Dermatillomania: the impact of skin picking
Date: Mar 2017
Mental health, despite its commonality, is still a topic many find difficult to talk about. Manifesting in various forms, mental health issues can often be isolating and misunderstood. Compulsive Skin Picking, otherwise known as Dermatillomania, is characterised by the repetitive picking of the skin to an extent where damage is caused. It is often categorised as an impulse control disorder under the Obsessive Compulsive Disorder (OCD) Spectrum as the skin picking is often repetitive, ritualistic and tension reducing. It can also be linked to Body Dysmorphic Disorder (BDD) as some suffers will feel that picking at acne or what they see as skin abnormalities (such as moles or freckles) will make them look more ‘normal’. The picking can create pronounced abnormalities that lead to a vicious cycle. It is a condition which affects as many as one in 20 people, however it remains relatively unknown in relation to other skin conditions. The physical and mental impact of compulsive skin picking can truly affect a person’s quality of life.
Liz Atkin, 40, a visual artist living in south London has been living with compulsive skin picking (CSP) since the age of 7. As a way of coping with the urge of skin picking, she has been making artwork for the last decade, but most recently has taken to sketching while travelling on trains. talkhealth recently spoke with Liz to find out a bit more about her and her artistic way of coping with CSP.
Speaking openly and honestly about the condition which has dominated so much of her life, Liz gave us an insight into the perceptions of compulsive skin picking, “CSP is a chronic disorder that gets very little press - it’s not just a case of picking the odd few spots that can pop up on your face from time to time. The disorder can dominate whole parts of the body with wounds and scars. I'd pick my face, my back, my arms, my feet. The behaviour can be conscious and unconscious so sometimes I'd feel a real urge to pick, at other times my hands would be busy picking without me realising it. Those living with CSP can often feel embarrassed or ashamed of themselves, with many who don’t understand it or aren’t aware of it commonly mistaking the condition as a ‘bad habit’ that needs to be supressed. It’s a condition that tends to be hidden by those who have it, myself included, out of fear of being judged. I'd cover up my arms with long sleeves; conceal scabs on my face with makeup. This can lead to feelings of isolation and stress, which in turn triggers yet more urges to skin pick, a never ending cycle.”
She went on to discuss her earliest experiences of skin picking, “I was very aware of my skin picking from an early age, other members of my family also pick at their skin. It's now thought there are hereditary links in the disorder. The lies and hiding started very early on. A parent at school noticed some wounds on my arms and asked how I had got them. Rather than telling them that they had been caused by my skin picking, I lied and said they were due to chicken pox. Concealing this behaviour continued throughout my childhood into adult life."
"The condition dominated my life; the illness was always in control. For many years I had to avoid certain social situations, wear clothes to conceal the marks, all due to this condition which dominated not just my waking life but my sleep too. Very often I'd wake up to blood on my sheets, evidence of the skin picking activity that had gone on while I was asleep. It was very hard to control the urges.
"About 12 years ago I Googled 'Skin Picking' and finally found information on the disorder. By then I was struggling with the severity of my condition, and the constant the urge to pick. This coincides with me studying dance at university, my lecturer advised us all to record ourselves and how our bodies moved. After recording myself for a few hours and watching it back, I was horrified I lasted only fractions of a second before the picking started, and it happened again and again throughout the video. Seeing it from an outsider's perspective made me realise how much time this condition had stolen from me. I remembered endless occasions where I'd end up in the mirror, either getting changed to go to work or while getting ready to go to bed, and 4 or 5 hours would pass while I zoned out picking and picking before suddenly realising I was either late for work or it was the early hours of the morning. It was at that point that I decided to take back control of my body."
Through video, photography and art Liz slowly began to transform her skin picking.
It was the art in particular that offered a great deal of catharsis, and ultimately resulted in her gaining control of the condition. Her #Compulsivecharcoal ‘graffiti’ - 1 minute drawings, which she produces daily while commuting, have acted as a kind of therapy on the go, keeping her hands busy and replacing the urge to pick, “Art has helped me take back control. It's hard to explain Skin Picking to others. But art can do it without words. My recent drawings channel the energy of the disorder. The repetitive scratching of the charcoal against the paper is another kind of mark making. I have given away close to 10,000 free drawings in the last year... a tool to help me, advocacy for mental health, and acts of kindness wherever I am.
Although the condition is and always will stay with me, this system of drawing helps me a great deal. Finding something to occupy my hands and slow my mind down has been an amazing tool to help me control my Skin Picking urges; everyone has to work out their own process.”
In recent years Liz has become an advocate for raising awareness for CSP, speaking at workshops all over the world and connecting to the community of those living with the condition through social media. Most recently she took her free drawings to Singapore.
Although there is currently no cure for this condition, many find medication; Habit Reversal Therapy and Cognitive Behavioural Therapy can be effective treatments. Support is crucial, especially when experiencing feelings of helplessness and isolation, “I didn’t find support until later on in life. But there is a community there for you. Get in touch with your GP to be referred for CBT therapy. You can speak with the TLC Foundation in USA who specialise in supporting those with compulsive skin picking and hair pulling disorders, as well as numerous support groups that you can find online. There are so many people going through the same experiences, you are not alone.”
If you are living with CSP and would like to find out where you can get support and advice, please visit Anxiety UK and OCD Action. To find out more about Liz Atkin and the work she is doing around skin picking, please visit her website. If you would like to share your story with CSP, please do email us at email@example.com, we would love to hear from you.
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Last revised: 10th March 2017
Next review: 10th March 2020