Body-Focused Repetitive Behaviors: Skin Picking

Raise your hand if you are a chronic “skin picker!” 🙋‍♀️

As long as I can remember having acne, I have been a chronic skin picker. I don’t know what it is, but I just can’t leave sh*t alone! Unless you have excellent impulse control- I do not, you are probably guilty of messing with blemishes on your face as well, don’t lie.

It wasn’t until I was in my mid to late twenties that I started to realize that maybe skin picking wasn’t really the satisfaction of attacking that blemish on my face. I started to realize it was an issue with more to it…

Dermatillomania or Excoriation Disorder aka Skin Picking, is defined by Psychology Today as: “psychological condition that manifests as repetitive, compulsive skin picking.”

Psychology Today (Skin Picking)

Skin Picking / Dermatillomania / Excoriation- falls under the category of Body-Focused Repetitive Behaviors which consist of disorders relating to nail-biting, pulling one’s hair (scalp, eyelashes, and eyebrows), cheek and lip biting. The Diagnostic and Statistical Manual of Mental Disorders, often referred to as the DSM, classifies these disorders under the umbrella of Obsessive Compulsive Disorders.

People who engage in Body-Focused Repetitive Behaviors do so with or without full awareness and are often triggered by feelings of tension, stress and anxiety, and are found to be a form of distraction and gratification and not a result of being obsessed with one’s appearance. One may also feel the desire to engage in such behaviors even when the trigger is not negative, such as boredom.

According to The TLC Foundation for Body-Focused Repetitive Behaviors:

“Research indicates that 2%-5% of the population picks their skin to the extent that it causes noticeable tissue damage and marked distress or impairment in daily functioning.”

The TLC Foundation for Body-Focused Repetitive Behaviors- What is Excoriation?

The TLC Foundation for Body-Focused Repetitive Behaviors also maintains that a whopping 75% of people affected with Excoriation are female.

Behaviors such as skin picking often begin during early adolescence (ages 10-13, per healthychildren.org) but also can start occurring at any age.

Is Excoriation the same as Self Harm?

I think that it is important to address that even though both behaviors do have overlapping symptoms, they are absolutely not the same.

Per The Recovery Village’s article Excoriation vs. Self-Harm:

“In a person who self-injures, triggers like intense emotions or numbness are too uncomfortable, so self-harm becomes the solution to the problem. It may seem like the causes of self-harm produce the behavior, but it is a lack of coping skills in the individual that sets the action in motion.”

“One of the main differences between excoriation vs. self-harm is repetition. Someone with excoriation could absentmindedly pick their skin hundreds or thousands of times per day. Self-harm occurs much less often, and there is always a conscious awareness of the action.”

“The level of pain is another contrasting point separating skin-picking disorder from self-harm. In self-injury, the behavior is performed to create a feeling of pain, but in excoriation, pain is not a motivating factor.”

The Recovery Village- Excoriation vs. .Self-Harm

Symptoms of Excoriation include:

  • Reoccurring skin picking resulting in bleeding, scabbing, bruising or lesions
  • Skin picking multiple sites on the body
  • Picking healthy and previously damaged skin tissue
  • Repeatedly attempting to stop the impulses and urges picking at skin
  • Targeting areas to pick at such as blemishes, moles, or imperfections on the skin

Long Term Effects:

  • Infection
  • Scarring
  • Bleeding
  • Open and exposed wounds
  • Disfigurement
  • Self isolation
  • Shame and embarrassment
  • Depression and anxiety
  • Strained relationships
  • Difficulty with everyday life such as work, school, or social activities

Treatment:

  1. Therapy: Habit Reversal Training / Stimulus Control
  2. Some psychiatric medications, such as SSRI’s (selective serotonin reuptake inhibitors)

PLEASE NOTE: Some psychiatric medications are occasionally used to treat skin picking disorder, such as SSRI’s (selective serotonin reuptake inhibitors) are the best-studied class of medicines for skin picking. HOWEVER, NO MEDICATIONS HAVE BEEN FDA APPROVED OR “WELL ESTABLISHED” FOR THIS PURPOSE.

