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.
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The prevalence of skin picking is unclear, but current data suggests it might be more common than researchers thought. This blog post contains a more thorough discussion of the prevalence of dermatillomania. However, traditional epidemiological estimates state that 1.4% of the general population may meet diagnostic criteria for skin picking disorder. In a non-clinical sample, or people who respond to a general survey, 14% out of 318 respondents reported skin picking behaviors that lead to wounds. Other data shows that about 2 percent of visits to dermatologists are because of the consequences of dermatillomania. Also, an anonymous phone survey found that one in ten respondents picked their skin until they caused damage. When mental distress was added to the mix, 1.4% satisfied the criteria for dermatillomania. Another study showed that 63% of respondents engaged in skin picking behavior, with 5.4% of respondents meeting criteria for a dermatillomania diagnosis. This wide variance reveals a common theme in this disorder. Most people pick their skin, causing damage, while a lesser number (though still unknown how many) reports a pattern of emotional and mental distress that goes with skin picking. Regardless of the actual numbers, the theme is that the prevalence of skin picking disorder is higher than the data reports.
There are several reasons dermatillomania is still a secret disorder.
Skin picking is a complex problem with many causes and patterns of behaviors. Education reduces the stigma and shame attached to the disorder and teaches people about treatment options available. Not only does awareness increase the likelihood of early recognition of the disorder, but also makes it easier for people to seek treatment. As dermatillomania moves out of the hidden realms, health care providers and support will become more available. Creating support systems, and educating the public on when to seek help, is the best way to solve this under recognized problem.