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Skin picking: what it is and why we do it

Do you have Dermatillomania? If you can't stop picking at your skin, two experts give their advice and suggestions

When I was younger, I used to compulsively pick the skin around my thumb, especially when going through a stressful period. I never spoke to anyone about this, and thought I was the only one who did it, without realising it was an actual disorder.

So what happens when you start to obsessively pick your skin, spots, moles, and scars? We’re talking about when you’re unable to stop, and it gets to the point where you’ve caused cuts, bleeding, bruising and/or scarring.
You might spend hours each day picking, using your fingers, a pair of tweezers, pins or comedone extractors, as a result of stress, anxiety, or even boredom. You may even do this without realising it, and in some extreme cases, in your sleep.

In this case, you might have Dermatillomania, also called ‘Skin Picking Disorder’ or ‘Excoriation Disorder’ which is where you cannot stop picking at your skin.
We hear from two experts, Anxiety Support Specialist, Cai Graham, and Clinic Lead at Face the Future, Kimberley Medd, to discuss in further detail.
“Dermatillomania is often misdiagnosed as a ‘self-harm’ tactic, but this isn’t the case. Sufferers may do it to relieve anxiety, to delve into negative emotions like guilt, to ‘escape’ a situation they feel uncomfortable in, or even to cure boredom, as opposed to wanting to cause pain to themselves," says Cai Graham. "It might also be due to compulsive perfectionism, which is the belief that skin picking will lead to ‘perfect’ skin."
"The disorder sees the sufferer entering a trance-like state in which they obsessively pick, pull, and/or scratch at their skin. This varies from the face, to the arms and chest, to calves, or even the scalp, among many other places on the body.
"They may target ‘healthy’ skin, but also ‘imperfections’, such as blemishes, scars, scabs, moles and freckles. When in this trance, time passes by extremely quickly. 30 minutes. An hour. Time passes in the blink of an eye without the sufferer realising it.
"While the sufferer feels intense relief and control during the skin picking session, once they are out of their ‘trance’, they feel extreme shame and guilt for what they have just done.
“It can be difficult knowing how to support someone with Dermatillomania. While you may be tempted to remind them to ‘stop picking’, this can cause further mental anguish, as well as potential conflict within your relationship.
"First of all, avoid pointing the blame or shaming them for having Dermatillomania. As difficult as it can be, do not express anger at them. It is important to remember that it is an uncontrollable condition–it is not a decision, nor a bad habit, but rather a compulsion.
"Ensure that you provide unconditional support, and help the sufferer to reach out to their GP to discuss remedies, such as cognitive behavioural therapy (CBT) or medication. Further encourage them to keep their hands busy with something else, such as a stress ball, when they do get the urge to pick.
"Also, try to help them recognise their triggers. For example, are they most likely to pick when they’re cooking dinner? When they’re in a meeting? On public transport? Recognising these triggers can make it easier to manage the skin picking ‘sessions’ by implementing certain steps, such as wearing gloves, to minimise or prevent the damage.”

How does Dermatillomania affect skin?

“While Dermatillomania is derived from a mental health condition, it does directly affect the skin. Continuous picking and pulling at the skin can cause deep scarring, as well as potential skin infections," says Kimberley Medd.
"In an ideal world, it would be recommended to not pick at your skin, however with debilitating conditions such as Dermatillomania, it really isn’t that simple.
"After a picking session, wash your hands and clean the skin thoroughly with warm water. Pat dry with a clean towel and do cover any potential skin infections with a bandage.
"It’s crucial that you do not share items such as towels, flannels or razors with anyone else, as bacteria found on these items can cause or exacerbate an infection on wounded skin."

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