I Live With A Chronic Skin Picking Disorder — Here's What It's Like

by Kimberly Zapata
Originally Published: 

I’ve done “it” for as long as I can remember. When I was a kid, I picked my cuticles. I destroyed my nail beds with both my fingers and teeth. When I was a teenager, I buried my nails deep into my ankle. Wounds would form on the surface of my skin — and beyond — and as I matured, so too did my behaviors. I became better at hiding the picking. The scratching. The soles of my feet carry stories. My lips, forever chapped, will tell you more about my mental health than I ever will. Why? Because I live with dermatillomania, or excoriation disorder: a chronic skin picking disorder which manifests as repetitive, compulsive gouging, scratching, and picking.

Of course, at first glance, you wouldn’t know it. There are no obvious marks or blemishes. My extremities aren’t covered, as they once were, in wounds or scars. But anyone who really knows me knows the truth, whether they realize it or not. I constantly run my fingers over my lips, feeling for breaks and cracks. For bits of skin I can tug on or pull. When I’m at home, I turn my attention to the base of my foot, which is naturally cracked due to poor hydration and circulation, and I pick. For hours. Usually to the point of pain or discomfort. On numerous occasions, I’ve exposed the dermis.

Sometimes, there is blood.

And while I would love to stop, I can’t. The act is instinctive. Habitual. I usually don’t notice the picking until there is pain or blood. Plus, there is an odd comfort in picking. My mental health has been in shambles for the last year, but when I pick, I am fixated. I am focused. It’s like a moment of silence for my noisy, broken brain. I also feel like I am “in control,” though I know the latter is a delusion (or illusion).

Addictions are, by definition, unmanageable.

Dermatillomania is, by definition, a condition which is beyond my control.

“Excoriation disorder (also referred to as chronic skin-picking or dermatillomania) is a mental illness related to obsessive-compulsive disorder,” Mental Health America explains. “It is characterized by repeated picking at one’s own skin… [and] individuals may pick at healthy skin, minor skin irregularities (e.g., pimples or calluses), lesions, or scabs. This disorder is usually chronic,” MHA continues. “With periods of remission alternating with periods of greater symptom intensity.” And that is the case with me.

I’ve been picking — on and off — for more than 20 years.

The severity of my disorder has changed several times. When I was 15, picking led to cutting; I regularly engaged in self-harm. In my 20s, the act was nothing more than a distant memory. I never cut, and rarely dug or scraped my skin — today the behavior is trauma- and anxiety-induced. I pick when I’m worried, bored, or nervous. When I’m scared or lonely. When I’m despondent or sad, and everything from tests and deaths to relationship issues can cause picking. There are more band-aids. More blood. More scars. Hell, this article has caused me to touch my lips hundreds of times over the last few days. My mouth feels like a sheet of notebook paper pulled from a spiral bound sleeve. The edges are frayed. My skin is (beyond) thin.

That said, there is help. There is hope. Dermatillomania, or excoriation disorder, is manageable. Skin picking can be treated with therapy and/or medication. Habit reversal training is also key. “[With habit reversal training,] your therapist will help you find other things to do instead of skin picking, such as squeezing a rubber ball,” WebMD explains. “This will help ease stress and occupy your hands.” Naming the condition can be helpful. I didn’t know dermatillomania was a diagnosable disorder until I was in my 30s, until a (near) lifetime of rubbing, scratching, picking, digging, and gouging. And knowing meant something.

Scratch that: It meant everything.

But that doesn’t mean it is easy. I still pick. I still bleed. And while my husband points out this behavior regularly — he tells me when I’m doing “that thing” again — I still struggle. I’m not going to pretend otherwise. Despite years of therapy and medication, every day is a battle between my will and my mind. But I write about my experience so I won’t feel so alone. I write about my experience so others won’t feel so alone, and so I’m not consumed by silence and shame.

For more information about dermatillomania and/or to find a body-focused repetitive behavioral therapist or support group, visit The TLC Foundation.

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