How Can I Help? Tips for Supporting Someone with Skin Picking Disorder

Let’s be honest. Nothing really prepares us for talking about hard things with someone we care about. Mental health can be particularly difficult to talk about:

• Mental health is often misunderstood and sometimes even stigmatized.
• Struggles with mental health aren’t always easy to recognize. You might suspect someone is struggling but you don’t want to assume or offend them.  
• You might not know the words to use or worry you might say the wrong thing

You want to help but you don’t know how.  Maybe you’re not even sure what they’re struggling with. Like other mental health disorders, the signs of a skin picking disorder aren’t always readily apparent. It can be mistaken for severe acne or another dermatological disorder. Not everyone picks their skin in noticeable places or in the same way.

Even if you know what the issue is, knowing what to say and how to support them isn’t always easy. But saying nothing or acting like it isn’t there doesn’t seem like the right answer either.

If you have a friend or loved one dealing with skin picking, there are things you can do to engage in a way that invites dialogue and feels safe. And sometimes, just knowing that they’re supported can be the first step to healing.

Understand Skin Picking Disorder

Understanding what your friend or loved one is dealing with can shape how to engage with them. Skin picking disorder, clinically known as excoriation disorder, is more than just a “bad habit” and they can’t “just stop.”

Skin picking is a body-focused repetitive behavior (BFRB) characterized by compulsive picking of the skin resulting in damage to the skin and tissue. Criteria set out by the Diagnostic and Statistical Manual 5 (DSM5) for the diagnosis of skin picking disorder include:

• Recurrent skin picking resulting in skin lesions
• Repeated attempts to decrease or stop skin picking
• The skin picking causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
• The skin picking is not due to the effects of a substance or another medical condition.
• The skin picking is not due to another mental health disorder.

Skin picking is more than just picking at the skin. There is also significant emotional impact. People living with a BFRB like skin picking often struggle with feelings of guilt, shame, and embarrassment. There is frequently worry of being judged by others for their appearance. Social interactions can intensify these feelings and fears. They may avoid social situations that may lead to questions about their appearance or judgment from others. They may go to great lengths to hide their skin damage. These fears may also discourage seeking help and support.

It’s important to note that people experience skin picking in many different ways and with varying severity. Understanding your friend or loved one’s experience can help you to feel more confident in talking with them.

How Can I Help?

This is the question friends and loved ones often struggle with. While you can’t “fix it” for them, you can be a source of support and encouragement. The most important thing to remember is to come from a place of acceptance and non-judgment. If you think your friend or loved one is going through something, here are some ways to start a conversation:

Ask – Yes, it’s ok to ask. In fact, people living with skin picking often express feeling appreciative when a friend or loved one is willing to talk with them in an honest and non-judgmental way. Hesitating or talking around the subject can be interpreted as if talking about skin picking is somehow taboo or not ok to talk about. It can also contribute to those feelings of shame that can prevent them from seeking treatment.

Listen – Once you ask, listen to what they say. Respond with empathy and compassion. The key to effective communication is listening to understand and not simply to respond. You may not understand their picking experience or what they’re trying to share. If you don’t understand, it’s ok to ask questions. “I don’t understand. Could you explain that to me?”

Support and Encourage – For those living with skin picking, having a support system is essential to recovery and a sense of being heard and accepted. A lack of support can reinforce feelings of shame and guilt, making progress in recovery hard. Let them know that you are there to lend support and are a safe person to talk with. And it’s ok to ask, “How can I support you?”

Tips for Teachers

Skin picking often emerges in late childhood or early adolescence so it’s likely that a teacher may be the first to recognize a problem. Kids often feel comfortable talking to a trusted teacher. While not mental health professionals, teachers can be an important source of support and help facilitate referral to appropriate resources. Of course, it’s important to maintain good boundaries and follow all protocols for dealing with mental health issues in your school system.

While the exact issue may not be clear, there are ways to support a student who is dealing with a mental health disorder like skin picking:

• Know the signs of a possible mental health issue
• Normalize talking about feelings
• Let students know that while you’re not a mental health professional, your door is open if they need to talk
• Listen without judgment
• Facilitate referral to an appropriate mental health resource (e.g., school counselor)

If the child is not sharing, but you suspect a problem:

• Gently share your concern for them and that you’re there if they want to talk.
• Encourage them to talk to a mental health resource such as a school counselor

If you’re not sure how to help a student, seek guidance from your school’s counselor.

The Takeaway

Having genuine support and acceptance from friends and family can make the journey to recovery feel less isolating. While you may not always know what to say or do, sometimes all a person needs is a compassionate listening ear, and to know that you accept them unconditionally and are there to support them.

References

1. 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