What is dermatillomania and why obsessive attention to one’s own skin can become uncontrollable

What is dermatillomania and how does it manifest?

Experts call dermatillomania obsessive behavior aimed at the skin: scratching wounds, squeezing out inflammations, combing uneven skin, picking off hangnails, biting the lips and cheeks from the inside.

There are actually many more such examples - they all belong to a large group of body-focused repetitive behavior disorders (BFRB - body-focused repetitive behavior). Along with dermatillomania, it also includes trichotillomania (uncontrolled hair pulling), onychophagia (obsessive biting of nails and cuticles), rhinotillexomania (the need to pick the nose and damage its mucous membrane).

With dermatillomania, open areas of the body most often suffer, or rather, those to which there is direct access - the face, head, hands. But it also happens that a person injures his back, chest, and the front of his legs.

Dermatillomania and perfectionism

The fact that people most often focus on exposed areas of the body has led researchers to believe that dermatillomania is triggered by the desire to achieve an ideal appearance (for example, to eliminate a certain “flaw”). As a result, comprehensive skin care can take on inadequate forms over time.

Ira Polevaya blogs about dermatillomania on Instagram. She has lived with the disorder for eight years and associates its appearance in adolescence with the attitudes of “ideality” that were broadcast by fashion glossy:

“When I was 10 years old, I started collecting women’s teen magazines, where all the models are presented with perfect retouched skin. So a strange attitude arose in my head: “I must have perfect skin, otherwise there is no other way.” To me, it felt like a vital commitment, like knowing how to breathe.

But at the age of 12, as luck would have it, I started getting small rashes on my face, and it knocked me off my feet. I decided to get rid of these “imperfections” on my own: I crushed them and pierced them. At the same time, I tried to treat my skin the normal way, but the sight of an unpopped pimple forced me to resort to the old “bloody methods.” This dragged on for 8 years. At 17, an exacerbation began: I picked my cheek very badly, a large pink spot remained, and I began to fear that it would always be like this. This means that I will never be able to get closer to a non-existent ideal.”

Other girls also agree with the idea that beauty culture, Instagram fetishes, lookism and other stereotypes around appearance can influence the development of dermatillomania in adolescents:

“Photoshopped photos can create the erroneous impression that everyone around you has perfect skin without flaws,” says Yulia.

But the idealized image of skin in popular culture is just the tip of the iceberg. Researchers believe that the causes of dermatillomania lie deeper and have an individual background: the special biological sensitivity of the nervous system and anxiety that arises in childhood.

Symptoms

The main manifestation of growths is their unpleasant and repulsive appearance. But women will also be reminded of condylomas by other unpleasant moments. The time elapsed from the first contact-infection to the moment when condylomas become clearly visible can be completely different. Sometimes a week or a month is enough for condylomas to appear; in other situations, years may pass. The incubation period depends on the general health of the woman or man, their immunity, lifestyle, etc. Condylomas in women and men cause itching and burning in the genital area and near the anus. This occurs during the period of germination of condylomas; in the future, such symptoms may disappear. An increase in the amount of whitish discharge, sometimes mixed with blood and an unpleasant odor, provokes condylomas in women, which are localized on the vaginal mucosa or cervix. When condylomas are found in the anus, the passage of feces can injure them and cause ichor.

Dermatillomania and anxiety

The American Psychiatric Association considers dermatillomania within the framework of obsessive-compulsive disorder (OCD). The term “neurotic excoriation” is used, that is, uncontrolled scratching.

The consciousness of a person with OCD is guided by a closed chain “restless thought - anxious expectation - fear - habitual ritual - relief”:

1. The thought of imperfection fuels a chronic anxiety background, in which it is unbearable to constantly exist.
2. A person again and again resorts to a familiar ritual, because he sees this as the only way to at least temporarily get rid of painful anxiety.
3. And the usual ritual here is bodily obsession: only after exposure to the skin does the stage of temporary relief and internal satisfaction begin.
4. Then discomfort inevitably increases again, dissatisfaction with the condition of the skin arises - the chain closes and everything happens again.

Manipulations lead to the desired relaxation, but not for long: anxiety subsides only for a while, and feelings of guilt and shame for one’s own “weakness” and loss of control are overwhelming.

“When you pick, you forget. Afterwards the relief will not last long. And when you look at the spotty face afterwards, you ask, “Why again?” After all, you could just not pick,” and it became sad to look at yourself in the mirror” (Ilona, ​​24 years old).

The girl says that she often gets hung up on negative thoughts:

“Usually this happens if I’m driven for some reason. Or after a quarrel with someone, I may feel somewhat inferior. On nerves, so to speak."

