little you can't find on TikTok. And for people who experience dermatillomania, in particular, you might just find community on the social media platform, too.
Recently, sufferers from this condition — which impacts as many as 1 in 20 people, according to the International OCD Foundation — have been sharing their experiences on TikTok, explaining the myriad ways skin-picking impacts them emotionally and physically. In the process, they're spreading awareness about the disorder that has frequently been underreported and undiagnosed, according to multiple recent studies.
Ahead, everything you need to know about dermatillomania, including causes and treatment.
What Is Dermatillomania?
If you've ever picked at a blemish or a scar (despite your derm's cautions), you likely know how low-key cathartic it can feel, even if it makes matters worse and potentially opens your skin up to infection. (Eek!) But getting handsy with a pesky pimple every once and a while is different from feeling a compulsive urge to poke, prod, and pick at your skin regularly — although both can be quite satisfying. The latter is more along the lines of dermatillomania (aka excoriation or skin-picking disorder), a mental illness related to obsessive-compulsive disorder, according to Mental Health America (MHA).
Also known as excoriation or skin-picking disorder, dermatillomania "is characterized by repeated picking at one's own skin, which results in skin blemishes, scars, or lesions," explains Terri Bacow, Ph.D., New York City-based psychologist and author of Goodbye Anxiety. While individuals with the condition might very well pick at pimples or, in the MHA's words, "minor skin irregularities" (e.g. calluses) as well as scabs, they may also do so on healthy skin, blemish-free skin. Sufferers can often stay focused on picking a specific area for hours, possibly without even realizing they're doing it. (Related: Can Popping a Pimple In the 'Danger Triangle' Actually Kill You?)
Dermatillomania can cause "significant disruption in one's life that leads to significant distress, social anxiety, causes you to cancel plans, or cover up your body with makeup or clothing," adds Bacow. In fact, "significant distress" or problems in other areas of life caused by skin-picking are often what distinguishes a tendency to pick at your skin from an actual disorder, according to the International OCD Foundation.
The condition is also considered a body-focused repetitive behavior (BFRB), which is "a cluster of habitual behaviors that include things like hair-pulling (trichotillomania), nail-biting (onychophagia), nose-picking (rhinotillexomania), and lip/cheek-biting (dermatodaxia)," says Bacow. "[Those with a BFRB] tend to be impulsive in that one tends to do them mindlessly or thoughtlessly, often without realizing it. These habits are also compulsive [and] difficult to control — sufferers often feel they 'have' to do them to get a sense of relief."
What Causes Dermatillomania?
While the cause of excoriation disorder is still somewhat TBD, evidence does suggest that it's more common in individuals with OCD and their family members than in the general population, according to the MHA. While excoriation disorder typically involves consistent continuous picking or biting at skin (i.e. on a daily basis), it can also come and go in phases, notes Bacow. "It can worsen or be exacerbated by stress and stressful events. It can also completely disappear for months and then suddenly come back for seemingly no reason at all."
People with the disorder "typically have additional psychiatric conditions, such as depression, anxiety, eating disorders, etc.," says Bacow. "It is classified as a mental health disorder because it has an emotion regulation component as well as an impulse control component."
As mentioned earlier, those with the condition tend to find skin-picking to be self-soothing during moments of stress and anxiety. This can lead to a cycle of shame, guilt, sadness, increased anxiety, or even feeling out of control upon seeing self-inflicted wounds or scars that they're further compelled to pick at. Skin-picking "habits are a little addictive because the person doing them feels a sense of immediate positive reinforcement, which strengthens the behavioral pattern and keeps the habit going," explains Bacow.
How to Treat Dermatillomania
The "gold standard" of treatment for skin-picking disorder is cognitive-behavioral therapy (CBT), says Bacow. ICYDK, CBT is a form of psychotherapy in which patients work with a practitioner to identify unhelpful behaviors or thought patterns — in this case, recording instances of picking or desire to pick — and then work to develop helpful, productive ways to cope and reverse the patterns. — e.g. squeezing a stress ball or wearing gloves to prevent picking, explains Bacow.
"It is helpful to examine what are the thoughts and feelings underlying the behavior — what are you trying to accomplish by doing these behaviors? And how can you accomplish that (i.e. cope with stress, reduce boredom, stimulate yourself) in ways that do not involve skin picking?" she says. Depending on the severity of your condition, your practitioner might also refer you to a psychiatrist to help determine whether you could also benefit from medications. Selective serotonin reuptake inhibitors (SSRIs), which are antidepressants that also help reduce obsessive thoughts and compulsive behavior, have been shown to be particularly helpful in treating dermatillomania, according to MHA.
Unfortunately, long-term therapy isn't always easily accessible, which is where self-help resources, such as the SkinPick app — which Bacow says some of her patients have found to be helpful — come into play. The app makes monitoring and identifying triggers simple and easy. And while she says TikTok (or other apps) are not a replacement for real therapy, "social media can be a good way to not only educate yourself but to realize you are not alone in whatever you might be going through." (Up next: How to Decode Your Health Insurance to Find Affordable Mental Health Care)