My friend called them ‘the other eyeballs’; my cousin ‘little crater-faces’. My mother, despairing, signed off all her text messages with, ‘Love you – stay away from the mirror please!’ That I have a problem is as plain as the nose on my face. But it was only after I spent six years picking at my face that I disocvered – thanks to the Internet – that Skin Picking Disorder is actually A Thing.
It even has its own acronym: SPD, or the infinitely scarier sounding dermatillomania. It’s an impulse control disorder, and largely tends to affect those who already suffer from body dismorphia or OCD. To give a sense of scale, that is 1.2% and 0.5% of the population respectively but it’s rarely discussed: just finding a therapist who had heard of it took some doing, and in the end I had to opt for a specialist in trichotillomania – another impulse control disorder wherein people pick their hair out obsessively. Here in the dermatillomaniac’s department we have similar compulsive urges but with the skin – picking not just zits, but blackhead, bites, scars, moles, ingrown hairs and even imagined blemishes or bumps for hours without pain, just an intense feeling of release and achievement. If it’s skin, and within reach of our fingers, it’s fair game.
READ MORE: Things You Only Know If You Have Trichotillomania
At first thought I thought was a bad habit – a hangover from the spot squeezing we all do as teenagers. Then I wondered if it was a feature of relationship issues or work stress. My family despaired, alternating between anger, fear and concerned sympathy when we finally found out what it was. Like me, they felt that I must surely be able to just stop it. ‘It’s like losing weight, Clare,» mum said. ‘Just don’t eat that doughnut.’ It wasn’t until I found myself turning up to work two hours late, blood streaming down my face from holes I’d gouged that morning and lost all hope of concealing that I finally admitted to myself what I had wasn’t a bad habit, but a bona fide compulsion.
I’m almost out the woods now. One scabby, itchy craterface to go and I’m in the wide blue yonder of clear skinned freedom and eternal bliss – though, as with trichotillomania, there'll always be a chance I might go back in there. If I do, I’ll go back to cognitive behavioural therapy, use some of the coping mechanisms my therapist has given me and, most importantly, I’ll ask my family and friends. As with all illnesses peer support is vital – but of course there will always be some things only people who have or have had dermatillomania can really know.
It doesn’t mean you’ve got bad skin...
You can have amazing skin and have dermatillomania. You can have terrible skin and not have dermatillomania. The condition itself has nothing to do with the cleanliness or otherwise of your pores. When I was a teenager my skin was fairly clear of spots, and it is now – at least it would be, if I didn't pick at it. Yet even the most enviably smooth of skin will turn spotty if you touch it constantly with fingers, which, however clean they look, carry germs which are just itching to breed in its warm, sebaceous environs.
The popular assumption that it is just bad skin, however, is a damaging one – both for the sufferer as well as for the prospects of this condition garnering further awareness and research. When you see someone with marks on their face you automatically assume they’ve got acne and haven't willpower or sense enough to resist a good squeeze. So do they – that’s why so many cases of dermatillomania go undiagnosed and untreated, with sufferers hiding away like shy, pimply teenagers: berating themselves for their weakness, avoiding social occasions and even taking sick days off work.
It can’t be improved by products...
If it could, I wouldn’t be writing this. As a journalist on lifestyle magazines I am lucky enough to have a bountiful supply of nice cosmetics I've been sent by beauty PRs, all of which promise miracles. They don't help, of course, because dermatillomania is a mental, not physical disease. Attempting recovery by slathering serum or night cream over your bod is the equivalent of trying to repairing a bike puncture before riding through broken glass in the gutter. When you're in it's throes, the best thing you can use is a cleanser and a moisturiser that is simple, oil free and light: too heavy and the cloying stickiness of it will make you want to pick more.
Not moisturising at all is tempting, too – but it does increase your risk of scarring. Some people suggest Vaseline, which when you’ve an open wound serves a triple purpose of helping it heal, preventing the germs entering and stopping you touching it. It’s not a great look, I’ll be honest, and it’s hard not to scratch it away again. That said, now I’m in recovery mode the thought of playing with product is a tantalising incentive – so bear that in mind before giving away your beloved Christmas gift box of Clarins.
Concealer conceals nothing
If you’ve a bleeding great hole in your face/leg/insert relevant limb stuffing it full of congealing foundation is not going to make it look or feel any better. Too well do I remember going home home and seeing a family friend for the first time in years. ‘You’ve got mud all over your face, dear – did your realise?’