Ulyana Kardashevskaya (18 years old) also associates dermatillomania with increased anxiety:

“For me, this usually happens after a difficult day or, conversely, before some important event. You walk up to the mirror, think you’ll just look, and don’t notice how your fingers have already noticed an unevenness on the skin. I think a difficult relationship with my mother, my low self-esteem and high anxiety played a role here.”

general information

Condylomas are a benign tumor formation that is “located” on the epidermis or mucous tissues and looks like warts and papillae. Single specimens (about 7 mm) or entire “colonial formations” (up to several tens of mm) of condylomas settle on the body of women and men and often resemble cauliflower in appearance. The color of these substances ranges from flesh-colored to brown. Condylomas are viral in nature, so such problems can even occur in children (during childbirth from an infected mother). As long as the growth has not reached the epidermis, the person does not pose a threat to others; the risk of infection increases if the growths are located in the epidermal layer. Condylomas are usually divided into two types:

• wide;
• pointed.

In the first case, condylomas in women and men look like a mushroom with a cap and a wide stalk and are most often a consequence of secondary stage syphilis. Condylomas of the genital type are transmitted through sexual relations; the human papillomavirus (HPV), which is activated under certain conditions, is involved in their appearance. The main location of genital warts is the genitals and oral cavity. Condylomas in women settle on the outer and inner parts of the labia, in the vagina, clitoris and anus. Warts and papillary growths in men select the glans penis and frenulum of the foreskin.

Dermatillomania as a way to survive violence

Nastya Simbirskaya also writes a blog about dermatillomania, in which she openly talks about the disorder. Its first manifestations occurred at the age of 6 years. According to the girl, in 20 years of living with dermatillomania, there was not a day when she did not touch her skin.

“This happened after my stepfather beat me for the first time. From that moment on, the punishments were regular; I could only distract myself by picking at my skin. And I began to understand that this was already a disease almost 20 years later. I thought I was the only one who was crazy.”

Psychoanalysts talk most about the relationship between skin diseases and traumatic memories from childhood.

According to their observations, the psyche of an adult is capable of regressing - returning to early childhood in order to act out the trauma that occurred not through the child’s fault, but which is still preserved in his unconscious.

And the younger the child, the more physical or emotional abuse will be imprinted on him. The psyche will not record actual memories, but bodily sensations and marks on the skin will remain for life.

“Since for me it is associated with domestic violence and with all the accompanying feelings during the 12 years that I was beaten, now I feel dermatillomania as a way to get rid of obsessive thoughts, emotional swings, fears, stress and suffering. The brain knows no other way to deal with these problems. It’s more convenient for him to cause himself physical pain than to experience psychological pain,” Nastya shares.

Who treats trichotillomania?

Regardless of the patient’s age, a psychiatrist must be involved in treatment. Of course, specialists of the relevant specialization work with children.

We know how to treat trichotillomania because we have been doing this for more than 10 years and we can confidently say: providing assistance and significant relief to people’s condition is possible!

Trichotillomania? We are ready to help you! Call us

Dermatillomania and the need to hurt oneself

Because dermatillomania affects the skin, the disorder is often associated with self-harm and the desire to intentionally hurt oneself. But in fact, the mechanisms of these two conditions are different.

Unlike self-harm, when a person intentionally causes physical pain to himself (for example, to cope with unbearable mental pain), dermatillomania cannot be controlled by the notorious “willpower.”

A person can cause harm to his own skin in a dream or, in the process, plunge into a kind of hypnotic trance and only then see with horror the result of his actions.

Elina Plance (20 years old) began to resort to self-harm after severe stress and quarrels in the family:

“I didn’t think about what was happening then. Now I understand that it was a cry for help due to broken communication with my parents. Alas, an unheard cry. This process distracted from feelings. I switched my attention from internal pain to external pain. This made me feel better. And from the feeling of punishment too.”

According to her, this happens consciously:

“It seems to me that I can even control it, but I don’t want to. In case of a breakdown, I emotionally go wildly destructive and do not want to save myself or feel sorry for myself. Well, emotion is followed by auto-aggressive behavior.”

Why am I doing this?

Many people understand that by not allowing their wounds to heal, they are only aggravating the situation, but obsession takes over.

Often this behavior is dictated by the desire to make oneself better, to remove imperfections, as if to get rid of an annoying problem.

But systematically picking the skin gives only imaginary relaxation: in fact, a person is worried about another, “invisible to the eye” problem, but since it cannot be solved here and now, the person changes the focus of attention to what he (she) is able to eliminate. Namely, visual imperfections of the skin.

“I do this when I’m not paying attention, when I’m bored, when I’m anxious, when I’m just irritated by uneven skin. I realize that the latter is my fault. But everything else is unconscious impulses,”

- writes Alaura.

Sometimes the cause of dermatillomania can be a person’s personal characteristics: pathologically altered character traits that interfere with a peaceful life (perfectionism, suspiciousness), or disorders (hysterical, anxious, borderline). Dermatillomania as a symptom of neurosis can be expressed in the need to constantly use your hands, calm your nerves, and be distracted by such a ritual.

Although dermatillomania can be a cause and consequence of body dysmorphic disorder (when a person is overly concerned about a defect or feature of his body), this obsession cannot be called self-harm. Injuries are a result, not a goal.

