Advocating for Compassion: Transforming Perspectives on Dermatillomania

Despite progress that’s been made in awareness and acceptance, people living with a mental health condition continue face the brunt of societal misunderstanding and stigma, despite the prevalence of mental illness and its impact on individuals' lives. Being judged is a very real fear that keeps many people living with a mental health disorder from seeking help and support.

Dermatillomania, also known as excoriation disorder or skin picking disorder, stands as a poignant example. It is estimated that about 2-5% of the population has this disorder, with onset most common in the early teen years.

Despite its significant effects on a person’s physical and emotional well-being, and their psychosocial functioning, dermatillomania remains a misunderstood and stigmatized condition. Common misconceptions that it’s just a “bad habit” or due to poor hygiene or done for attention persist. People living with skin picking often report feeling intense shame and guilt about their condition. They avoid social interactions and even avoid seeking help for fear of being judged by others. They want to be engaged with others, but the fear of rejection can be too much to bear. And, based on anecdotal evidence, the judgment can be harsh.

If you’re living with a mental health disorder like skin picking, you may have felt judged or misunderstood by others, even those closest to you. Maybe you’ve even judged yourself a bit harshly.

Stigma is a social, fear driven phenomenon. It arises from external fear associated with someone or something that is different or doesn’t “fit” the societal or cultural norm. That stigma feeds the shame that people living with a mental health condition feel. It becomes a cycle that can seem endless.

Advocacy is a powerful tool for challenging and changing attitudes and increasing awareness about skin picking. Advocacy is a call for greater compassion and understanding, urging people to recognize and support those who experience stigma and discrimination due to their skin picking behaviors.

Understanding Dermatillomania

Unlike some mental health issues, the primary symptom of skin picking, damage to the skin, is visible, and can be the source of unwanted attention and even judgment from others. People with skin picking will go to great lengths to camouflage the damage or avoid situations that might draw attention. They worry about how others will perceive them. Societal attitudes often perpetuate harmful stereotypes, leading to the stigmatization of affected individuals. As a result, they often suffer in silence and are reluctant to seek help or reveal their struggles to others.

The Importance of Advocacy

Advocacy is any action that speaks in support of, defends, or pleads on behalf of others. Advocacy comes in many forms too:

• Self-advocacy – you advocate for your own interests and needs (e.g., knowing your rights, asking for what you need)
• Individual advocacy – the focus is on one or a few people (e.g., parents advocating for school services for their child)
• Systemic Advocacy – This type of advocacy focuses on changing systems on a larger scale (e.g., local or state laws or organizational policies)

Advocating for a shift in societal attitudes towards skin picking is important:

• It challenges the misconceptions and ignorance surrounding the disorder, paving the way for greater understanding and empathy.
• It empowers individuals affected by dermatillomania to seek help without fear of judgment or discrimination.
• It promotes inclusivity and compassion, fostering a more supportive environment for those grappling with the challenges of dermatillomania.

Despite the advances in mental health awareness, stigma still lurks. Talking about it can be scary and even frowned upon in some families and communities. Seeking help can be seen as a weakness or a reflection on the family. But shedding light on the truth about mental health and skin picking can create awareness and challenge the negative impacts of stigma. Confronting the shame can open the door to healing. 

Strategies for Advocacy

At the heart of challenging the stigma and misconceptions about skin picking is education. Education is key to dispelling misconceptions and fostering empathy towards those affected by the disorder. By raising awareness, we can help cultivate a more informed and supportive community. Advocacy doesn’t have to be complicated. Sometimes, simply taking time to educate someone or share your experience can go a long way in dispelling myths and creating awareness and compassion. Whether you’re living with skin picking or the friend or loved one of someone who is, there are things you can do to challenge the stigma and encourage compassion.

Know and Share the Facts

The first step in dispelling a myth is to know the facts. People not familiar with skin picking may not understand it. Even people living with skin picking don’t always understand their disorder. It's essential to recognize that skin picking is not a choice or  just a “bad habit”. It is a recognized mental health disorder and not something one can “just stop”.

Start A Conversation

Look for opportunities to share when and where you feel comfortable doing so. Whether it’s with family and friends, or a broader audience such as social media or an online forum, start a conversation about skin picking. When you share your story, you are educating someone, and you may just be helping to empower someone who is silently walking the path with you. And if you’re a friend or loved one of someone living with skin picking, it’s ok to ask how they’re doing. Listen to what they’re open to sharing. It’s ok to ask questions and it’s ok to not know all the answers. Sometimes, asking “how can I support you?” is a great place to start.

Build A Supportive Community

A supportive community is paramount in challenging stigma and promoting recovery. Support groups, whether online and in-person, provide a safe space for people living with skin picking to share their experiences, seek advice, and receive validation from others who understand their struggles. Peer support can be invaluable in reducing feelings of isolation and building resilience.

Your family and friends can be an important part of your support community too. Invite them to have conversations with you about your experience. Normalize talking about mental health and how to do so with care and compassion. Sometimes people don’t know if asking questions or using certain words is helpful or hurtful. Having an open dialogue can lead to greater understanding and foster acceptance while dispelling myths and reducing the fear of judgment or stigma. It’s also a great opportunity to teach others about the importance of using positive, affirming language.

Promote Self-Acceptance and Resilience

Part of challenging stigma is learning to honor and care for yourself. Extending care and compassion to yourself can help heal the shame and boost your confidence and self-esteem. Self-care practices, such as mindfulness, relaxation techniques, and positive affirmations, can help you cope with urges to pick and manage stress (a trigger for many people) more effectively. Caring for yourself is also a great reminder that you are indeed worthy of kindness, care, and compassion.

Normalize Seeking Help

Just as you’d seek treatment from a healthcare provider for a medical issue, therapy is quite often the first-line treatment for most mental health issues, including skin picking. Therapy, particularly cognitive-behavioral therapy (CBT), is a cornerstone of treatment for skin picking and other body-focused repetitive behaviors (BFRBs). Therapy can help you identify triggers, develop coping strategies, and challenge negative thought patterns. When you’re equipped with tools to effectively manage your symptoms, you can confidently navigate the challenges of skin picking.

We Can All Be Advocates

Compassion, understanding, and education are our most potent allies in confronting the stigma surrounding mental health disorders like skin picking. By challenging misconceptions and promoting positive practices, we can create a safe, supportive space where people feel understood, accepted, and empowered to seek help and support. Whether you’re living with skin picking, love someone dealing with skin picking, or support mental health advocacy, everyone can make a difference. 

References

1. Grant, J. E., & Chamberlain, S. R. (2020). Prevalence of skin picking (excoriation) disorder. Journal of psychiatric research, 130, 57–60.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7115927/

2. Anderson, S., Clarke, V., & Thomas, Z. (2022). The problem with picking: Permittance, escape and shame in problematic skin picking. Psychology and Psychotherapy: Theory, Research and Practice, 96(1), 83-100. https://bpspsychub.onlinelibrary.wiley.com/doi/10.1111/papt.12427

3. Khatib, H. A., Alghamdi, W. A., Subki, A. H., Butt, N. S., Alsallum, M. S., Alsulaimani, A. S., Alnajjar, S. F., Alzaidi, F. D., Alasmari, A. A., Alshamrani, H. M., Al-Zaben, F., & Koenig, H. G. (2022). Prevalence of and Risk Factors for Skin Picking Disorder Symptoms Among Adults in an Arab Middle Eastern Population: A Cross-Sectional Study. Clinical, cosmetic and investigational dermatology, 15, 2583–2591. https://doi.org/10.2147/CCID.S348258