It’s normal to have scars on your body. Everyone has at least a scar or two. Some scars are from memorable injuries, but other times we might not remember how we got it. Most of the time people don’t even notice or care about scars. But when you have a lot of scars, people tend to notice and remark on them. This is especially true when you have clusters of scars, such as with dermatillomania.
Dermatillomania, also known as excoriation disorder and skin picking disorder, is a mental illness that causes an individual to pick their skin to regulate their emotions. Picking at one’s skin is a normal self grooming behaviour, however, it becomes a problem when the picking becomes excessive, causing scarring, life disruption, and persists despite several attempts to stop. Skin picking disorder is classified as a Body Focused Repetitive Behaviour (BFRB) and is an OCD-related disorder. BFRB includes lip biting, nail biting, hair pulling, skin picking, and other such behaviours which are disorders when done excessively.
I have lived with dermatillomania since I was 8 years old. Prior to that, I used to bite my nails excessively but was able to successfully stop. However, my emotions were still very dysregulated and I think that inability to regulate my emotions caused me to subconsciously turn to skin picking as a way to soothe my intense anxiety. Oftentimes, I don’t even realise I am picking my skin and only realise if I draw blood and make a mess, or if I have someone point out my behaviour. Other times, I see a bump or spot on my skin and feel compelled to remove the blemish. I feel unresolved and tense until I pick at that area, after which I feel immediate relief. Each time I pick my skin, I feel relief. I don’t pick my skin with the intention of feeling relief, but I don’t deny feeling less tense after picking. This relief, however, is very short lived. Immediately following the relief comes longer lasting waves of shame. Shame that I do this to myself. Shame that I can’t seem to stop. Shame that my entire body is riddled with deformed scars that will never go away. Shame when I have to clean up the blood I drew from my own skin.
I’ve tried to stop several times and I’ve failed each time. My anxiety feels out of control when I refrain from picking. I’ve tried using fidget toys to keep my hands occupied but I always find a way back to my skin. I’ve tried keeping my nails short but I always find them picking still. I’ve also tried Cognitive Behavioural Therapy and that didn’t help much for this, although it helped my anxiety more generally. It is during the times I’ve tried to stop that I’ve realised I’m not always entirely aware of when I’m picking my skin. I go into a sort of trance where I’m present enough to know what’s going on around me but not present enough to engage with it. This is why I’ve noticed most of my picking happens when I’m reading or watching TV, because I’m paying enough attention to my surroundings, but am also in a relaxed state where my mind feels that it can cope with the emotions I’ve been feeling all day.
No one in my life really understands dermatillomania. Loved ones just tell me to stop picking, but if it was that easy I would’ve stopped already. I used to feel so ashamed of my scars and I still do sometimes, especially when others point out my scars. I used to constantly cover up the scars on my chest and back. Summer has always been a difficult season for me because wearing typical summer attire, like shorts, t-shirts, tanktops, dresses, and swimsuits would reveal my scars and open space and conversation where I was shamed and ridiculed for the appearance of my skin.
When I had finally started accepting that the scars are a part of me and who I am and stopped covering them, I was told to continue covering them. The scars and my skin picking didn’t make sense to others and made them uncomfortable, so I was asked by multiple people to cover up. They never said it was because of my scars and picking, but they would gesture to it vaguely, as if even mentioning it was shameful. When I didn’t feel shame over my scars, I was told that I should feel shame—that this thing out of my control is shameful and should be hidden.When my self esteem is lower, I find myself covering up my scars again and I’ve noticed people are always nicer to me when they don’t see my scars.
On days when my self esteem is better, I don’t hide my scars because I shouldn’t have to cater to the comfort of those who don’t care about my lived experience with this condition and how difficult it is for me to live with.
Even as a disability and mental health advocate, I felt uncomfortable talking about dermatillomania. I have been advocating for a couple years now and have only just gathered the courage to talk about it more recently. There’s a lot of internal and external shame that dermatillomania brings on and that can make it difficult to talk about. Additionally, it makes people uncomfortable and they don’t want to have to see the scars, let alone talk about why they are there.
I hope people become more aware of this condition and how it affects people. One in twenty people are affected by a BFRB condition, but it’s not well known. Although I still struggle, I’m learning not to blame myself for my scars and picking and that if someone really cares for me, something like the appearance of my skin won’t change that.