Dr Pimple Popper: Helpful or harmful?

Have you heard of Dr. Pimple Popper? I recently stumbled acorss an article about Dr Sandra Lee, a dermatologist and cosmetic surgeon who goes by the name of Dr Pimple Popper on Instagram and YouTube. Through these popular forms of social media, Dr Lee is broadcasting videos and images of pimples being popped and squeezed, and cysts oozing or exploding with pus. some of you may be wondering...why would anyone want to post this kind of images onto social media, and who would watch it? Well according to the article Dr Pimple Popper caters to more than 200, 000 followers! She describes her audience as either hardcore or softcore poppers:

“There’s hardcore poppers and softcore ones. A “softpop” is a simple blackhead extraction, an easy pop. A “hardpop” is more hardcore - maybe a cyst or lipoma popped out via excisional surgery. There may be pus, there may be blood, and there is always a “pop”,” she said.

Who are the patients?

Most people with compulsive skin picking disorder suffer alone and in silence for fear of being looked upon in disgust, and out of shame and guilt. So where does Dr Lee find participants for these public displays of pimple popping? Well according to Dr Lee her patients can expect to pay $300-$500 for the excision or extraction of pimples or cysts. Instead, she offers the procedure for free if the patient allows her to record or photograph it to share on social media.

One of the theories Dr Lee has for the reasons people would want to watch these videos is because she thinks it may help relieve anxiety. She specifically mentions dermatillomania, suggesting that watching someone else’s skin get picked may distract someone from picking at their own skin. Of course this is just a an assumption on her part so it would be interesting to find out if any of her followers are in fact skin pickers and what their perspectives are. Even if this is true, the question remains: is this helpful or harmful to the dermatillomania sufferer?

Helpful or hurtful to skin pickers?

We know that Skin Picking or Excoriation Disorder is classified in the Diagnostic and Statistical Manual (DSM5) as related to Obsessive Compulsive Disorders (OCD), but that there are also some inherent differences from OCD. For one OCD is fundamentally centred on the presence of one or more recurring thought that the individual is not able to ignore and then compulsively acts on. In contrast, while dermatillomania is characterised by a compulsion to pick at the skin, this is not in direct response to an obsessive thought. For example, someone with OCD may be unable to shake the idea that pimples equal dirt and therefore will feel compelled to constantly clean the skin or remove the pimples. This thought and behavior often occurs independently from other factors such as stress or anxiety. On the other hand, someone with skin picking disorder experiences the urge to pick the skin in response to a sense of heightened tension such as stress or anxiety or due to sensory under load such as boredom. While negative thought patterns often do play a role, there is no specific, fixed and repetitive thought that the person is not able to ignore that is directly related to the act of picking. The more the person picks and experiences a sense of release from states of tension or anxiety, the more they seek out this feeling each time they feel stressed. The behavior becomes somewhat of an addiction. When recovering from addiction, the individual is usually advised to first remove any temptation as far as possible by, for example, not being around others engaging in the addictive behavior. Would watching pimple popping then not be counter intuitive to someone who is trying to stop picking their own skin?

Proven methods of treatment

One of the proven methods of treatment is based in Cognitive Behavioral Therapy (CBT), called Habit Reversal training. As part of the process, the individual has to select some alternate behaviours in response to the urge to pick, such as putting hand cream on. Could watching videos or looking at pictures of pimple popping be fulfilling the role of competing response? Or would watching these videos further serve to strengthen the urge to pick?

Dr Lee is adamant that she doesn’t want her patients to feel exploited, but what about the silent sufferer of dermatillomania? Does this nature if video not sensationalise pimple popping and skin picking in general? Is it contributing to a more positive attitude toward skin picking, or does it further perpetuate the negative stigma and perceptions about skin picking behaviors? The opinion on this will most likely be divided, because as Dr Pimple Popper says,

“People usually have a strong reaction to my videos- they either love them or detest them.”

What do you think?