I met Mandy several years ago, a friend of a friend. She was (and is) delightful, funny, quirky, and well-read. We really only saw each other at my friend’s parties, so after a year or so at a Christmas party, I asked Mandy if she’d like to go out and see a movie with me or get a drink. I could always use another quirky, well-read friend.
“I don’t go out,” she told me, smiling nervously.
“But you’re here,” I said.
“That’s different.” She nervously scratched her head and made a hasty exit.
I asked my other friend why she bolted so suddenly...was it me? Did she think I was weird? Did she think I was trying to pick her up, like a date?
“Oh, no,” my friend said as she rinsed plates shiny with ham, and macaroni and cheese remains. “She has trichotillomania.”
I had to admit, I didn’t know what it was. But when she explained, I understood: a condition where a person picks at her hair, eyebrows, pulls them out. It often causes bleeding, sometimes infection, depending on the severity.
“But she has hair,” I said, still puzzled.
Research reveals that personality and skin picking severity may be linked and that cognitive reappraisal is an effective strategy for reducing behaviors.
The study published in the Journal of Obsessive-Compulsive and Related Disorders considered the influence of personality on skin behaviors in a non-clinical sample. First, the non-clinical sample is important because it means the 240 adult participants were “normal people” and not only people who presented for treatment of skin picking disorder. Also, this sample was much larger than other research on excoriation disorder, so the results may apply to a broader spectrum of people.
The results indicate a connection between personality profile and skin picking severity. In people with an Impulsive profile have the highest severity of behaviors. Additionally, those with a Pro-Social profile responded very well to the use of cognitive reappraisal by showing reduced skin picking behaviors.
As uncomfortable it is to talk about suicide, increasing knowledge about its risk and protective factors help with awareness. The more people aware of the risk and protective factors, the more likely they will recognize when someone needs help.
A recently published research study suggests that people with body-focused repetitive behaviors are at higher risk than the general population.
Research has established that people with obsessive-compulsive disorder have a greater risk of suicide than the general population. However, previous research did not consider the spectrum of disorders within the OCD category. What makes this study unique is that it looked for research studies that specifically looked at suicide with people diagnosed with skin picking disorder and trichotillomania in addition to the other OCD related disorders.
Even though there were few studies included in this research, the data suggest that suicide attempts among people with skin picking disorder and trichotillomania are low, with 3.7-12% of participants attempted suicide in their lifetime. However, suicidal ideation is higher with 40% of participants reporting they think about suicide.
Food fuels your body and just like any machine that requires fuel, those with the highest fuel tend to perform best. Pardon the human to the car analogy, but most people would not put contaminated gas into their vehicle on purpose for fear of the vehicle breaking down. Our bodies are similar. Sometimes the body reacts immediately to a contaminant such as in cases of food poisoning or allergies, other times, the body reacts slowly in the form of oxidative stress and inflammation which wreaks havoc in the body in ways we do not always attribute to food.
Since skin is the largest organ in the body, it seems reasonable that would take a lot of fuel to remain healthy. Skin needs multiple types of vitamins and nutrients to be at its best. For people with skin picking behaviors, eating right can facilitate healing and might contribute to reductions in picking.
NOTE: The following list is not prescriptive, only suggested. There is no guarantee that the claims made will work because each person’s body is different. For dietary recommendations specific to your skin needs, consult with a registered dietician or registered nutritionist.
An official diagnosis of dermatillomania (also called skin picking or excoriation disorder) should be completed by a qualified healthcare professional. Keep in mind that although awareness of body-focused repetitive behaviors (BFRBs) increased in recent years, there are still many healthcare providers who are not trained to differentiate BFRBs from related disorders. However, preliminary self-diagnosis can be helpful for determining next steps.
First, it is important to understand that skin picking is not a problem because occasionally removing flaky skin or old scabs is normal. It only becomes a problem when a person finds it difficult to stop and the picking causes wounds. Therefore, it is useful to look at different skin disorders and their symptoms. Second, there are official diagnostic criteria specified in DSM5. Third, a person can use an online questionnaire as a means of self-diagnosis. Then, confirm the diagnosis with a physician, dermatologist, psychiatrist, or qualified mental health provider.
When a person bites their nails, it's considered a bad habit. But when they start biting the skin around the nails, causing bleeding, unsightly scars, and skin discoloration, it's a symptom of dermatophagia, a body-focused repetitive behavior. People suffering from dermatophagia are sometimes called “wolf biters” because they bite off chunks of flesh. Dermatophagia benefits from treatment, but the treatment varies based on the age of the person, as well as the severity of symptoms.
The first noticeable symptom of dermatophagia is bleeding. When somebody tries to bite off a bit of torn skin next to a fingernail, they can easily bite too deeply and cause bleeding. It can happen to anybody and it's not a reason for concern. But those who suffer from dermatophagia cause bleeding all the time and are not even bothered by it. Sometimes they don't even notice it. Or they may even find the pain pleasant because it offers relief from feelings of boredom or anxiety.
Dermatillomania or excoriation disorder is not a well-known or well-understood mental health condition. Unlike other disorders popularized in entertainment such as obsessive-compulsive disorder portrayed by Leonardo Di Caprio in “The Aviator” or bipolar disorder portrayed by Claire Danes in “Homeland.” Other disorders with widespread awareness include anxiety, PTSD, depression, autism spectrum and ADHD not only because they are more common, but because they often affect children. However, dermatillomania involves picking at the skin until it bleeds, causing wounds and scare, behaviors which carry a lot of stigma. Therefore, people who struggle with the disorder tend not to talk about it nor do they seek treatment.
As a superhero fan and former therapist, I love finding positive messages in comics, movies, and pop culture characters. The best part is connecting mental wellness themes with characters that people can relate to. An overall uniting theme in superhero character development stories is overcoming barriers and setbacks. During treatment for mental health issues, people tend to experience multiple setbacks which are clinically called “relapses.” While relapse connotes a negative, each setback provides an opportunity to overcome. The chronic pursuit of overcoming obstacles is what turned Carol Danvers into Captain Marvel.
Research suggests that yes, perfectionism makes mental illness worse. A recent report in the Harvard Business Review discusses the relationship between perfectionism and mental illness suggesting that young people today put incredibly high expectations on themselves, which leads to increased levels of depression and anxiety.
The definition of perfection changes based on who determines the qualifications. Therefore, perfection cannot be achieved; it is an impossible goal. As the article states, many young people have “excessive standards” for themselves, irrational ideals that can never be met followed by methods of punishing themselves for falling short. It goes on to explain three types of perfectionism, one directed at the self, one directed socially and the final version directed at others.
The study on perfectionism surveyed over 41,500 college students from the U.S., Canada, and the United Kingdom. They found that college students "are more demanding of themselves, perceive that others are more demanding of them, and are more demanding of others" with socially prescribed perfection twice as influential as the other two.