I Have a Skin Picking Disorder

woman with her face in her hands in shame

Most mental illnesses are invisible, but sometimes you can see evidence of mine. I have a skin picking disorder, known as Dermatillomania, or skin picking. Dermatillomania is from Greek: “derma”- skin; “till”- pull; and “mania”- madness.

I want to share my experiences of living with mental illness.

I am compelled to take the risk of sharing this, exposing myself to judgment and rejection, because I believe in the research by Brené Brown, as discussed in her famous TED Talk, The Power of Vulnerability. She researches shame and vulnerability, and so much of what I write about as it relates to my own life is rooted in those two exquisitely hard human experiences. Brown says,

…to let ourselves be seen, deeply seen, vulnerably seen… to love with our whole hearts, even though there’s no guarantee—to practice gratitude and joy in those moments of terror, when we’re wondering, ‘Can I love you this much? Can I believe in this passionately? Can I be this fierce about this?’ instead of catastrophizing what might happen, to say, ‘I’m just so grateful, because to feel this vulnerable means I’m alive.’

Also known as Excoriation disorder, Dermatillomania is an illness on the spectrum of Obsessive Compulsive Disorder. It is not the same as OCD, but it is related in the sense that the individual cannot stop themselves from the compulsion to pick their skin, to the point of damage to the skin and disruption to their life. 

There are many reasons for my skin picking, but I talk about it for one: practicing vulnerability lets me live wholeheartedly, out in the open. 

My preoccupation with my skin began when I was a kid, but it started with scratching my legs. They genuinely itched, but at a certain point, my scratching was perceived as pathological. I scratched my legs all night, even in my sleep, awaking to streaks of blood on my bed sheets. My shins would be raw pink and red, with scabs in various stages of healing. I also scratched my butt cheeks. I remember one time when I was about seven years old, my stepmother helped me dry off from my shower. She saw my backside and called to my dad with a sound of alarm in her voice.

“Get in here now,” she yelled.

He came rushing in, and she turned me around, tugging the towel down to expose my buttocks. He bent over to look, both eye level with my butt. I shivered and covered my front with the towel. That is the moment when shame first accompanied my skin picking.

My pediatrician placed a rubber band around my wrist and told me to snap it anytime I felt the compulsion to scratch. This technique is a form of self-administered aversion therapy. The idea being that unwanted behavior becomes associated with the painful snap of the rubber band.

girl lying in the grass

This probably begs the question: Why? Why was I scratching myself like this? Why would someone do something to themselves that caused harm, or embarrassment? There are many scientific and psychological theories. 

My oversimplified answer? It feels good.

It is important to distinguish skin picking from cutting, or non-suicidal self-injury (NSSI). NSSI is a purposeful decision to hurt oneself. And while picking skin does result in injury, it is due to an impulsive urge to pick. I also cut my skin when I was a teenager, but that is a story for another time.

Scratching turned to picking my skin sometime in my late twenties. I recall a girlfriend pointing it out to me, saying it bothered her. I also (still) hear my mother’s harsh voice, yelling:

“Stop picking!”

She has never understood.

My skin picking usually happens in private, but sometimes I let my guard down around people with whom I feel safe and comfortable, or—as is more often the case, I disassociate and don’t realize I’m doing it.

There are times when I have picked at the skin on my arm for literal hours and not realized it until my nails have blood under them and my arms are swollen and pockmarked, looking like I have a terrible case of chickenpox. 

I believe the reason it feels good to me is because it relieves tension and stress. I get a dopamine hit from it. It is a self-soothing activity.

Like skin picking, which I mostly keep hidden, I keep my depression and anxiety symptoms under wraps in public. This means I generally present myself as a well-adjusted, healthy, competent person. At the very least, I come across as someone with “high functioning” depression and anxiety. An article published by The Washington Post, posits this:

“…using the term ‘high functioning’ might be incorrectly interpreted as a less serious form of depression…using ‘high functioning’ as a descriptor can be misleading because it doesn’t take into account the effort it takes to function.”

I would add that the term “high functioning” does not consider the cost of functioning.

I made the scary decision to accompany this post with a picture of my arm, which is where much of my picking is concentrated. When you look at that image, you will see two things: anxiety, and a visual representation of the toll it takes for me to survive as a sensitive person in this world. 

I choose to show this picture to take the power away from the shame.

