What It's Like Having Excoriation (Skin Picking) Disorder

Here's how I learned to control my skin picking—a condition that I've experienced for over a decade.

I can vividly remember my very first time skin-picking at a school ceremony. I was in first grade, and a select few kids, including me, were all assembled on stage to receive an award from the principal in front of rows of students and parents.

I couldn’t tell you what the award was for (or even the principal’s name), but what I do remember is the unreasonable amount of tension I felt from being in front of so many people. This experience is forever etched in eternity in my family album, wherein a photo shows my irritated, busted lips that I was picking the entire time I was up there.

My Excoriation Disorder Diagnosis

Not long after, I was diagnosed with excoriation disorder, an obsessive-compulsive condition that causes the repeated urge or impulse to pick at my own skin. We all pick at a scab or a bump from time to time, but for those with a skin picking disorder (SPD or dermatillomania), this urge is intensified to the point that it’s nearly impossible to control them.

Whether I’m watching a movie or reading through emails, I'll often fall into a mindless trance doing this and lose track of time—it isn’t unusual for several hours to go by until I finally stop, and only because the area starts to bleed.

This condition is different for everyone. I’ve never really been a nail-biter, but picking and peeling at the dry skin on my lips and face (or anywhere else my hands can touch) has just always felt so good. I become obsessed with each and every blemish, learning its contours and digging into it with a vengeance. I’ve suffered with the ugly habit for most of my life, but it really comes and goes.

Relapse History and Lessons Learned

There will be times when the picking stops completely—with my longest pause being about a year. Being surrounded by people 24/7 definitely helps. But when I eventually relapse, which I always do, it's when I go through high levels of tension, anxiety, or stress. During finals in college, I'd have to develop elaborate rituals (and go through several tubes of concealer) to hide the incriminating marks.

When the quarantine first hit, it definitely felt a bit stressful, but it wasn’t until a couple of weeks into physical distancing that the anxiety really set in. Part of it came from the fear of my family getting sick, and the rest from the lack of control that I had over a problem that was only worsening by the day. As someone who likes (correction: needs) to be in control of my situation at all times, this was a difficult situation to accept.

So I started picking. The sheer boredom of having nothing else to do was definitely a driving factor. But the biggest reason for the repetitive, aggressive action stemmed from the fact that it was an empty distraction from everything going on—peeling away the dead skin felt like I was shedding layers of anxiety.

The compulsion to dig into my skin can best be described as a soothing security blanket of sorts. When I'm not stressed, I can control it; otherwise, I can't. When life gets out of control, this is the one thing I feel like I can manage, so doing it makes me feel just a bit better.

Treatment Options and Self Care

Herein lies the bittersweet irony: the picking itself becomes something that you can’t control. If you suffer from SPD, you already know that it is not a matter of will—trying to stop is like telling someone not to have food allergies or high blood pressure.

However, the good news is that there is therapy, medication, and dermatologic treatments that can help. Although no one treatment will be curative (you will likely go through bouts of remission and recurrence), utilizing the right tactics can help you squash the habit more quickly. Here's how I cope.

Know Your Triggers

First, and most importantly, know your triggers. It could be something external (i.e., acne onset) or something more emotionally driven (like stress and anxiety), but either way, you want to tackle the source.

For me, my picking gets worse when there is dry, dead skin to pick at, so I slather myself in moisturizing creams and thrust my face into a humidifier whenever I feel the tight pores coming on. If your picking is triggered by depression and anxiety too, you should consult with a mental health professional with expertise in skin picking.

Release Shame and Communicate

Although there is a bit of a shameful stigma that comes with SPD (there is nothing to be ashamed of!), tell someone that you trust and spend a lot of time with about the situation. My 7-year-long boyfriend, who lives with me, knows me better than anyone, and he is the best at catching the picking before it spirals.

At that point, I’ll walk away from what I’m doing and distract myself by switching to a more engaging activity. I find that it's a good idea to wear gloves whenever you catch your hands doing the deed—that way, you’re physically incapable of continuing.

Control Your Environment

Therapy can also include stimulus control, which focuses on making shifts in your immediate environment that will soothe your impulse to pick at your skin. "Each time you feel the urge to pick, force yourself to resist for longer durations," says Sanam Hafeez, MD, a neuropsychologist at Columbia University in NYC.

"If you are working, keep a squeezable ball on your desk. Meditation is also an excellent tool. If you have never done it before you can download meditation apps for beginners or go to YouTube. If small steps fail, consult a licensed therapist (even remotely) to talk through the process and help you understand this disorder and how you can conquer it."

The Bottom Line

While these methods help, by no means am I fully out of this—like any addict, I'll always be in recovery mode. Do I still want to touch my skin? Every single day. But the key is in feeling the urge when it approaches, identifying the issue, and being able to put myself in the mental state to walk away. When I feel myself falling into that trance-like state, I ask myself, "Why am I doing this?" This mindfulness is the first step towards recovery.

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