Editor's Note: Dermatillomania is currently classified as a body-focused repetitive behavior or BFRB, but taxonomic discussion continues as to whether it is also usefully described as an OCD-spectrum disorder.
OCD is sometimes described as being part of an obsessive-compulsive spectrum of disorders, an extended family of conditions that may include, among other things, anorexia, bulimia, compulsive gambling, body dysmorphic disorder and Tourette 's syndrome. Two or more of these conditions may or may not be present in any one patient.
One family member you may have heard of is trichotillomania, or compulsive hair-pulling. I don't suffer from that, but I am, unfortunately, on very close terms with its sister, dermatillomania, or compulsive skin-picking, and have been now for more than twenty-five years. I pick my skin, not a bit but a lot, and I can't stop although I truly wish I could.
Like many CSP sufferers, I used to think I was the only one, but of course I'm not. I recently joined an online group which has nearly 600 members, and I asked them what they would like people to understand about CSP. The answers went something like this:
1) We're not crazy. Everyone has that thing they do that they know they shouldn't: this is ours.
Everyone has their habits, and often these are less than healthy: some people eat too much, some drink too much, some spend too much, still others smoke; they know that they should stop, or cut down, but they just can't seem to do it. Many of these behaviours are socially acceptable, up to a point, but that doesn't make them rational.
2) Nobody chooses to have this condition. If we could just stop, we would.
Habits like picking are very hard to break, because, to put it perhaps too simply, they become rewarding on a chemical level. You become addicted to the hormones that your body releases when you pick.
3) Even if you can't see it, that doesn't mean it's not there, or that it isn't a problem.
Some sufferers - me included - have had the experience of disclosing their CSP to a therapist, only to find the problem dismissed, because the skin they display to the therapist really doesn't look that bad. Although it is true that some sufferers do pick to the point where it becomes seriously disfiguring - or, in some cases, even life-threatening, as it can lead to septicaemia - this is not the only measure of the severity of the problem. The therapist should also ask how much time you spend picking, about the impact the picking has on your self-image and self-confidence, and how much these effects have restricted your life. Many sufferers - and yes, this used to be me - spend years avoiding close relationships because they are too ashamed to show anyone what they're hiding under their high necklines and long sleeves. I'd call that a problem.
4) It has nothing to do with how bad your skin is to start with.
CSP can be a complication of acne, but this is not true in every case. Some sufferers start out with what is clearly problem skin; some don't. The picking can be motivated by a desire to make already good skin perfect.
5) Although it is quite normal to pick the odd spot, it is not normal for the picking to take over your life.
CSP is as different from ordinary, everyday spot-picking as alcoholism is from ordinary, moderate social drinking. It blights people's lives; it threatens their health. It's a real problem. Its sufferers deserve proper treatment.