In this series, we dig into our strange phobias, fixations, and neuroses, and ask ourselves — Is This Normal?
The skin around the nails of my thumbs is quite resilient, undeterred by the onslaught it graciously handles by the rest of its neighbors. It bleeds, but never complains, and always grows back, albeit a little more wary, and coarse.
I have taken pleasure in this excoriation for decades now, much to the chagrin of the people around me. They “tsk, tsk” at the habit, or worse, slap my hand away with the ‘I-know-what’s-good-for-you’ look. One advice to those do-gooders: Don’t. It’s skin-pickingly annoying.
The condition is called dermatillomania, an impulse-control disorder categorized as a “body-focused repetitive behavior,” in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders released by the American Psychiatric Association.
It is characterized by chronic skin picking — of cuticles, acne, scabs, calluses, and even perfectly healthy skin — in the form of biting, scraping, pulling or squeezing skin by using fingers or tools like tweezers. The usual targets are fingers, hands, arms, legs, and the face. For some, it can also be targeted at hair or the scalp.
It affects 2 to 5 percent of the population, according to the TLC Foundation for Body-Focused Repetitive Behaviors (BFRB); of these people, 75 percent are women.
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The skin-picking behavior often begins at puberty, which is also the time when people suffer from frequent dermatological problems. It can arise out of stress, frustration or anxiety, or even out of boredom, according to Psychology Today. The report adds that the possibility of censure from people around can lead to “anxiety, depression, shame, fear of exposure, and embarrassment,” which in turn prompts efforts to conceal the damaged skin somehow — with makeup or by other means.
While my excoriation disorder is mainly contained to my fingers and doesn’t seem to have done permanent damage, dermatillomania has been known to cause lesions, scars, infections, discoloration of skin, and severe damage to skin tissues, according to the TLC Foundation for BFRB.
While the DSM-5 chalks up repetitive chronic skin picking to an Obsessive Compulsive-related behavior, other researchers have made arguments for it being akin to a substance abuse disorder. Skin picking is usually a pleasurable experience, and is not controlled by obsessive thoughts, two characteristics that don’t fit the OCD description, according to Brian Odlaug and Jon E Grant’s research published in The American Journal of Drug and Alcohol Abuse.
They classify skin picking as an addiction, in the sense that people feel compelled to engage in the behavior, even though it’s harmful and often tangibly painful. Feelings of pleasure, strong urges, and a lack of willpower all point to similarities with substance abuse disorders, Odlaug and Grant argue. Furthermore, they found treatments that are usually employed to treat OCD patients — such as antidepressants or exposure therapy (wherein the patient is asked to confront the source of their anxiety) — usually don’t work for those with dermatillomania.
Ultimately, it’s a pretty diverse disorder with multiple possible causes, and can be categorized under substance abuse or OCD, depending on the individual, the researchers concluded.
Fewer than every one in five people seek treatment for dermatillomania, Psychology Today reports. Different approaches for psychotherapy have been found to be minorly successful in treating the disorder. For severe infections resulting from open wounds, however, antibiotics, or even surgery, can be required.
To be honest, I think this is making a mountain out of a molehill. Speaking from the immensely privileged vantage point of almost-passable looking thumbs, I think it’s okay if we dermatillomaniacs are left to our own (scraping) devices. Look away if you hear picking sounds, or see blood. It’s time everybody else grew a thick skin, too.
