Join us with Author and Advocate Angela Hartlin as she tells us her journey dealing with Dermatillioma.
AiT: In your words, what IS Dermatillomania?
AH: Dermatillomania is also known as compulsive skin picking (CSP). You may also hear it being called CSP, acne excoriee, psychogenic excoriation, or neurotic excoriation. It is a disorder that is linked with depression, anxiety, Body Dysmorphic Disorder, Obsessive Compulsive Disorder, but is generally known for being an Impulse Control Disorder fuelled by anxieties (from my readings). It has a sister syndrome called, “Trichotillomania”, which is pulling hair out compulsively; CSP was diagnosed as Trichotillomania by my doctor because there is currently no diagnosis in the DSM for compulsive skin picking.
Forever Marked: “Scars of Shame”
AiT: When did you know this started to become a problem for you?
AH: I remember always picking at my skin and have specific memories of picking as far back as four years old. It’s a little unclear about when the picking started because I had “acne” that started in grade 3, but now I look back and wonder how much of it was acne and how much of it was from my own doing. My picking probably became a problem for me in grade 8 because it was the first summer where I had to stop revealing my legs, although I had “good days” and “bad days”. Once grade 9 started, I never had the luxury of feeling comfortable enough to wear shorts or skirts outside again because of the noticeable scarring and wounds.
AiT: Do you know what may have caused this, or even made it worse?
AH: There are so many things that may have caused this disorder for me, so I don’t know exactly where it stemmed from. There are factors that may have contributed to me having a full-fledged disorder, such as being made fun of for having acne at a young age by my peers. Again, I don’t know when the acne started or if the acne was really just me picking tiny zits or fixating on normal things beneath my skin.
My life was changed when I was 10 years old because my father had a blood clot to the brain. Any issues I had seemed to solidify because I lost so much in a matter of a day- the day it happened. Everyone in my family found ways to cope, but unfortunately my way of coping came from already enjoying picking my skin. When my solid foundation of a happy home life collapsed, it gave room for abusive people to become active in my life and take advantage of my family and I. It makes me wonder, if the brain injury never happened to my father, would I have this problem? I know I would pick my skin a “normal” amount to get rid of blackheads, white heads, but would it have become this obsession? Even if the brain injury never happened, was it always in my makeup that something tragic would eventually turn this into a disorder? I can sit back and speculate, but it’s unhealthy and won’t change the facts of what my life is now and what I have the power to do with it.
AiT: How did friends and family react? Did you have problems in public?
AH: Immediate family members knew about my skin picking because of the hours I would spend in the bathroom picking- sometimes I pulled all-nighters in the bathroom. They also witnessed my mindless picking while watching tv, which I wasn’t aware of; it still happens all the time and the only thing that makes me realize I’m doing it is if I feel the temperature change on my fingers from blood touching them. A few relatives have been extremely supportive while others have not even uttered a word about it; all relatives found out about it from me writing the book, but even a couple of them still don’t even know about the book!
It was more difficult with friends because I’ve had various reactions over the years that made me completely seclude myself from the outside world. I had a tendency to be friends with people who I perceived to be better than me, someone with characteristics I wanted. Most of these “friends” would look down on me for my depressive thoughts or strange quirks, so I never felt good enough for anyone. As the years went on I was able to weed out negative influences and my true friends stayed. When it comes to talking about Dermatillomania, one of my very best friends of six years only found out that I had this problem when my book came out last year because I felt too beaten up over the years to have someone else throw me to the curb. What I have learned is that I have this disorder, probably always will to some extent, and that I would rather be without friends than have friends who cannot accept or support me. This particular friend was understanding, despite his own views on mental illness, but he knew me and doesn’t think any less of me for having this issue.
I still have problems in public. I don’t know if my social anxieties were created from being under scrutiny for my physical appearance for most of my life, or if I have always had social anxieties that were calmed by picking my skin. I guess it doesn’t matter whether it’s the chicken or the egg, but I still have days where I refuse to leave the house because of a large visible wound on my face.
AiT: What kinds of treatment can one seek to heal this?