(WebMD-Skin Picking Disorder- Excoriation)

My Personal Experience With Body-Focused Repetitive Behaviors

When I started to notice that I really may have an issue with face picking, I had just started a new, highly stressful, overly oppressive job, after resigning from a job that was also highly stressful and straight up abusive.

I was having trouble with the adjustment, going from a sort of leadership position, back down to the very lowest rank on the totem pole. My potential wasn’t being optimized, my skills were way more advanced than the job I was doing, and extremely bored. Overall, it just wasn’t a good time in my life. It was during this time the obsessive skin picking started.

During the work day I would constantly find reasons to get up out of my seat, walk to the bathroom, lock myself in and obsessively pick at my face. During days my stress and anxiety were high, the more picking I would do. I would pick and dig into my face until it bled, I would wait for the bleeding to stop, wash my face with cool water and dry it off and go back to my desk. No one noticed me there anyway, so I didn’t have to hide my face too much. Day after day, from punching in until punching out, I would constantly pick at my face.

I am also notoriously have been a lip and cheek biter, my lips are constantly ripped up and chapped and the inside of my cheeks are riddled with scar tissue that interfere with my bite plane causing me to bite down on the built-up scar tissue, frequently while eating, and damage the inside of my mouth further.

Some other displays of Body-Focused Repetitive disorders I recall having when I was a child are Trichotillomania related (“hair pulling disorder”) such as hair twirling and twisting really tightly, and chewing on the ends of my hair. I also had Onychophagia (finger nail-biting) pretty badly, and I would also pick and rip off the skin around my cuticles. Luckily I grew out of both by the time I was a teenager, but then I moved my way right on to skin picking, so we won the battle but lost the war with those particular Body-Focused Repetitive disorders.

The picking didn’t stop when I was at home, or anywhere else, to be honest. If I were in a bathroom at a friend’s house, my parent’s house, or even a public restroom, I would look in the mirror for anything I could pick at on my face. The shame and embarrassment that came along with it, I chalked up to the act being embarrassing because it looked like I had horrible adult acne instead of this has spiraled into a straight-up obsessive, chronic issue.

This problem has come and gone throughout my life and for some incredible reason, with the chronic skin picking and having severe cystic acne in my early twenties I have little to no scarring which is pretty unbelievable considering the damage I have caused.

My last bout with a Dermatillomania was about three weeks ago, and I have noticed that the healing process as I have gotten older has significantly slowed down, but I also do tend to pick at scabs as they are starting to heal, so I really don’t know for sure, it could, quite possibly, be a combination of both.

In conclusion, I am very glad to have further researched into this topic, it makes me more self-aware of behaviors and actions I wasn’t even aware that I was doing and why I was doing them.

I hope that this post can help someone struggling with Body-Focused Repetitive Behaviors as well.

If you or someone you know is dealing with Body-Focused Repetitive Behaviors, please check out the following sources:

  1. The TLC Foundation for Body-Focused Repetitive Disorders
  2. Picking ME Foundation
  3. Psychology Today Body-Focused Repetitive Behaviors
  4. WebMD Skin Picking Disorder (Excoriation)
  5. The Recovery Village Excoriation vs. Self Harm

Do you have any type of Body-Focused Repetitive Behaviors? How have you dealt with or overcome them, if so? Leave me a comment with some words of wisdom!

5 thoughts on “Body-Focused Repetitive Behaviors: Skin Picking”

  1. It’s a well-researched article, and by sharing your personnel experience, you have brought more awareness to the matter.

    Thanks for sharing, Amanda. Happy 2022

    1. Thank you so much for reading! I appreciate your feedback! ♥️ I always wondered why I was so obsessed with the “skin picking” and I looked into it and I’m like ohhhh 😯 that’s me 100%!

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