Finding the Root of My Dermatillomania

I had a realization the other day. As one may see from reading any of my previous articles, is that I am quite introspective. I would like to give therapy some credit, although I honestly believe I was born this way; an “overthinker” as coined by my parents, my sisters, society. I have always loved the idea of keeping a diary or journal, something I off and on did as a child, and have consistently been doing as an adult for the past seven years. As I overthink and journal and TALK (I am quite talkative), as well as research (I love the internet), I have learned more about who I am as a person as well as who I am with my neurodivergent identity.

So, what exactly was this week’s realization?

I learned that I had some form of sensory processing disorder (SPD) last fall (see previous article I wrote about sensory issues). I was initially skeptical because SPD has typically been portrayed as being a condition solely related to autism. I do not have autism, however I do have other “related” conditions: ADHD, anxiety, tic disorder, OCD, nonverbal learning disability, to name a few.

While anxiety and OCD are prominent conditions in my life, and always have been (since a very young age), I realized that those labels do not explain certain issues for me.

For instance, I have been struggling for the past three years with skin picking (dermatillomania). This is technically its own separate disorder, but said to be in the “OCD family.” I feel lucky to say that while my depression and OCD are not causing substantial problems for me at the moment, thanks to medication and therapy, I don’t understand why this skin picking impulse was so hard to break!

But, then I had a thought. So far, my skin picking disorder has been treated as if it were an extension, an additional manifestation of my OCD. My doctor tried a couple different antidepressants to treat it, and nothing has worked. I’ve now realized the issues.

Issue No. 1 — Too strong of an emphasis on medication rather than therapy and behavioral changes
Issue No. 2 — Too much of a focus on treating skin picking issues as part of the OCD-spectrum.

Now, I’m no doctor, but in my case, I do not believe my dermatillomania is OCD related — because if it were, I feel it may have responded to the medications that were tried (the same medications that my “classic OCD” has responded to).

This is my long-winded way of saying that in my case, I feel the dermatillomania is actually sensory related. You heard me. I am not picking at the skin on my forehead, ears, and scalp because of an obsession/compulsion, anxiety, or a lack of serotonin.

I feel I pick because …

In all honesty, it feels good.

When I told my mother this, she was initially surprised. She, like most people, figured I picked out of anxiety or stress.

I pick when I’m bored, under-stimulated, or in need of a pleasing sensory experience. Like many people with sensory processing disorder, I experience a mixture of sensation seeking and sensation avoiding. My skin picking “habit” that began three years ago has morphed into an addiction almost, something I feel I cannot stop.

The biggest obstacle I truly have though? I like the way it feels too much, no matter how “gross” it looks, no matter how bad it is for my skin.

So yes, I do pick my skin.

But, I wouldn’t necessarily call it compulsive. I pick my skin because I crave the sensation; the way it feels to run my fingers over a scab and to remove the skin, causing a surge of some sort of adrenal, perhaps, through my bloodstream.

I do not know the actual science, but I do know that while part of me wants to stop skin picking for rational reasons — scarring, infection, perception from others, etc.— a part of me enjoys the sensory experience of touching, rubbing, picking.

It’s for the same reasons that I smell my hand, or chew on pens, or sleep with a 25 pounds weighted blanket, or even pet my dogs ears over and over (even to the point at which they walk away from me because they want space).

As a child, I did not pick my skin. However, I did peel my nails, have a constant desire to touch water or be in water, could not go sockless (even on the beach), loved getting my hands covered in mud or Play-Doh or lotion, yet hated touching “sticky things,” or going on rollercoasters, or brushing my teeth or being a room with lots of noise was too much.

As both a kid and an adult sensory issues can shift and change shape and appearance. Now that I know my dermotillomania is more an issue related to sensory processing disorder, I hope to find new and better ways to stimulate my senses, so that I can slowly move away from picking … because even though I do like it, I do not want to risk infections or scars.

If you skin pick, do you have any advice on getting over it? If you have sensory issues (regardless of what your other diagnoses may be), how do you satisfy “the itch” when sensory seeking? Tell us in the comments.