I spend a lot of my time covering up my arms. Summer is hard. I often wear long sleeve shirts, despite feeling overheated, because I cannot stand the stares. Most people do not say anything, but there have been comments over the years. Sometimes, I worry people will think I have a substance use disorder, specifically meth, as it is often associated with scabs and lesions from picking at one’s skin. Sometimes I worry people will think I have some kind of contagious disease.

I choose to show this picture to normalize mental illness and skin picking.

I choose to show this picture to let other people who have embarrassing conditions know that they are not alone.

I choose to show this picture because I am following Brené Brown’s lead on vulnerability.

an example of the wounds caused by skin picking disorder- the arm is pale with some darker pink areas of irritation.

“Vulnerability is based on mutuality and requires boundaries and trust. It’s not oversharing, it’s not purging, it’s not indiscriminate disclosure, and it’s not celebrity-style social media information dumps. Vulnerability is about sharing our feelings and experiences with people who have earned the right to hear them. Being vulnerable and open is a mutual and an integral part of the trust-building process.”

The etymology of the word vulnerable is derived from the Latin noun vulnus (“wound”), leading to the verb vulnerare, meaning “to wound.”

I have wounds on my arms. It is evidence of a private, invisible pain made visible. I wear my heart on my sleeve.

Brown found that in her research on people who demonstrated vulnerability in their lives, they had one thing in common: courage. Courage is from the Latin word “cor,” meaning heart. 

Brown says that the definition of courage is to tell the story of who you are with your whole heart.

I find that courage and vulnerability are often expressed in the context of intimate relationships.

True, authentic connection requires vulnerability. I was especially vulnerable when I started dating someone for the first time after a terrible separation from my child’s father. I hadn’t dated in four years, and I had never dated with the new identity of being a mom. But there was something about the dynamic of this relationship—an imbalance of power, that made me anxious. My new partner tended to be controlling and judgmental. Nonetheless, for whatever reason, I was enamored with her.

One day, while sitting in a restaurant, about to put a few fries in my mouth, my partner curled her lip and said,

“You’ve been picking at your arms. That’s not attractive, you know.”

I completely lost my appetite, put down the fries, and covered myself with my cardigan. It took all I had not to cry.

That same partner and I took a vacation in Cape Cod. On a windy, cool day, I took a picture of her walking over sand dunes, facing the ocean. She remarked on how nice the photograph came out. While she saw herself walking toward the water, all I could see was her walking away from me. I felt her slipping from me, the way a fistful of dry sand won’t stay in your grasp, sliding through your fingers. Our relationship felt like an hourglass with no bottom: when the sand is gone, it is over. There is no flipping it to start time again; when the sand runs out, so does the love.

Sand dunes

We open ourselves up to love at the risk of being rejected. I contend it is still worth it. Vulnus. Vulnerare. Let me show you where it hurts.

I also felt vulnerable the first time I showered after giving birth. I was a single body again, instead of two. My uterus, still large but empty, was just starting to shrink. There was dried blood between my legs. Warm water never felt so lovely. The old and fresh blood pooled between my feet. I felt like I was a newborn taking my very first bath, and I washed myself as such. I was gentle with my bruised body, holding myself the way I would any fragile, holy, newly born life.

As parents, we open ourselves up to so many great risks. I opened my body wide enough for a midwife to reach in, and for a baby to come out; enough for love to come in, and life to come out. Vulnerability goes both ways, in either direction. It is a door that revolves: an entrance, an exit, an entrance…

Now, I open myself up on paper, online. I am showing you where I have been wounded, where I hurt. Vulnus. Vulnerare.

I just moved into a new home—a brand new building carved into fresh earth. It is too new yet to settle in, but I have slept in plenty of old houses that creak when they settle into their foundation. I feel vulnerable with this big move, especially as the sun sets and I am alone. It feels like sand slipping from a fist; blood sliding down a leg; fear settling into my bones.

It is on these nights I try to remember Brown’s words:

“Yes, I am imperfect and vulnerable and sometimes afraid, but that doesn’t change the truth that I am also brave and worthy of love and belonging.”

Beautiful woman with short hair, smiling

Meanwhile, I let the tender parts of me take a reprieve. My skin heals itself all on its own. I’d like to think the heart does, too. When I sleep, my body does the work of resilience and self-love. Even when I can’t love myself, my body repairs what keeps breaking.

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I Have a Skin Picking Disorder

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