Dermatillomania or excoriation (skin picking) disorder is not a very well known condition, primarily because the behaviours that manifests in this disorder are not often shared by people who engage in them. As a skin-picker you are often riddled with shame and guilt about your behaviour, covering up the ‘evidence’ to protect your closely guarded humiliating secret. Ironically the secrecy often isolates you from those you care about and, ironically, prevents you from receiving the much needed support and help you need to overcome it.
This short film (by Rhiannon Harris) called “She’s lost control” portrays just how lonely the shame of dermatillomania can be. In the film, a young beautiful girl is shown picking at sores (most likely created by her in the first place) until they bleed. She is disturbed by her mother knocking at the bathroom door asking her why she was taking so long.
Onychophagia is a behavioral disorder characterized by compulsive nail biting. It is categorized with other disorders such as skin picking disorder (aka dermatillomania or excoriation disorder) and hair pulling disorder (trichotillomania) under the umbrella term body-focused repetitive behaviors (BFRB). These are compulsive habits that are automatic in nature and in its mildest forms are not perceived as socially unacceptable and therefore often not recognized by the individual as a clinical problem. Of the BFRBs, compulsive nail biting is the most socially accepted habits, viewed as simply a ‘nervous habit’. It is also commonly occurring in childhood with frequency tending to decrease by adulthood. However, the behaviour is known to intensify or persist through adulthood, and the severity of onychophagia can range from a very mild presentation to behaviours that are so severe that physiological complications occur.
Onychophagia, as with other BFRBs are believed to be caused by feelings of anxiety and the individual’s inability to cope with these feelings in an effective way. The act of nail biting is believed to serve two functions:
The Trichotillomania Learning Centre (TLC) was initially aimed at providing support to people with thrichotillomania (hair pulling disorder). However as TLC has grown it has come to recognised the links between trichotillomania and other conditions such as skin-picking disorder (SPD) which are classified as body-focussed repetitive behaviours (BFRB). They have since evolved into a prolific organization in the support of education, awareness and research into the cause and treatment of all BFRBs including skin picking. However, since skin picking, also known as dermatillomania or excoriation disorder, is still a growing community, resources and support to the skin-picking community is not at the same level as programs focused on hair pulling. As such TLC are conducting a survey to understand needs of the skin-picking community to guide them in creating and improving programs that will benefit those suffering from skin-picking disorder. TLC therefore invites you or anyone you may know with skin-picking disorder to participate in a short 10 minute survey to share your views.
There has been disagreement in the medical fraternity about the classification of skin-picking disorder (SPD) with some grouping it with obsessive compulsive disorders (OCD), while others categorising it as a body-focussed repetitive behaviour (BFRB). One might question what the importance is of classifying the skin-picking disorder into any specific category when they are all so similar. The importance lies in the advancement of knowledge and understanding of the causes and developing guidance of treatment of the condition. There are distinct clinical differences in the presentation of obsessive compulsive disorders and the underlying causes, and those of BFRBs. As such, there are also differences in the treatment approaches that are most effective within each category of disorder. In a recent 2012 internet study comparing the rates of problematic BFRBs in individuals with SPD, it was found that skin-picking disorder is associated with body-focussed repetitive behaviours.
Dermatilloma is a skin-picking disorder that not only leads to skin damage, but the severity of the behaviour is directly proportional to the social and emotional distress experienced by the person who engages in the behaviour. Anyone with a skin-picking disorder will testify to the shame and embarrassment the condition causes. People with dermatillomania (official term: excoriation disorder) often suffer in silence, unaware of how common the condition actually is. The explosion of web-based technology has given millions of people suffering from dermatillomania access to information and enabled individuals to seek support anonymously. One of the most common questions asked by people seeking information about skin-picking disorder is, “did I inherit it?”, or, “is it genetic?” Often people asking this question have noticed members of their immediate or extended family having similar habits, which leads them to conclude that they must have inherited the behaviour. This is also a concern for people who do not suffer with skin picking, but have witnessed the debilitating impact it can have on a relative’s life, and are concerned that there may be a possibility that they could inherit the condition.
Dermatillomania or skin-picking disorder manifests in many forms. Common areas that are the focus of skin picking include the face, arms, neck, and scalp. Skin-picking disorder is part of a cluster of disorders known as Body-Focussed Repetitive Behaviour (BFRB). When dermatillomania presents as an obsessive-compulsive scalp-picking behaviour, it can often be confused with another BFRB called trichotillomania. Trichotillomania is a hair-pulling disorder, which leads to hair loss and sometimes baldness. However, scalp-picking is motivated specifically by the person’s urge to pick at the skin of the scalp, whereas hair-pulling is the urge to pull the hair out of the scalp.
Cosmetics brand Dermablend Professional recently launched an advertising campaign on YouTube called the Camo Confession Campaign. The cosmetics industry is often slated for being superficial and encouraging women and girls to strive for the unrealistic ideal of perfection. Dermablend Professional hopes to challenge this view with the Camo Confession ad campaign. The campaign kicks off with a young model named Cassandra removing her make-up and sharing her personal story of shame and ridicule as a young teenager because of her terrible facial acne. Even though she is talking about acne, we thought the heart of the story is something that many who suffer with skin-picking disorder can relate to.
Becca is a vlogger who covers her life with trichotillomania on her YouTube channel, TrichJournal. She recently made a video discussing 6 useful tips that will help you have a good time at the conference, and even make a few friends in the process
1. Being Nervous is Normal Doing anything for the first time can make you anxious. And that's fine because there are lots of things to take care of: settle down in your hotel room if you're from out of town, find the venue, and finally register. If it all makes you feel nervous, look at people around you. Seeing that everybody is going through the same experience will help you relax.
2. Respect Others' Privacy Each person has a different attitude toward their condition. Some are more outgoing about it than others so, if you want to take photos with other people, ask them for permission first.
3. Make Friends! Trich affects 2 to 3 percent of the population. For that reason, people with trich or skin picking sometimes feel isolated and alone, ashamed and hiding their condition. At a conference, you will be surrounded by people who understand what living with BFRB feels like. So use this opportunity to open up - listen, learn, socialize, and make new friends.
A picture is worth a thousand words, right? This infographic concisely explains Dermatillomania.
Dermatillomania’s name explains the condition, which is compulsive picking of the skin despite causing physical damage. People who pick at their skin experience skin damage as well as psychological and emotional distress. What makes the condition a disorder is the amount of time someone spends doing it, usually impairing their ability to go to school, work, or socialize. Additionally, people with skin picking disorder devote much time and expense, covering up the damage.
While not very common, skin picking disorder affects 1-6% of the population and usually begins in early adolescence. Although it lasts a lifetime, picking behaviors are often episodic and correlate with stress, anxiety, or depression. However, every person is different, which is why thorough assessment by a qualified professional helps determine the best course of treatment. Therapeutic interventions include cognitive-behavioral therapies like habit reversal training and acceptance and commitment therapy. Successful recovery is possible and usually consists of a healthy lifestyle, therapy, and social support.