Skin Picking Disorder, also called Excoriation Disorder or Dermatillomania, goes beyond just popping a zit or scratching at the mosquito bite. It means the sufferer compulsively removes perceived imperfections from their skin to the point of causing tissue damage, often creating infections and permanent scars. It affects approximately one in twenty people. This disroder is differentiated from Body Dismorphic Disorder, which is more about self-hatred directed at the body and covering flaws. Both are considered body-focused repetitive behaviors.
I have picked at my skin obsessively almost my whole life. As a child, I would scratch at bites until they formed scabs, and then pick the scabs over and over. It was soothing to make the scab disappear, even though I would bleed or get painful infections. In the summer, I’d get black fly bites on my head, and I’d pick at them until I had bald patches. I’d obsessively trim my cuticles or bite at hangnails. I gave myself blood poisoning more than once, but I quickly learned how to deal with it.
Around age eight, I created a game to try to get myself to limit picking. I could only scratch at a scab the number of times of my age, and I could only pick lightly. This helped until I got to junior high and the number of picks was too high to do any good.
When acne set it (which I still have), it came with a whole new world of things to pick. And I could wear makeup to hide it. Of course, picking at acne tends to make a breakout area worse, and the cycle continues. For a long time I refused to wear sleeveless clothes because of the scarring on my upper arms and the usual current scabs. For some reason, scabs on my legs don’t bother me as much and I’ll wear shorts. I think I perceive the legs as harder for others to see. And I also can’t see them as well. I pick my upper legs and buttocks more anyway.
Skin picking is often related to major depressive disorder. Once I finally started wholeheartedly treating my depression in my 30s, my skin picking diminished. I also started taking spironolactone, which lowered my occurrence of acne and gave me less to pick at. Still, I usually have a spot or two. Currently, I have a scab on my upper arm that has been unhealed for at least two months. And because I’ve been under a lot of stress lately, I’m in the midst of an acne outbreak that is now mostly scabs. I’m embarrassed to show my face without makeup to anyone but my husband.
Skin picking is also largely an unconscious behavior. I will be in the middle of something (like editing this post), and one hand will be picking at something. I often pick as I’m falling asleep or in my sleep. All of my pajamas have blood stains, as do my sheets and pillow cases.
I still choose clothes based on covering areas of picking, but less so to hide scars. I also always carry kleenex in case I make myself bleed excessively. People are remarkably polite about me bleeding in front of them. It almost makes me think they don’t notice.
I’ve made great strides in curbing this behavior using cognitive behavior therapy and acceptance and commitment techniques. I take physical steps like keeping my fingernails super short, carrying fingernail clippers everywhere so I can use them to neatly and more safely trim my cuticles, and transferring some of my anxious energy into more healing rubbing of my palm or back. Sometimes I can even just rub over a scab or bump but not pick it. Working on my depression and anxiety also makes a huge difference. The more in control I am of my emotions, the more in control I am of skin picking.