How to tell someone you have dermatillomania

On this blog we talk a lot about the value of support in overcoming dermatillomania. We therefore advocate for compulsive skin picking sufferers to open up about their struggles with the disorder to someone you trust and feel you can confide in. However we do recognize that this is far easier recommended than done. One of the characteristics of this disorder is that the behavior consumes the person with immense shame and guilt.

Why it is difficult to tell the one’s we love

The people we love and care about, their opinions have the greatest impact on us barring our own feelings toward ourselves. It is human nature to seek approval from other human beings. This is evident in our propensity to engage in behaviours or assume identities in line with peer or societal pressures. However, it is the deeper, more complex connections we share with those we love and care about that have the greatest impact on us. One of the distinctly human characteristics is our fear of being a disappointment. This is something human beings struggle with in general, so it is exponentially greater in those with compulsive skin picking who already experience feelings of disappointment in themselves. On top of that there is the negative stigma and lack of awareness about the condition that perpetuates the fear that the person you care about will judge you negatively. It is therefore important not to minimize the significance and difficulty of the disclosure process.

Start with the person in the mirror       

You are your own harshest critic. Much of the fears you hold about the reactions of your loved ones stems from your own views about yourself. Before telling anyone you have dermatillomania, first reflect on your own feelings about the disorder. If you do not acknowledge the clinical legitimacy of the disorder and perceive instead the behavior to be a sign of weakness or lack of control, then you will fear others will have the same views. Of course the reality is that the lack of awareness of this condition means the person you tell could have these views, but it is important that you are able to defend against these views to prevent feeling hurt when these negative attitudes are being reinforced.

Knowledge is power

Of course the reason you need support in mental health in the first place is to find extra strength and motivation when experiencing these negative feelings about ourselves. So how then do you combat the fear of telling someone when you are judging yourself harshly already? The key is to learn more about your condition. There is incredible value to be gained from reading articles on sites such as this one and the CBSN (Canadian Body-Focused Repetitive Behavior Support Network) is that you start to develop a more accurate understanding of the condition. The more you read and learn about the condition, the more empowered you will become to answer any questions the person might have. It may also help to print or make a note of any specific articles you found particularly helpful and informative that you think your loved one might appreciate reading.

Deciding who to tell

While we do advocate for more open discussions about this disorder to bring more awareness to it, we also recognize that telling people you have a mental illness is a very personal decision. If you think of skin picking disorder as you would any physical condition such as arthritis or diabetes for example, it is not necessary for every person you encounter to know you have it. Consider the reasons you would want a particular person to know. Your immediate family such as a spouse or parent may be a huge part of your recovery process for example so it is important that you have them on board if you are to engage in any sort of treatment program. You might really need someone to talk to about your journey to recovery or help you brainstorm way to overcome the picking and you have identified a close and trusted friend. In some instances you may even find it necessary to extend disclosure beyond family and friends to an employer if you need to take time off work to attend doctor or therapist appointments.

Preparation and practice

Now that you have reflected on your own feelings about dermatillomania, empowered yourself with intellectual knowledge about the condition, and know who you would like to tell, now comes the challenge of having the hard conversations. We have all done it, where we find ourselves playing a future conversation in our mind, dreaming up what we would say or do in a particular situation. This is because preparation is an important mental strategy we use to protect ourselves against the unknown. Preparing what you are going to say when you tell someone you have dermatillomania can be a huge confidence booster. Write it down if necessary, but prepare the words and even prepare a list of possible questions the person might ask and the answers you will give in response. Once you know what you are going to say – practice, practice, and practice. The more familiar you are with the words, the more comfortable you will become saying them and the easier it will be to share.