Skin deep

A number of conditions are considered to be related to OCD and to fall on the obsessive-compulsive spectrum; some share the obsessive element of the disorder, others the compulsive. Amongst the latter is Compulsive Skin Picking (CSP) - also known as dermatillomania - and about a quarter of people diagnosed with OCD suffer from CSP as well.

The driving urge behind CSP is the need to relieve anxiety, which is achieved by the sufferer removing what they perceive to be imperfections from the skin. These may be real - such as blackheads, scabs or dry patches - exaggerated, or imagined. Sufferers may pick consciously or unconsciously, and will use either their fingernails or tools, such as tweezers or pins. 

Whatever the picking method, this activity invariably leads to an injury, scabbing or scarring that is far more unsightly than the original 'flaw'. The immediate relief that picking generates is, therefore, quickly replaced by distress at the consequences...which is relieved by yet more picking.

Image courtesy of Stuart Miles/
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Sufferers may go to great lengths to conceal the damage to their skin, with make-up or clothing, and this damage can adversely affect their self-esteem, and even lead to them becoming socially isolated.

Recently, I was engaged in a Twitter exchange with a fellow blogger, who writes about her experience of CSP, as well as OCD and other conditions, on her site roseversusblackdog.

I confessed to chewing the skin around my nails and she told that me this has a name, too: dermatophagia. She directed me to a website, which lists a whole raft of 'Body-Focussed Repetitive Behaviours' (BFRBs): 'An umbrella term for any chronic behaviour that causes a person to consistently cause physical damage to oneself unintentionally through a compulsive act in order to relieve anxiety.'*

I certainly recognised my own behaviour under the dermatophagia ('skin-biting disorder') heading, including biting my lip - to the point that I have caused a lump which will require minor surgery to remove! It seems, also, that my habit of picking at healing or calloused skin is bracketed under CSP.

Although I'm not aware of being anxious at the point of picking, I do know that I don't seem to be able to stop myself. No sooner do I realise that my fingers are, for once, blemish-free, than I find myself attacking them again; hunting down the tiniest bits of protruding or dry skin for the attention of my teeth or fingernails. If I'm not re-opening healing wounds, I'm creating new ones,

I know at least three people who do the same, so perhaps a mild form of this condition is relatively common. One told me that he is 'just tidying up', which is an objective I can relate to. Tidying up so often results in my making a mess, though. 

Finding out that these behaviours have a name seemed, initially, to give them more weight, but, fortunately, they don't pose a significant problem for me. Like all conditions, they manifest in more or less severe ways and, in me, very much at the lower end of the spectrum.

There is hope for those who suffer more severely, in that Cognitive Behavioural Therapy, which is used to treat OCD, can also successfully address CSP and similar conditions, sometimes in conjunction with the use of medication. 

The help is certainly out there, if you realise that this is a problem for you.

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*Skin Picking Support - this website includes information about many related conditions (BFRBs). You can also find out about skin picking on OCD Action's website.