Dermatillomania is a little known condition classified as a Body-Focussed Repetitive Behaviour (BFRB) within the Obsessive Compulsive Disorder Spectrum. BFRBs in general have only recently received attention in the medical research fraternity, leading to increased awareness of the condition as a clinical disorder. Prior to its inclusion in the Diagnostic and Statistical Manual (DSM5), there was still much confusion and disagreement about where Skin Picking Disorder (SPD), now also known as Excoriation Disorder, should be classified. The limited awareness of SPD has meant that many people sufferring from dermatillomania, as well as the many other BFRBs have suffered in silence due to the embarrassing nature of the behaviour.
Dermatillomania has recently been added to the Diagnostic and Statistical Manual 5th Edition (DSM5) as a Body-Focussed Repetitive Behaviour (BFRB), within the Obsessive Compulsive Disorder (OCD) Spectrum. This suggests that while the behaviours of compulsive skin picking are related to OCD, it is not an OCD in itself, but is better defined with similar conditions in its own category. BFRBs are characterized by repetitive, direct body-to-body contact, which unintentionally causes physical harm to the body. While the urge to engage in these behaviours are defined as compulsions, some have described the inability to stop picking and the irresistable nature of the urge to be similar to addiction. An estimated 25% of people suffering from a BFRB are also addicts. And, since underreporting is an unfortunate but very true phenomena in both dermatillomania and addiction, it’s likely these numbers are even higher.
Dermatillomania is still a relatively unknown condition, with many people who compulsively pick their skin not even knowing that it is a recognised clinical condtion in the Diagnostic and Statistical Manual 5 (DSM5), or that it even has a name. When people hear about dermatillomania, most will not even know what the word means. The most recent edition of the DSM5 also refers to compulsive skin picking as excoriation disorder. Dermatillomania is one of many different Body-Focussed Repetitive Behaviours (BFRBs) such as trichotillomania (hair pulling disorder) and Onychophagia (nail biting disorder). BFRBs have been gaining awareness over recent years particularly due to the power of social media marketing and awareness campaigns being harnessed by organisations like the Trichotillomania Learning Centre (TLC) and the Canadian BFRB Support Network (CBSN). However there is still much to be learned about BFRBs in general, and skin picking disorder specifically.
Dermatillomania, or compulsive skin-picking, can be devastating not only to the person suffering from it, but also to their close friends, loved ones, and families. Many people with dermatillomania are not even aware that they have a clinical diagnosis, despite experiencing significant distress as a result of the scars left behind. Dermatillomania can cause people to withdraw from society, affect performance at work or in school, and lead to isolation from family and friends. Dermatillomania is typically a very private condition, with sufferers going to great lengths to hide their habits, often never seeking treatment. However, once the individual is aware there is a problem, there are treatment methods available to help people with the condition find relief.
For some people picking at skin imperfections is just an undesirable habit, but for many it is a habit that they cannot control. If you find the urge to pick uncontrollable despite the damage it causes your skin, you might be suffering from dermatillomania. Dermatillomania, also known as excoriation disorder, is a common condition, yet often undiagnosed due to the lack of awareness that it is a disorder to begin with, as well as the intense shame and guilt often experienced by those with the condition.
We are all familiar with the main symptoms of depression: sadness, lethargy, changes in appetite, feelings of hopelessness and failure, low self-esteem and suicidal thoughts or feelings. These are all very serious, and hard enough to handle in their own. But what happens when depression moves from the internal to the external? The physical symptoms of depression can be just as distressing as the mental ones: cutting, burning, and other forms of self-harm are common among people struggling with depression, but there are lesser-known conditions that can be triggered by depression. One of the least understood, and often un-diagnosed of these is dermatillomania.
Throughout media history, popular culture has had a major impact on the youth and how they interact and perceive the world. In all industries the media has been blamed for having a negative influence the youth and the evolving way the new generation socializes in the world. Mental illness has had a particularly hard time contending with negative stereotypes and the stigmatization of being ‘different’. So it is no surprise that with the rise in awareness of body-focussed repetitive behaviours, that one of these conditions would bear the brunt of one of these socially irresponsible media campaigns.
In October 2014 popular culture channel MTV posted an offensive article on their website featuring a young woman with a life threatening trichobezoar (mass of ingested hair in the intestinal tract), who suffers with a condition called trichophagia (hair eating disorder). The article came to the attention of Leslie Lee from the Trichotillomania Learning Centre (TLC) outreach programs, who proactively pointed out the role MTV was playing in perpetuating a damaging stigma about a very real and difficult condition.
Skin picking disorder is characterized by a compelling urge to pick, scratch or rub at the skin repetitively, often causing scarring and open wounds on the skin surface. Aside from the physically unsightly appearance of these wounds and the embarrassment it causes for the person suffering from dermatillomania, there is also the added risk of tissue infection. This risk is particularly high during the winter months when cold and flu germs are rife in the air. One online beauty magazine publication recently published an article titled, “Bracing for Cold Season? Here's How to Stop Touching Your Face”, in which the author points out the reality of increased vulnerability of the skin to bacterial infections in the winter months, citing the automatic contact of the hands to the face as possible avenues of transmission of germs.
During the first week of October 2014 we observed body-focussed repetitive behaviours (BFRB) awareness week. With the recent reclassification and grouping together of disorders such as excoriation (skin picking) disorder and trichotillomania (hair pulling) disorder as BFRBs; organizations such as the Trichotillomania Learning Centre (TLC) and the Canadian BFRB Support Network launched campaigns to grow awareness of all these conditions. A number of initiatives were marketed such as the purchase and wearing of the green ribbon to raise funds for much needed research and highlight the plight of those suffering with BFRBs. There was also an initiative across the various support and networking sites encouraging people from all over the world to take photographs of themselves holding a sign or poster with a positive message about any of the BFRBs and upload it to social media with the hash tag #IamNotMyBFRB or #BFRBawareness. These photographs were then used by the Canadian BFRB Support Network to create the youtube clip featured here. The hash tag for the video campaign was #SpreadTheWord #BreakTheStigma.
Skin picking disorder, formerly known as dermatillomania, was recognized for the first time as an official medical condition in the fifth edition of the Diagnostic and Statistical Manual (DSM5) in 2013. This is a huge stride toward the increased awareness, improved diagnosis, and development of treatment options for the millions of people challenged by this condition. With its new found status, comes a new name, with the DSM5 referring to skin picking disorder as excoriation disorder. According to the American Psychiatric Association (APA) it is estimated that between 2 and 4 percent of the population could be diagnosed with this disorder, and that resulting problems may include medical issues such as infections, skin lesions, scarring and physical disfigurement.
The criteria for the diagnosis of dermatillomania (excoriation disorder) as outlined in the DSM5 are as follows: