What is dermatillomania and why obsessive attention to one’s own skin can become uncontrollable

What is dermatillomania and how does it manifest?

Experts call dermatillomania obsessive behavior aimed at the skin: scratching wounds, squeezing out inflammations, combing uneven skin, picking off hangnails, biting the lips and cheeks from the inside.

There are actually many more such examples - they all belong to a large group of body-focused repetitive behavior disorders (BFRB - body-focused repetitive behavior). Along with dermatillomania, it also includes trichotillomania (uncontrolled hair pulling), onychophagia (obsessive biting of nails and cuticles), rhinotillexomania (the need to pick the nose and damage its mucous membrane).

With dermatillomania, open areas of the body most often suffer, or rather, those to which there is direct access - the face, head, hands. But it also happens that a person injures his back, chest, and the front of his legs.

Etiology

This psychological deviation may be due to personality problems. We can say that the main reason is a person’s behavioral disorder.

Seeing the appearance of acne on the skin, a person susceptible to such disorders may experience a symptom of psychosomatics. A person becomes nervous and irritable, all his thoughts are only about this “defect”, he constantly and uncontrollably scratches the skin there. But the face is not the only part of the body where such scars can appear. People injure themselves in the scalp, neck, shoulders, back, arms and legs.

Dermatillomania and perfectionism

The fact that people most often focus on exposed areas of the body has led researchers to believe that dermatillomania is triggered by the desire to achieve an ideal appearance (for example, to eliminate a certain “flaw”). As a result, comprehensive skin care can take on inadequate forms over time.

Ira Polevaya blogs about dermatillomania on Instagram. She has lived with the disorder for eight years and associates its appearance in adolescence with the attitudes of “ideality” that were broadcast by fashion glossy:

“When I was 10 years old, I started collecting women’s teen magazines, where all the models are presented with perfect retouched skin. So a strange attitude arose in my head: “I must have perfect skin, otherwise there is no other way.” To me, it felt like a vital commitment, like knowing how to breathe.

But at the age of 12, as luck would have it, I started getting small rashes on my face, and it knocked me off my feet. I decided to get rid of these “imperfections” on my own: I crushed them and pierced them. At the same time, I tried to treat my skin the normal way, but the sight of an unpopped pimple forced me to resort to the old “bloody methods.” This dragged on for 8 years. At 17, an exacerbation began: I picked my cheek very badly, a large pink spot remained, and I began to fear that it would always be like this. This means that I will never be able to get closer to a non-existent ideal.”

Other girls also agree with the idea that beauty culture, Instagram fetishes, lookism and other stereotypes around appearance can influence the development of dermatillomania in adolescents:

“Photoshopped photos can create the erroneous impression that everyone around you has perfect skin without flaws,” says Yulia.

But the idealized image of skin in popular culture is just the tip of the iceberg. Researchers believe that the causes of dermatillomania lie deeper and have an individual background: the special biological sensitivity of the nervous system and anxiety that arises in childhood.

Dermatillomania and anxiety

The American Psychiatric Association considers dermatillomania within the framework of obsessive-compulsive disorder (OCD). The term “neurotic excoriation” is used, that is, uncontrolled scratching.

The consciousness of a person with OCD is guided by a closed chain “restless thought - anxious expectation - fear - habitual ritual - relief”:

1. The thought of imperfection fuels a chronic anxiety background, in which it is unbearable to constantly exist.
2. A person again and again resorts to a familiar ritual, because he sees this as the only way to at least temporarily get rid of painful anxiety.
3. And the usual ritual here is bodily obsession: only after exposure to the skin does the stage of temporary relief and internal satisfaction begin.
4. Then discomfort inevitably increases again, dissatisfaction with the condition of the skin arises - the chain closes and everything happens again.

Manipulations lead to the desired relaxation, but not for long: anxiety subsides only for a while, and feelings of guilt and shame for one’s own “weakness” and loss of control are overwhelming.

“When you pick, you forget. Afterwards the relief will not last long. And when you look at the spotty face afterwards, you ask, “Why again?” After all, you could just not pick,” and it became sad to look at yourself in the mirror” (Ilona, ​​24 years old).

The girl says that she often gets hung up on negative thoughts:

“Usually this happens if I’m driven for some reason. Or after a quarrel with someone, I may feel somewhat inferior. On nerves, so to speak."

Ulyana Kardashevskaya (18 years old) also associates dermatillomania with increased anxiety:

“For me, this usually happens after a difficult day or, conversely, before some important event. You walk up to the mirror, think you’ll just look, and don’t notice how your fingers have already noticed an unevenness on the skin. I think a difficult relationship with my mother, my low self-esteem and high anxiety played a role here.”

Symptoms

Psychology is the basis of this disease, so symptoms that accurately indicate the development of pathology may not be visible. This is not a physical pathology that is accompanied by a certain set of symptoms.

Doctors identify some main symptoms:

• a person rejoices if new skin defects appear, for example, acne, abrasions;
• a person gets pleasure, joy and release when he deforms his own skin;
• after squeezing out, joy is immediately replaced by disappointment - in order to re-experience the same feelings, the tearing of the same area continues;
• the desire to self-inflict skin mutilation spontaneously - a person can do this at any time, anywhere, even with dirty hands;
• when looking at himself in the mirror, the patient sees only acne, and not the general image;
• The beginning of the development of a deviation is always facilitated by a person’s negative psychological state.

Symptoms manifest differently in each person. This pathology cannot be self-medicated, because a person cannot independently refuse to squeeze pimples and pick the skin. This is a psychological condition that only a psychologist can help you get rid of.

Dermatillomania as a way to survive violence

Nastya Simbirskaya also writes a blog about dermatillomania, in which she openly talks about the disorder. Its first manifestations occurred at the age of 6 years. According to the girl, in 20 years of living with dermatillomania, there was not a day when she did not touch her skin.

“This happened after my stepfather beat me for the first time. From that moment on, the punishments were regular; I could only distract myself by picking at my skin. And I began to understand that this was already a disease almost 20 years later. I thought I was the only one who was crazy.”

Psychoanalysts talk most about the relationship between skin diseases and traumatic memories from childhood.

According to their observations, the psyche of an adult is capable of regressing - returning to early childhood in order to act out the trauma that occurred not through the child’s fault, but which is still preserved in his unconscious.

And the younger the child, the more physical or emotional abuse will be imprinted on him. The psyche will not record actual memories, but bodily sensations and marks on the skin will remain for life.

“Since for me it is associated with domestic violence and with all the accompanying feelings during the 12 years that I was beaten, now I feel dermatillomania as a way to get rid of obsessive thoughts, emotional swings, fears, stress and suffering. The brain knows no other way to deal with these problems. It’s more convenient for him to cause himself physical pain than to experience psychological pain,” Nastya shares.

Causes

Skin manipulation often helps a person suppress their own negative emotions. It's about anger, rage, disappointment. Complexes such as guilt, shame, and self-abasement can lead to the development of the disease. Other causes of dermatillomania:

• anxiety disorder;
• clinical depression.

In this case, the disease is one of the symptoms of mental disorders. Perceptible intense and acute stress conditions that last for a long time can also provoke the development of a disorder when a person constantly scratches the skin.

Nervous disorders alone cannot cause dermatillomania. Most often it begins after skin diseases or accompanies cosmetic problems.

A person sees a skin defect in the mirror and assumes that a pimple or acne may indicate the onset of serious diseases, so he begins to scratch the skin, since rashes and inflammations make him nervous and irritated. The degrees of the disease vary. Someone begins to uncontrollably squeeze out acne, and someone scratches a small injury, for example, an insect bite, on the scalp, believing that the consequences are invisible to others.

Dermatillomania and the need to hurt oneself

Because dermatillomania affects the skin, the disorder is often associated with self-harm and the desire to intentionally hurt oneself. But in fact, the mechanisms of these two conditions are different.

Unlike self-harm, when a person intentionally causes physical pain to himself (for example, to cope with unbearable mental pain), dermatillomania cannot be controlled by the notorious “willpower.”

A person can cause harm to his own skin in a dream or, in the process, plunge into a kind of hypnotic trance and only then see with horror the result of his actions.

Elina Plance (20 years old) began to resort to self-harm after severe stress and quarrels in the family:

“I didn’t think about what was happening then. Now I understand that it was a cry for help due to broken communication with my parents. Alas, an unheard cry. This process distracted from feelings. I switched my attention from internal pain to external pain. This made me feel better. And from the feeling of punishment too.”

According to her, this happens consciously:

“It seems to me that I can even control it, but I don’t want to. In case of a breakdown, I emotionally go wildly destructive and do not want to save myself or feel sorry for myself. Well, emotion is followed by auto-aggressive behavior.”

Diagnostics

It should be noted that not every person who squeezes pimples is mentally ill. Dermatillomania can also be a separate pathology.

By seeking help from a specialist at the first stage of the disease, there is a chance to get rid of the problem in a short time. But this does not mean that any itching of the skin is already dermatillomania. In some cases, this is a simple manifestation of an allergy.

To accurately diagnose the disease, you should consult several doctors, for example:

• therapist;
• dermatologist;
• psychologist;
• psychiatrist.

After conducting the necessary examinations, doctors will make a general diagnosis.

Dermatillomania and fear of judgment

An important diagnostic criterion for dermatillomania is preoccupation with causing damage. A person experiences a mixture of negative feelings towards himself (pity, shame, disgust, disappointment) due to the fact that he has lost control. Promises that this was the last time, that this will not happen again, are often not fulfilled - and the person is ashamed of his weakness, considers himself weak-willed.

As Nastya talks about it:

“Yes, at first the process is satisfying. But as soon as your consciousness returns and you see the result of your actions, a feeling of self-loathing, pity, powerlessness, apathy not only towards yourself, but also towards everything around you arises, aggression.”

Traces of dermatillomania - wounds and scars - provoke avoidance behavior and increase feelings of shame. A person in this state may withdraw, avoid public places, and experience difficulties in his personal life, work and friendships.

“With my brain, I understand that these [inflammations and traces of them] are trifles and people don’t care at all. They saw and forgot. But my sense of comfort does not allow me to take this calmly. I feel complex, I can’t leave the house without makeup,” Nastya shares.

“I know that they DO NOT CARE about my skin, but I still get stressed and feel awkward if a stranger is close and can easily see all my “imperfections,” says Ira Polevaya.

Dermatillomania and stigma

People with dermatillomania tend to deny the disorder to the last minute and attribute bodily obsession to a bad habit.

Advertising with photoshopped skin, taboo topics in the media, presenting information in such a way that it appears as if the person himself and his insufficient efforts to care for himself are to blame for imperfect skin - all this only pushes people to compulsively seek out and eradicate their “shortcomings.”

Elina Planze:

“Standards are a very narrow framework that not everyone fits into. Hence a lot of complexes, dislike and self-hatred. If a person is prone to this kind of behavior, all of the above can seriously undermine him. And in order to find relief, a person may resort to self-harm.”

Having imperfect skin is supposedly “unacceptable” from the point of view of beauty standards. Difference and dissimilarity from the person on the cover/screen/banner are unconsciously perceived as rejection in the social environment. You are different = you are a stranger. This can cause a lot of anxiety.

“I believe that the media should show different faces and bodies more often so that people do not strive for a non-existent ideal. When you see photoshopped skin, it seems that if you squeeze out a pimple, you will get the same one, but in reality you get a scar,” says Ulyana Kardashevskaya.

Dermatillomania is stigmatized, and it is shame that causes a person to remain silent and not seek help. It is difficult to explain to others (and most importantly, to oneself) why it is so difficult to control the obsessive desire to harm oneself.

Keeping the problem under wraps creates the perception that the disorder is rare. But, according to research, about 5% of people feel the need to harm their skin in one way or another, and this is one in twenty. It has been found that 3/4 of those who experience dermatillomania are women.

Treatment

After consultation with several specialists, treatment will be carried out in a complex:

• if the case is severe, a psychiatrist will come to the rescue - during classes, a psychologist will not be able to rid a person of an internal problem, so additional medications are prescribed;
• such patients undergo cognitive behavioral psychotherapy, that is, the person is weaned from bad habits - this is quite difficult to do, often the result is short-term, but the main thing is to teach the person to perceive differently attacks of “wrong desires” directed against the skin.

During treatment, it is necessary to establish the reason why this happens. For example, this occurs in a fit of anger or due to feelings of guilt. A person understands that if he is scared, squeezing out a pimple does not mean getting rid of the feeling of fear, but this will be a kind of distraction from the problem that has arisen.

Therapy is about teaching the patient to recognize their trigger and respond appropriately to it. In other words, you can breathe deeply in a fit of anger, and if you’re scared, just think about something good.

For most people, the trigger is the mirror: if a person looks into it, then the search for “salvation” in the form of a pimple begins. In this situation, the patient is advised to look less in the mirror, and it is better to do it from a short distance.

Medications are prescribed to people with advanced illness when depression is too deep.

How to help yourself with dermatillomania?

Dermatillomania is a reflection of internal problems, suppressed anxiety, aggression and a range of other emotions. It is pointless to treat only visible manifestations (damage or scars) if the behavior remains unchanged and the person will resort to the same way of responding every time.

It can be difficult to notice obsessive behavior, especially when it brings illusory comfort and is perceived as the only chance to cope with difficult emotions. But recognizing the disorder is the first and important step.

“I first learned about dermatillomania from the book “The Skin We Live In.” I was very surprised that this was a disease, and not just a bad habit,” recalls Inna (25 years old).

“Overcoming” the disorder in the usual sense will not work—the symptom cannot simply be removed from your head, like an annoying app on your iPhone. But it is quite possible to work with the disorder and find out what is hidden behind self-harmful behavior.

Some psychotherapeutic techniques have proven their effectiveness in the treatment of dermatillomania, for example, the dialectical behavioral approach or the habit reversal therapy method, borrowed from cognitive behavioral therapy.

Who treats trichotillomania?

Regardless of the patient’s age, a psychiatrist must be involved in treatment. Of course, specialists of the relevant specialization work with children.

We know how to treat trichotillomania because we have been doing this for more than 10 years and we can confidently say: providing assistance and significant relief to people’s condition is possible!

Trichotillomania? We are ready to help you! Call us

How would people with dermatillomania want to be treated?

Environmental support is an important factor in dealing with any disorder. Dermatillomania has always been a taboo topic: it is not so easy in the era of eternal improvement and striving for the ideal to admit one’s imperfection.

“I would like at least someone to care what happens to me. So that close people who would notice that I have problems would try to find a solution with me (for example, support me in finding a psychotherapist). At the same time, I can’t blame those who think it’s just a bad habit. I myself once thought so, because little attention is paid to this disorder,” shares Inna.