Obsessive-Compulsive Disorder and Dermatillomania: It’s More Than Skin Deep

We’ve all been there: as you’re getting out of the shower, ready for work, or preparing to go out with friends, you glance in the mirror and see something no one wants to see. Right there, in the middle of your chin–a red, inflamed bump.

Acne. Pimples. Whiteheads. Blackheads. Zits. Whatever you choose to call them when they appear, they aren’t pretty–and can sometimes be really painful. It’s completely natural to want to squeeze out whatever might be lying under the surface of your skin, and a more common impulse than most even realize, even for those who only get one here and there.

Unfortunately, there is a certain aesthetic pressure that comes along with not only being human, but also being under the umbrella of a society that values physical beauty to a high degree. We are shown and told that perfection is our aim, flawlessness is success, and those attributes that make us unique are things to be loathed. For those who are already prone to or suffering from conditions like anxiety or OCD, the worry over being perfect can be overwhelming. Unbearable at times. Each pimple, flake, or spot feels like a broadcast to the world: I am flawed. I am unworthy. I am ugly.

For those with existing anxiety and OCD, picking then becomes a way to momentarily ignore and hide these damaging thoughts. If I can just get rid of my flaws, I’ll be accepted and loved. The problem is that these feelings don’t go away–and they get worse with every additional pimple, spot, or scab that appears. As the habit grows, acne and skin problems get worse as bacteria spreads–and the cycle is only perpetuated, turning into a nearly unstoppable compulsion called dermatillomania.[1. http://www.skinpick.com/dermatillomania]

Below the Surface


Dermatillomania is a skin picking disorder that affects nearly 1 in 20 people–and is not confined to demographics that usually have skin problems, like teenagers and those with hormonal imbalances. While these factors certainly may contribute to severe picking because of existing skin conditions, dermatillomania is much more closely related to obsessive-compulsive disorder, and is considered on the spectrum when diagnosing OCD.[2. https://iocdf.org/wp-content/uploads/2014/10/Skin-Picking-Disorder-Fact-Sheet.pdf]

Obsessive-compulsive disorder is characterized primarily by the urge or drive to repeat the same behaviors over and over again, usually in response to underlying and recurrent thoughts, feelings, or events that cause anxiety and stress. Sufferers use these compulsions to cope with those negative emotions as it focuses their attention acutely to one, usually harmless, action.

In the case of a skin picking disorder, the action is far from harmless. No matter what the root emotion, thought, or event is that drives the afflicted to pick, it can lead to extreme tissue and nerve damage, open wounds prone to even more bacteria and infections, and lifelong scars–both physically and emotionally. The shame and guilt in this battle is not only felt internally, but is externally visible: scarring, healing blemishes, and other excoriation marks–along with that same shame and guilt–contribute to the onset of other co-occurring disorders like depression, anxiety, and even substance abuse.

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My Silent Skin-Picking Battle


In high school, my skin was perfect. Well, not perfect, but an occasional pimple or flaw here and there didn’t bother me much. It was only in my last year of college that I began to develop deep, painful, cystic acne out of nowhere–and only recently have I realized that my already stressed, compulsive, anxiety-ridden mind was afraid of leaving my friends and entering “the real world.” Because I had never experienced this as a teenager, it was new and extremely embarrassing for me as a young adult to show my blemish-filled face socially without covering each and every red mark.

Though my flare-ups waxed and waned from time to time, the picking, and compulsion to do so, remained constant. I would spend several hours a day fretting and obsessing over my skin, looking for any sign of imperfection that I could attempt to eliminate. My racing mind and confusion over how to handle everything around me was stilled by picking, peeling, popping, scratching, squeezing–you name it. The way I treated my skin was the way I felt about myself, and my skin was never able to fully heal; my reflection became one of the major reasons for my worsening depression, anxiety, and acute stress. I canceled plans, I lost friends, I picked fights, I missed work. All losses were nothing compared to the shame and guilt I would experience when out in public, assuming all eyes were on me and my flaws.

After years of hiding from myself and the world, I knew it was time to get help: my constant hands-on approach led to a severe staph infection after my immune system had been compromised for so long. I recognized that my excoriation disorder had less to do with the way I looked or a spread of pimples, and everything to do with my underlying mental conditions. It was time for help, and I was ready. I found a compassionate therapist specializing in self-love, sought out a dermatologist, and practiced yoga and meditation as often as possible. While I still break out with the occasional pimple, dry skin patch, or trouble spot, I now know that the face of beauty I show to the world is much more than skin deep.

Hands-On, Hands-Off Approach to Health


Finding support systems as you go through treatment and work on self-love can be uncomfortable and scary; vulnerability in the way of better health is necessary in order to learn from others and realize that you are not alone.[3. http://www.skinpickingsupport.com/2013/01/09/12-dermatillomania-myths-dispelled/] Having a conversation with a trusted friend is one way to begin opening up and preparing yourself for the journey ahead.

While it may feel vain to seek help for a physically and mentally scarring disorder, that is simply not the case. Because dermatillomania goes hand in hand with other co-occurring disorders, it is important to recognize that the underlying mental health conditions must be treated in order to effectively treat the symptoms of skin picking. Individualized programs like art therapy, music therapy, and even yoga therapy can be used to meet your needs; finding treatment for co-occurring disorders at a quality center like Bridges to Recovery is a healthy first step for not just your skin, but your mind, body, and spirit.

Bridges to Recovery specializes in individualized treatment for a wide range of mental health disorders, including co-occurring disorders like dermatillomania. If you or a loved one is ready to begin the path to recovery, please reach out to us today.