On Skin Picking

If we were to need any further evidence of the difficulties of being human, we need only study the poignant phenomenon that psychologists call dermatillomania – more commonly known as skin picking.

Those who suffer from it will, by definition, be at the anxious end of the spectrum. Few days will be free of great worry, sometimes a specific concern that feels like it will be the end of us, or else a general eeriness and nameless dread.

In response, as we’ve probably done for years, we will start to pick. Perhaps we reach for one of our hands and a very special zone we’ve almost certainly not told anyone about; a zone of hardened skin made up of extra layers that we begin to press or squeeze at, file down or unsheathe. Or we go to an area of our face and start worry away, pinching, squeezing, lifting, skewering. It might equally – or also – be a part of our lips we go to or a bit of our ankle. In all cases, the skin buckles, damages, goes sore and on occasion, when we go too far, starts to bleed, perhaps profusely. If someone were to come into the room, they might gasp – though we generally do a good job of covering up the blood once we’re done. 

We know – of course – we shouldn’t be doing any of this. But it feels, at the time, so nice, or more accurately, irresistible, like the only thing that is going to work, like exactly the action that will be able to deliver relief. What can it matter, in the context, that we’ll be left with a pitted face or a bleeding foot or a purple raw thumb? It’s what we had to do – and have been doing, probably, for many years. We know we do it, but it escapes and resists direct thought. This might be the first time we’ve heard anyone else talking about it.

Dermatillomania, the psychologists tell us, has to do with anxiety; that much is evident. What is distinctive is how the anxiety is being handled. Some will act out their pain in dramatic and noisy ways; screaming, insulting, cursing… Skin picking is a quieter, more solitary way of trying to come to terms with alarm and self-loathing. It is an introvert’s affliction. 

The skin picker might well like to scream, panic loudly, tell someone to go away or collapse in another’s welcoming arms – but their characters have been shaped through aeons of solitude. They have no faith in any possibility of turning towards someone else for help. They are fundamentally alone. They only have experience of directing anger and sorrow in on themselves. They are taking their pain out on the only character they can reach. 

Knowing all this helps us to imagine what a cure might look like. For a start, it will involve recognising the degree of solitude that has inspired the masochism. No one ends up picking their skin raw who had an early consistent experience of tenderness and attuned care. One does this kind of thing because absolutely no one was around or those that were did a lot of humiliating. It may help to recognise that one is still now terrified pretty much all the time. The targets may shift – losing one’s job, being made fun of, being sexually rejected, ridicule – but the essential drift is that one is a terror-struck person.

When we can compassionately realise that the picking is about fear and self-disgust (the legacy of neglect or cruelty), we are in a position to start to ‘see’ rather than merely be compelled by our pain. We need to find a better way of being worried. We are trying to gain control over a cruel-seeming and cold world, but turning our index finger raw or taking a penknife to our heel isn’t where the issue lies. We need to know that this isn’t some un-analysable quirk. It’s a known and very moving problem, one of the many things a sensitive mind will do in response to a lack of love and to a basic fear that’s had to be borne alone. We need to start to pick at the real source of the agony and learn to leave our innocent bleeding body in peace.