Learning to live with my chronic skin disorder

A decade of dermatillomania.

We all have coping mechanisms. While my little bubble of life experience probably pales in comparison to others, brains can be cruel. Instead of running, calling a friend, or screaming into a pillow, my coping mechanism is to compulsively scratch my skin for hours, sometimes until I bleed.

My mother tells me that I was anxious from the moment I cried out to enter this world. I had normal childhood issues, of course, but everything was just a little more exacerbated. My phobias were life-threatening, I had chronic sleep problems, and performance expectations preoccupied me from the age of eight.

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It was only after reading the memoir of writer Cat Marnell, How to murder your life, I realized I had a problem. Coincidentally, it was a book I had bought on my post-college trip to Europe. I drank cheap beer, rationed my money, and stayed in overcrowded hostels. My usual bed was a dormitory with 12 bunk beds and a single shared bathroom. Needless to say the privacy was lacking.

In the book, Cat describes herself as “a tweaky self-harm who sat in front The show tonight with Jay Leno, digging bloody abscesses in his bikini line”. Cat, beauty editor then associate at Condé Nast’s Plie Fortunate magazine, detailed the brutal realities of his drug addiction — including his experience of compulsive skin-picking.

In 21 years, it was the first time I realized other people might share my shameful secret. I, too, had spent hours picking hairs, spots, and completely clear skin on my bikini line (among other things), resulting in angry, open sores. During one particularly bad summer, I covered my crotch with betadine and bandages, hoping to ease the pain I was inflicting on myself. I avoided swimming for almost three months.

The severe lack of privacy in these hostel rooms meant I struggled to find pockets of time in which I could find a mirror and rip the stains off my face. I even lost my pair of tweezers somewhere in transit and decided not to buy them again. My brows were bushy and my skin – miraculously – was the clearest it had been in a long time. And then I started again.

Dermatillomania – also called excoriation disorder or chronic skin hair removal – is a mental illness linked to obsessive-compulsive disorder (OCD). As Dr. Lisa Zakhary explained to Harvard Health, “We all pick a scab or bump from time to time, but for those with skin picking disorder (SPD), it can be nearly impossible to control these cravings. Besides the aesthetic impact of skin lesions recurring and scarring, SPD can lead to serious infections, shame, depression and anxiety.

Although it falls under “obsessive-compulsive behavior”, excoriation disorder is also body-focused repetitive behavior (BFRB) with no specific cause yet identified. As noted in a 2019 article in The Guardian, “the condition is considered to be different from obsessive-compulsive disorder, as it is neither self-harm nor necessarily driven by a deeper issue or unresolved trauma”.

It is important to note the difference between the occasional selection of blemishes (blackheads, pimples, etc.) and the behavior of dermatillomania. As described in psychology today, “the repetitive skin picking extends to pulling, squeezing, scratching, pricking and even biting healthy and damaged skin from various parts of the body. People with dermatillomania often target their face, hands, fingers, arms and legs; they can use either their fingers or an instrument, such as tweezers or pins.

While I consider myself an extremely open person (sometimes to my detriment), dermatillomania has always remained my embarrassing secret. As a young adult, I invested both money and time in my skin – and whenever I felt over- or under-stimulated, I would destroy it all in one trance-picking session. I was cleansing, moisturizing, and putting on a face mask, only to tear out my pores moments after.

Then, when I felt really down about my face, I would move on to another area. I rationalized that I could spend more time picking less visible targets (my cuticles, bikini line, inner thighs, etc.) and wouldn’t be reminded of my “dirty habit” every time I I looked at myself in the mirror. This led to my most damaging period of chronic skin picking.

In 2013, I was a year away from graduating from high school and my mental health was just plain devilish. To cope, I would find my “zen” sitting in front of the mirror with tweezers. My immune system was already suffering, which meant that the open sores I had created were starting to get infected. After putting it off for as long as possible, I admitted the problem to my doctor. He rejected it, told me I “absolutely needed to quit” and went through several rounds of antibiotics.

It took me years before I could talk to a professional about it again. Through my own research, I learned that Cognitive Behavioral Therapy (CBT) has been shown to be effective for skin picking. I was already undertaking it for separate reasons, so I explained my dermatillomania to my therapist and told her that I would like to work on it. She validated my emotions, put me at ease, and helped me overcome my compulsions.

As a warning, this is not a complete success. Although my picking has decreased significantly, I am still working to completely eradicate the behavior. For those also struggling with skin hair removal, these are the tools I’ve used to soothe – not cure – my skin hair removal issues.

To start, I got rid of my “tools”. I get my eyebrows waxed or tweezed, so I don’t need to keep tweezers at home. I also threw away all the magnifying mirrors, so I just use the large common mirror in my shared bathroom. When I feel an urge (or do something where my hands are idle, like watching TV), I try to find something to tinker with. A stress relief toy is usually the most effective for me.

I’ve also found that telling the person you spend the most time with (your partner, your best friend, a family member) can also be very effective. As difficult as it may be, explaining the problem can help them support you when it happens. I will – often without realizing it – pick my bloody cuticles when I am distracted. My partner now knows how to withdraw my hand, with a soft but firm “stop picking”. It doesn’t always stop him, but it helps.

For more tips on managing chronic skin, go here.

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