AH: Sadly, there are no known cures for this disorder, but there are options available to lessen its symptoms. The best way to deal with having Dermatillomania is to learn techniques through Cognitive Behavioral Therapy to become aware of when you pick, how often you pick, what you feel before/ after/ during a picking session, what triggers you to pick, etc. After becoming aware of your specific patterns, you can then begin a process of Habit Reversal Therapy. It has not worked for me because the urges are too overwhelming and I still cannot deal with the anxiety that not picking creates.
A lot of people are skeptical about the power of SSRIs, but the option of being on one is just another tool we have. They can help with sustaining other symptoms, such as depression, OCD, and anxiety. In 
general, removing the intensity of these symptoms can reduce the urge or need to pick at your skin- and any improvement is something we all strive for.
AiT: Can you tell us a little more about your book, FOREVER MARKED?
AH: I originally wrote this memoir for me, and no one else. I felt like I couldn’t open up to anyone in my life about the shameful feelings surrounding my skin picking or how devastating the effects were on me, so I opened up an online blog dedicated to my journey to vent and hopefully make sense of why I did it and what I could do to make it better. Eventually I let a few people from skin picking communities in on my journey to get insight or feedback from them, or even just acknowledgment of someone reaching out and telling me I wasn’t alone.
As time went on and my overall mental health improved, I wrote less and less in this blog because I was able to start living my life, starting with the ability to leave the house. With an abandoned account online, I went back to it in 2008 and was going to delete it, but then I thought that there was so much in there that could help someone else. I left it alone, thought about it, and then decided to compile the entries together to create, “FOREVER MARKED: A Dermatillomania Diary”.
One thing I have been surprised about is that many people who do not have Dermatillomania, but were curious about the condition, have read my book and told me that the book describes them to a tea. I have heard feedback from as many people with this condition as I have without and overall, people understand suffering. Most people have had very dark moments, days, or elongated periods in their life that mimic exactly what I wrote in my memoir. If I had written that journal knowing it was going to become a book, my natural instinct would’ve been to sugar coat my feelings and thoughts; it is truly raw material that includes thoughts that have lingered in most of us at some point, but the only courage I had to write it was because it was thought to have been for me.
AiT: If you had any advice for someone suffering from Dermatillomania right now, what would you tell them?
AH: From being suicidal for years mainly due to this condition to now looking forward to life, my changed outlook is what has kept me alive. I was also lucky to have supportive family members who did not look down on me for having this; I have had “friends” throw my disorder in my face and deem me crazy, but all of them have been weeded out from my life. I may not show my skin in day-to-day life, but everyone I love knows about this. Just knowing that they accept me takes a huge burden off of my shoulders because it’s my ugliest attribute, yet they still love me.
I still struggle with the shame of knowing what I do to my body on a daily basis, knowing that I have to find ways of covering everything up is from my own hands, but it doesn’t define me. Once I stopped seeking a fix, my life became manageable. I was so focused on finding a cure and if I didn’t, then I didn’t deserve to be happy, or find a partner, go to school, or to live. Now Dermatillomania is the ball on chain that I carry around with me and may for the rest of my life, but I’m okay with it. A cure is now just an asset in my life, not mandatory for happiness. Give others a chance to be a part of [what feels to be] your secret life and never let the mirror tell you that YOU are the scars you see in the mirror; we are truly our worst critics.
More information:
AH: I have been working on a documentary about my experience with Dermatillomania and what it’s like to live with it daily. On my YouTube channel I have “The First Interview on Dermatillomania” along with 2 others, but in the near future a sneak peak of the documentary will be posted. These videos can be found at www.youtube.com/anonymity86. If you would like to get a copy of “FOREVER MARKED: A Dermatillomania Diary”, please e-mail me at forever.marked [at] yahoo [dot] ca or go to Lulu.com and type it in the search. I always visit my Facebook page and get involved in the discussions on the wall and discussion board. I welcome you to be a part of it: http://www.facebook.com/pages/FOREVER-MARKED-A-Dermatillomania-Diary-by-Nova-Scotian-author-A-Hartlin/177738602694?ref=ts
Thank you for the opportunity to share a bit of my story with Anxiety in Teens. In a few months I will be graduating from a post secondary institute with my Child & Youth Care w/ Addictions Counseling diploma and my goal is to help youth and their families deal with issues that may not be taken seriously. I look forward to hearing from you if you have any questions or comments.