‘It’s concealer,’ I muttered as my hands flew to face and felt where blood had mingled with the beige paint. Over the years, I’d spent a fortune on concealers of all varieties – antiseptic, anti-blemish, total cover – but far from helping, they clogged up my wounds with more gunk. I knew too, deep down, that their a presence also gave me a get out clause: if I could effectively cover up the mess I’d made I could pick to my heart’s content, and still look normal.
At least that's what I thought – until someone thought I had mud on my face. Until I was questioned about it by a client. Until the guy I really fancied asked if I’d drunkenly fallen on my chin the previous evening. In the end, the situation became untenable, as I realised how much I was impacting my life. It was the second Damascus moment that lead me to cognitive behavioural therapy.
It doesn’t feel like you've been in the bathroom for two hours...
But you have. At my worst I spent a minimum of 45 minutes each night and each morning, boring away. It’s not just the bathroom, either: so intent do you become on digging into your dermis you'll actively seek out the best light, the clearest mirror and the perfect angle from which to get at a good bit. You enter a time warp, one in which the clock seems to stand still and nothing becomes too weird or dangerous. I’ve been known to balance a pocket mirror and a searchlight on my window to maximise light, and abandon the use of my fingernails for the superior implements of tweezers, safety pins – even the pointy backs of earrings – in my haste to further the deep excavation of my chin.
It’s not painful – it’s actually incredibly soothing
Far from feeling the pain you would ordinarily feel were you tearing your skin off, there’s a ‘cognitive distortion’ with dermatillomania, meaning at the time you become trancelike. Your mind starts to wander – and if it does drift back, it often registers what you’re doing to yourself only in the most abstract way. Some of my most calm, satisfying moments have been in the dead of night with a magnifying mirror and a bright light in a ‘good’ pick pose: as with trichotillomania, the effect of a successful pick is to trigger a reward system, which is what makes the behaviour so addictive. Only when, after the tenth or 20th round of washing the blood off your face, drying it, seeing it in the mirror, grimacing and renewing the pick, you’ve finally dragged yourself away, does the pain start: sore, mentally exhausting and debilitating for your confidence. More terrifying still, the ability of some sufferers to dissociate the pain is so good that they can tear into muscle, veins or arteries that need immediate medical attention, all without really feeling a thing.
If you had a penny for every resolution you’d made not to pick...
You’d be rolling in it. Even as you swear to yourself and everyone who cares to listen you’re off it, you know it’s a promise you can’t keep. It’s a negative feedback loop – that is to say, you pick at your skin out of an inherent anxiety or tension, then become anxious because of the visible marks you make, which heightens your anxiety so you start picking again to reduce that anxiety and so on ad nauseum. Or CBT.
It’s not just your face….
What little research there is cites examples of every (and I mean every) body part being picked at. Ingrown hairs-come-inflamed welts make summer a Hobson’s tossup between hairy legs and spotty ones. Anything perceived to be foreign is the enemy, to be driven out of hiding under your skin or in your hair follicles. If there is a ‘rationality’ to dermatillomania, it is that you want to get your skin perfect – and though the irony here is not lost on us, we can often be seen subconsciously scanning out bodies in search of insurgent bodies we can remove.
Some picks are ‘better’ than others
Each time we justify it: just this one bit, it will be better for it. Exactly what you’re searching for depends on the blemish, but all roads lead to the woe. The satisfaction of getting a good pick – that is one that yields pus, an ingrown hair or buried scar tissue – can be almost religious, but there’s always a comedown (see negative feedback loop) – not least when you’re constructing yet another elaborate excuse as to why you’re late for work/a party/social engagement and with a face riddled with holes.
**Asking for help does actually work **
Even if they aren’t cognitive behavioural therapists. A kind word, some positive encouragement, and compliments on your hair or clothes can make all the difference between us dermatillomaniacs coping, and hiding ourselves away. Even my recovery has been driven largely by people encouraging me and pointing out when my skin looks clearer. Of course it’s easy to feel powerless, even embarrassed, as an onlooker, but don’t underestimate how much you can help us. All that’s necessary for the fingers of evil to win in our world is for enough good men and women to do nothing.
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This article originally appeared on The Debrief.