Compulsive Skin Picking 101

Before passing judgement, please be aware that this is a very personal and sensitive topic for me. I can't help my mental health.

Compulsive skin picking (CSP), also known as dermatillomania and excoriation disorder, is a type of body focused repetitive behaviour (BFRB) most commonly associated with obsessive compulsive disorder (OCD) and impulse control disorder (ICD), but can also be linked with self injury.

CSP is most common in teens and those in their early twenties and affects girls more than boys. The causes are unknown, but there are theories linking it to addiction, uncontrollable habits, and underlying mental health issues.

Skin, spots, scabs, scars, freckles, blisters, psoriasis, eczema, and cuticles are all areas of focus, but anywhere on the body can be affected whether there are real or imaginary imperfections or not. Most commonly, CSP is carried out with the fingernails, but tools such as scissors, tweezers, and pins are also used in some cases. Picking often leads to bleeding, broken skin, and the risk of infection.

The reasons and emotions behind CSP vary from person to person, but the action itself can be described as a compulsion, similar to those seen in OCD. The compulsion to pick can follow a particularly intrusive or obsessive thought that renders the sufferer unable to function until they have picked an area to satisfaction. This can often start a destructive cycle of an area not being 'good enough' and in need of more picking, which becomes an obsessive thought, which leads to continued picking, increasing chances of infection and permanent damage.

Emotions related to CSP can be very intense and overwhelming for the sufferer, usually beginning with frustration or tension which results in the picking, followed by shame, guilt, disgust, and embarrassment. It is not unusual for a person engaging in BFRBs to hide the affected areas as well as the behaviours themselves. Low self esteem and self image can also arise.

Research into CSP has been conducted, so there are no known cures. However, cognitive and talking therapies can be carried out as a way to accept and change the behaviours, as well as recognise situations and feelings that lead to them.

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Keep the area and your hands clean
Help eliminate the chance of infection for those times when picking is unavoidable

Replace skin with something else
If the urge to pick can't be ignored, aim it to something that isn't part of your body (nail polish, paper, stress balls, paint etc)

Keep your hands occupied
When the need to pick arises, take up a manual task so that your hands can't stray to your skin

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So... Now you know a bit more about one part of my mental health that I'm not happy to discuss. I've been a compulsive skin picker for as long as I can remember and I've always been ashamed of it and tried my best to hide it from people. It's not nice to have skin that's so raw you can't bend your fingers or put weight through your feet (yes, that's right: my picking even extends to my feet), and it's even worse to have people comment on it.

Because they will comment on it, and they very rarely say the things you want to hear - because you don't want to hear anything. Even the most well meaning question about 'what happened to your fingers?' is unwanted. It means they noticed. Someone expressing sympathy or sadness is unwanted. It's uncomfortable to hear when you feel so much shame at your actions. And the nasty remarks fuelled by disgust are the ones no one wants to hear. Because yeah, it's hurtful, but you can't help but agree.

I've been coming up with excuses for why my fingers are always red and sore since I was in single digits in primary school. That's over half my life. And not once in that time have I met someone who understands or has cared enough to try. Sure, a lot of that is on me as I try my best not to talk about it, but I know that people have noticed. I've seen the not-so-sly glances. I know that people think it's a gross thing to do. But I can't help it.

So please. Just stop before you judge someone who skin picks.