Excoriation Disorder, also known as Dermatilomania or compulsive skin picking disorder is a serious condition that is categorized in the Diagnostic and Statistical Manual (DSM5) as an Obessive-Compulsive and Related disorder (OCD-R). Sufferers compulsively pick at their skin until they cause damage to themselves. Stress and anxiety lead to an increase in picking and this compulsive behavior quickly becomes addictive. In her candid YouTube video about her struggle with the disorder, Lizzie, a 21 year old Dermatilomania sufferer from Newcastle, England opens up and explains this poorly understood disorder and its cause and offers tips for managing it. She admits that
this is a very hard video to make
We talk a lot about raising awareness on this blog. Awareness by those who are afflicted with a body-focused repetitive behavior (BFRB), and awareness from the medical profession and general public. So what's all the fuss about awareness anyway?
Awareness is defined as:
knowledge or perception of a situation or fact.
For people suffering with compulsve skin picking, the words 'beauty' and 'bfrb' used together seems like somewhat of an oxymoron. When you constantly pick your own skin, the last you thing you feel is beautiful. This brings with it immense feelings of guilt and shame for the damage you have caused your own skin. It should therefore come as no surprise that skin picking disorder is big business for the cosmetic and business industry. Not all, but many skin pickers spend large amounts of money on creams and cosmetics to heal faster or to cover up the evidence of their actions. One study hopes to examine this relationship in an effort to see how makeup affects people’s feelings about their BFRB. The Brain and Behavior Lab of Dr. Corey White is interested in learning more about the ways women with Body-Focused Repetitive Behaviors (BFRB’s) use cosmetic products (beauty products for the hair and skin) and how different factors of cosmetic use (time or money spent, number of products used) can be used to predict how severe someone’s BFRB is.
click on image to play
We have spoken many a times about the important role bloggers and vloggers play in spreading awareness about skin picking disorder and other body-focused repetitive behaviors. Without awareness many people conitnue to suffer alone and in silence, never reaching out for help, and never receiving the treatment they need. We often feature some of the impactful videos we come across in the virtual community, and this video in particular seems to be making waves. The video was a collaboration between BFRB advocate Nicole Santamorena and Refinery29, an independent fashion and lifestyle online publication in the US. The video was shared on the Refinery29 facebook page on 10 February 2016, achieving 2,591,279 views, 14,766 likes and 7,348 shares by the time of this post being crafted! But what is most inspirational are the comments. As one facebook follower commented:
May compulsive skin pickers report also having a number of other chronic skin conditions such as psoriasis or eczema. It is even thought to be traced back to the onset of skin picking disorder or excoriation disorder for some, while for others the reverse relationship is true, whereby compulsive skin picking worsened the effects of eczema.
I am starting to think that it’s quite likely that the eczema I had on my face for all of my 20s was made worse by me and my habit of picking” – Ellican, skinpick.com forum
The very first clinically recognized case of skin picking was documented by French dermatologist Brocq in 1898, in the Journal of Practitioners, Clinique Generale and Therapy Review. Brocq identified the disorder in a young girl who compulsively picked her acne. Since then the disorder has been referred to by many different names: Skin Picking Disorder, Chronic Skin Picking, Compulsive Skin Picking, Neurotic Excoriation, Acne Excoriee, Pathological Skin Picking and even Pyschogenic Excoriation. But for many years the most recognized name has been Dermatillomania. The term Dermatillomania is from Greek origin meaning:
Derma – skin | Till - pull | Mania – madness
There is nothing funny about mental illness. Millions of people worldwide suffer from conditions like depression or anxiety disorder. For many the difficulty is compounded by having more than one mental illness at the same time. Research has shown that certain mental illnesses are more prone to co-occur that others. Dermatillomania has often been seen to occur comorbidly with depression, anxiety and OCD, although no causal link has been found. Although stigma is rife across all conditions of the mind, conditions like depression are far more well known and has been to focus of an abundance of clinical research and advancements in treatment and therapy.On the contrary, dermatillomania and other body-focussed repetitive behaviors (BFRBs) are considered of the most under-diagnosed mental illnesses, primarily due to the lack of awareness by those sufferring with dermatillomania that it is a clinically recognized condition.
Picking the scalp and face are believed to be the most common focal areas in dermatillomania, however compulsive skin picking can affect any area of the body. One of the lesser spoken about areas that people sometimes feel compelled to pick are the gums. Gum picking can entail a variety of actions on the gums from picking, scratching, excessive flossing and brushing, or pressing at the gums. Although these actions can cause pain and bleeding, and even damage to the gums, it is often precisely these sensations that the individual craves when they continue to pick. When browsing through support forums and tumblr blogs around the subject od compulsive skin picking, it is not uncommon to come across desperate pleas for help from individuals asking why they can't stop picking at their gums and whether there is something seriously wrong with them.
Do you have any tips for quitting gum-picking? I'm addicted to poking my gums, and to the nausea and bleeding that comes with it. It's scaring me and I want to stop.
A large part of the stigma around body-focussed repetitive behaviors (BFRBs) such as dermatillomania is the perception that is is just a bad habit and therefore there is the expectation that the person just has to have the will power to stop. Thus the person who is not able to refrain from this behavior is perceived as 'weak' or not strong-willed by others as well as by him or herself. However, we know that one of the key characteristics in the diagnosis of skin picking disorder is that the person recognizes they need to stop picking and have tried, but have not been able to stop. This then often contributes to feelings of deep guilt and shame. In order to discuss whether it is possible to use will power to overcome compulsive skin picking, it is important to first define the term 'Will Power'.
According to most psychological scientists, willpower can be defined as: