Although widely experienced, compulsive skin-picking is a little known, often undiagnosed condition that an estimated 2 to 5 percent of the U.S. population has. If it is so common, why do we know so little about it? And why are there so few mental health professionals who are skilled and knowledgeable in the treatment of it?
I have heard the experiences and heartfelt “confessions” of countless people struggling with compulsive skin-picking via the online therapy program at SkinPick.com, and often I hear expressions of guilt and shame around the act of picking and extreme embarrassment about the condition of their skin. Compulsive skin-picking, also known as dermatillomania, was included in the most recent version of the Diagnostic and Statistical Manual (DSM) in 2013 under Obsessive Compulsive and Related Disorders as excoriation (skin-picking) disorder. Because there is so little awareness around it being a clinically recognized disorder, if you compulsively pick your skin you may often feel like you are “weird” or “gross” and therefore never seek any help.
Compulsive skin-picking varies in severity and is triggered by different things for each individual. For some people it may be triggered by stress, for others anxiety, while there are also many who pick automatically without even realizing it. In its most severe form, repetitive skin-picking can lead to infection and permanent scarring. Skin-picking often has a detrimental impact on self-esteem and impact negatively on your social functioning, with many of my skin-picking clients reporting that they often avoid meaningful and enjoyable activities or social situations for fear of others seeing their scars and being harshly judged the way they already judge themselves. A common phrase used by people with skin-picking disorder is “When I stop picking…” However, a regular blogger over at Diary of a Skin Picker published a post stating that you shouldn’t wait:
“Don’t put off today’s happiness, for some imagined happiness tomorrow.”
I am not a skin-picker so I can never claim to understand or know what someone with this sometimes debilitating condition feels or is going through, fighting the irresistible urge to pick every day. So I would never preach to you or your loved ones challenged by this disorder to just get on with life and not let it bother you. But from the experiences of the many clients who have completed our program, I can report that often engaging in those very activities you avoid because of the picking is what also breaks the cycle of picking.
In cognitive behavioral therapy (CBT), which shows the greatest evidence of effectiveness in the treatment of skin-picking disorder, acceptance and commitment therapy (ACT) is a modality that discourages the resistance of negative thoughts and emotions, instead teaching the client to embrace them and accept that they are part of our human experience, but that we have a choice in how we respond to them. The client is encouraged to reflect on their personal values in life and to identify what occupations (role-based activities) and behaviors are aligned with these values. Clients often find that the very occupations they value are also the occupations most affected by their disorder. This becomes a vicious cycle whereby the more you avoid doing the things you love and enjoy, or avoid pursuing your passions due to skin-picking; the more likely you are to be mentally and emotionally unhealthy and therefore the more likely you are to engage in unhealthy defensive behaviors such as skin-picking.
In the profession of occupational therapy, the key core philosophy is that we can achieve well being through engaging in meaningful occupation. The belief is that we are on a continuous path of development throughout the lifespan, and doing helps us fulfill who or what we want to become as human beings. Therefore, instead of waiting till you have skin-picking under control, perhaps it is doing what makes you happy and fulfills you that is what is needed to help you overcome skin-picking in the first place.
There is a well-known saying that goes:
“Life happens while you are making other plans”
So live your best life today!