Dermatillomania - A Hidden Disorder?

Dermatillomania or excoriation disorder is not a well-known or well-understood mental health condition. Unlike other disorders popularized in entertainment such as obsessive-compulsive disorder portrayed by Leonardo Di Caprio in “The Aviator” or bipolar disorder portrayed by Claire Danes in “Homeland.” Other disorders with widespread awareness include anxiety, PTSD, depression, autism spectrum and ADHD not only because they are more common, but because they often affect children. However, dermatillomania involves picking at the skin until it bleeds, causing wounds and scare, behaviors which carry a lot of stigma. Therefore, people who struggle with the disorder tend not to talk about it nor do they seek treatment.

How Common is Dermatillomania?

The prevalence of skin picking is unclear, but current data suggests it might be more common than researchers thought. This blog post contains a more thorough discussion of the prevalence of dermatillomania. However, traditional epidemiological estimates state that 1.4% of the general population may meet diagnostic criteria for skin picking disorder. In a non-clinical sample, or people who respond to a general survey, 14% out of 318 respondents reported skin picking behaviors that lead to wounds. Other data shows that about 2 percent of visits to dermatologists are because of the consequences of dermatillomania. Also, an anonymous phone survey found that one in ten respondents picked their skin until they caused damage. When mental distress was added to the mix, 1.4% satisfied the criteria for dermatillomania. Another study showed that 63% of respondents engaged in skin picking behavior, with 5.4% of respondents meeting criteria for a dermatillomania diagnosis. This wide variance reveals a common theme in this disorder. Most people pick their skin, causing damage, while a lesser number (though still unknown how many) reports a pattern of emotional and mental distress that goes with skin picking. Regardless of the actual numbers, the theme is that the prevalence of skin picking disorder is higher than the data reports.

Why Is Dermatillomania a "Secret Disorder"?

There are several reasons dermatillomania is still a secret disorder.

• We live in a society that values physical beauty and stresses constant improvement to appearance. In a culture obsessed with celebrities who spend hours each day working out or applying make-up, while photo editors use Photoshop to smooth out any remaining imperfections, people feel compelled to amend their bodies to achieve an unattainable ideal.
• The quest for perfectionism can drive behaviors. No living being is symmetrical. The left side of every face differs from the right, with moles, acne, birthmarks, and other flaws that show up as we age. To some people, imperfections cause intense anxiety, which they try to ease by picking at the imperfect bits resulting in wounds and scarring, making them even less perfect.
• Some people believe they are not worthy of love and affection but intensely crave love and affection which fuels a mortal fear of rejection. They pick at the skin, which makes them less attractive so they avoid social contact ( “surely they would be disgusted by me now”), making anxiety even worse and establishing a vicious negative feedback loop.
• Like many conditions, dermatillomania correlates with genetics. High anxiety levels and obsessive-compulsive traits can be inherited which leads some to develop skin picking for no reason other than it “runs in the family.” These circumstances lead to depression and feelings of powerless and shame.
• Dermatillomania is a condition characterized by compulsions and a lack of control. Society values self-control and initiative viewing anyone without self-control as somehow inferior. Therefore, many mental health disorders are perceived as if an individual has a weakness and is not confident and assertive. Cultural pressure not only makes them feel like a failure, but internalizing those expectations causes people to judge themselves as inferior for perceived lack of self-control.

Education - A Path to Greater Visibility

Skin picking is a complex problem with many causes and patterns of behaviors. Education reduces the stigma and shame attached to the disorder and teaches people about treatment options available. Not only does awareness increase the likelihood of early recognition of the disorder, but also makes it easier for people to seek treatment. As dermatillomania moves out of the hidden realms, health care providers and support will become more available. Creating support systems, and educating the public on when to seek help, is the best way to solve this under recognized problem.