Loving Someone with Skin Picking Disorder: A Guide to Understanding and Supporting Your Partner

Loving someone with skin picking disorder, clinically known as excoriation disorder or dermatillomania, can be at the same time both satisfying and uniquely challenging. Skin picking is a mental health disorder that is often misunderstood and steeped in stigma, and for the person living with it, a source of considerable shame and embarrassment. Skin picking is more than skin deep. It’s a disorder that can impact the person, their emotional well-being, and even their relationships. 

When you love someone with dealing with skin picking, it isn’t always easy to know how to support and help. You want to help but what’s the right thing to say or do? How much is too much or not enough? The fact is, you can’t “fix it” for them, but you can be an important source of love and support which is essential in the healing process. Learning how to understand and support your loved one can help strengthen your bond and help you navigate this journey together.

What Is Skin Picking Disorder?

To fully understand and support your loved one’s experience, it’s vital to first understand just what their disorder is and how it may impact them. 

Skin picking disorder is a mental health disorder characterized by repetitive picking, scratching, rubbing, or digging into the skin resulting in noticeable skin damage and lesions. Picking can occur anywhere on the body but occurs most often on the face, arms or hands. The person may target healthy or unhealthy areas of the skin (e.g., blemishes, rough patches, scabs), resulting in skin discoloration or lesions, and sometimes even scarring or skin infections. Aside from the physical damage, skin picking creates significant emotional distress and impaired psychosocial functioning, even sometimes affecting relationships. 

Triggered by stress, anxiety, or other emotional factors, skin picking can leave those who experience it feeling ashamed, isolated, and frustrated, caught in a vicious cycle. The same picking behavior that brings temporary relief from the emotional distress results in feelings of shame, guilt and failure leading to more emotional distress. It’s a cycle that is difficult to break. 

Skin picking isn’t just a “bad habit”, nor is it an issue of willpower or attention-seeking. Skin picking is a complex condition influenced by neurological, psychological, and emotional factors. It can be confusing for your loved one as well as for others who may not fully understand the struggle. 

Building Compassion and Understanding

As someone who loves them, your role is not to “fix” your partner or loved one. What you can do is walk alongside them with compassion and understanding.

See the Struggle Through Their Eyes

While you can’t experience exactly your loved one is going through, try to view it from their perspective. What might their day-to-day challenges be? What might that feel like?

Imagine feeling a relentless urge to pick at your skin that’s almost impossible to resist. Imagine battling self-criticism and shame for behaviors that feel out of your control. 

They Can’t “Just Stop”

Your partner’s skin picking is not a choice. It’s a coping mechanism. Resist the urge to tell them to “just stop”. Skin picking is more than just a “bad habit” and they can’t “just stop”. If they would, they already would have. In fact, telling someone to “just stop” something they cannot control can actually have the opposite effect. 

Lead with Curiosity

It’s ok to ask questions to learn more about their experience and how you can help. Open-ended questions like these can establish a dialogue: 

• What does it feel like when the urge to pick arises?
• Are there situations or emotions that make it harder for you?
• Are there things that help?
• How can I best support you when you’re struggling?

These questions can help your loved one feel seen and valued while giving you insight into what they are experiencing. 

Create A Safe Space

One of the greatest gifts you can offer your partner or loved one is a safe, nonjudgmental space to express themselves freely. Some ways to do this include:

• Active listening – This means listening without interrupting, advising, or trying to “fix” something. Sometimes, they might just need a place to vent or say something out loud. 
• Validate their emotions – There is no “right or wrong” way to feel. We feel how we feel, and it’s perfectly ok if you don’t feel the same as your partner. However, it’s important not to negate or minimize their feelings. For example, instead of saying, “You shouldn’t feel that way” or “Just let it go”, try saying something like, “I can see how this must feel overwhelming for you” or simply, “I hear you” (three of the most powerful words you can say to someone struggling).
• Avoid criticism or ultimatums – First of all, they don’t work and can actually exacerbate the situation. Comments like “You need to stop” or “Your skin will look better if you’d just stop” are hurtful and counterproductive. Worse, they can deepen your partner’s sense of shame and create emotional distance between you. They need to feel safe knowing you won’t judge or reject them. 

Educate Yourself

Take time to learn about skin picking. Learning about your partner’s disorder signals that you are committed to their well-being. The more you understand it, the better equipped and confident you will be to offer empathy and support. Seek out reputable resources, books, and support groups. If your partner is open to it, consider attending therapy sessions together to gain deeper insights.

No Pressure

It might be tempting to pressure your loved one into treatment or to stop picking. There’s a fine line between encouragement and pressure. Encouragement is helpful and empowering. Pressure is overwhelming and dismissive. 

So, what can you say? Instead of, “I think you need to…”, try:

• I will support you if you choose to try therapy or other strategies.
• Have you thought about talking to someone who specializes in treating skin picking? 
• How can I help?

Remember, the decision to seek help has to come from your loved one. Your role is to provide loving encouragement and unwavering support.

For those trying to support a child rather than an adult, of course you may need to make certain decisions for them. However, the same approach to compassion and support applies. The essential key is approaching a loved one with empathy and understanding. 

Celebrate the Little Victories

Recovery from skin picking is never a straight path, and more like a long, winding road. Make it a point to recognize the victories, no matter how small. Each success builds on the last and even a high five, “great job” or “I’m proud of you” boosts confidence and motivation to keep trying. 

Take Care of You

Supporting someone with skin picking disorder can be emotionally demanding. It’s hard to be a strong, loving partner when your emotional tank is empty. It’s important to prioritize your own wellness needs. 

• Make time for self-care
• Set healthy boundaries (It’s ok to say no when you need to.)
• Consider seeking your own support if needed, whether it’s confiding in a trusted friend, joining a support group for loved ones, or talking to a therapist. Your mental health matters too. 

Meet Them Where They Are

At the heart of it, loving someone dealing with skin picking disorder means fully embracing them where they are. Your partner’s skin picking doesn’t define them or diminish their worth. Remind them of all the qualities that make them who they are. 

Being in a relationship with someone who has skin picking disorder is an opportunity to grow in empathy, patience, and love. By understanding their struggles, offering support, and a safe place to land, you can build a deeper connection and help your partner navigate their journey with hope and resilience.

References

1. Anderson, S., & Clarke, V. (2017). Disgust, shame and the psychosocial impact of skin picking: Evidence from an online support forum. Journal of Health Psychology, 24(13), 1773-1784. doi:10.1177/1359105317700254

2. Weingarden, H., & Renshaw, K. D. (2015). Shame in the obsessive compulsive related disorders: a conceptual review. Journal of affective disorders, 171, 74–84. https://doi.org/10.1016/j.jad.2014.09.010

3. How to support a loved one with trichotillomania or dermatillomania. (2021, October 4). MHT. https://www.mentalhealthtoday.co.uk/blog/disorders/how-to-support-a-loved-one-struggling-with-trichotillomania-or-dermatillomania

4. Houazene, S., Leclerc, J., O’Connor, K., & Aardema, F. (2021). “Shame on you”: The impact of shame in body-focused repetitive behaviors and binge eating. Behaviour Research and Therapy, 138, 103804. https://www.sciencedirect.com/science/article/abs/pii/S0005796721000036

5. Skin talk : Blog : Picking me Foundation NFP. (2018, September 6). Picking Me Foundation NFP - Advocating on Skin Picking. https://pickingme.org/blog/blog.html/article/2018/09/06/how-can-friends-support-dermatillomania-sufferers