A person suffering from dermatillomania does not want to harm themselves, and sometimes the damage is unconscious , such as when a person scratches their skin in their sleep. Self-harm is an attempt to consciously hurt yourself, to drown out mental pain with physical pain.

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Dermatillomania and fear of judgment

An important diagnostic criterion for dermatillomania is preoccupation with causing damage. A person experiences a mixture of negative feelings towards himself (pity, shame, disgust, disappointment) due to the fact that he has lost control. Promises that this was the last time, that this will not happen again, are often not fulfilled - and the person is ashamed of his weakness, considers himself weak-willed.

As Nastya talks about it:

“Yes, at first the process is satisfying. But as soon as your consciousness returns and you see the result of your actions, a feeling of self-loathing, pity, powerlessness, apathy not only towards yourself, but also towards everything around you arises, aggression.”

Traces of dermatillomania - wounds and scars - provoke avoidance behavior and increase feelings of shame. A person in this state may withdraw, avoid public places, and experience difficulties in his personal life, work and friendships.

“With my brain, I understand that these [inflammations and traces of them] are trifles and people don’t care at all. They saw and forgot. But my sense of comfort does not allow me to take this calmly. I feel complex, I can’t leave the house without makeup,” Nastya shares.

“I know that they DO NOT CARE about my skin, but I still get stressed and feel awkward if a stranger is close and can easily see all my “imperfections,” says Ira Polevaya.

Dermatillomania and stigma

People with dermatillomania tend to deny the disorder to the last minute and attribute bodily obsession to a bad habit.

Advertising with photoshopped skin, taboo topics in the media, presenting information in such a way that it appears as if the person himself and his insufficient efforts to care for himself are to blame for imperfect skin - all this only pushes people to compulsively seek out and eradicate their “shortcomings.”

Elina Planze:

“Standards are a very narrow framework that not everyone fits into. Hence a lot of complexes, dislike and self-hatred. If a person is prone to this kind of behavior, all of the above can seriously undermine him. And in order to find relief, a person may resort to self-harm.”

Having imperfect skin is supposedly “unacceptable” from the point of view of beauty standards. Difference and dissimilarity from the person on the cover/screen/banner are unconsciously perceived as rejection in the social environment. You are different = you are a stranger. This can cause a lot of anxiety.

“I believe that the media should show different faces and bodies more often so that people do not strive for a non-existent ideal. When you see photoshopped skin, it seems that if you squeeze out a pimple, you will get the same one, but in reality you get a scar,” says Ulyana Kardashevskaya.

Dermatillomania is stigmatized, and it is shame that causes a person to remain silent and not seek help. It is difficult to explain to others (and most importantly, to oneself) why it is so difficult to control the obsessive desire to harm oneself.

Keeping the problem under wraps creates the perception that the disorder is rare. But, according to research, about 5% of people feel the need to harm their skin in one way or another, and this is one in twenty. It has been found that 3/4 of those who experience dermatillomania are women.

Treatment

Condylomas and HPV require a systematic approach to treatment.

Medication

To combat condylomas in women and men, doctors act in three directions:

• against viruses;
• in order to increase immunity;
• for fortification of the patient.

Cycloferon and inosiplex act against HPV activation and its reproduction. Inferon and allokin-alpha stop viruses and help restore the immune system. To improve the general health of women and men, Immunal, Amixin, Poludan, etc. are prescribed. A complex of vitamins and minerals is also an essential component of treatment for condylomas.

Local

Condylomas are successfully treated using ointments and sprays of antiviral action (epigen-intim, condylen, etc.). Women and men will not have to think about condylomas if they are treated with inquimod, podophyllotoxin. For pregnant women, you can use trichloroacetic and nitric acids. Women need to fight condylomas in stages: first remove them, and then, or in parallel, act to reduce the number of viruses. Often (in every third woman) condylomas enter the stage of relapse (especially if preventive measures are not followed and the recommendations of the attending physician are ignored).

Removal

Methods for removing condylomas in modern medicine are varied:

• Electric coagulation. This method has disadvantages - many contraindications, painful procedure and long recovery.
• Cryotherapy. Condylomas are removed using liquid nitrogen. The positive aspects of this technique are the absence of scars, painless effects, and the absence of anesthesia.
• Surgical method. The growths are removed during surgery, and stitches are placed at the site of the wounds. Doctors use local anesthesia.
• Use of chemicals. This method is contraindicated during pregnancy and lactation.
• Laser therapy. Condylomas are removed with a laser beam; this is a treatment that does not affect healthy cells and leaves virtually no scars.
• Radiosurgical method. The use of a special device helps remove condylomas without contact with the body. Removal of growths is accompanied by simultaneous sealing of blood vessels. This technique is one of the most modern and in demand.

How to help yourself with dermatillomania?

Dermatillomania is a reflection of internal problems, suppressed anxiety, aggression and a range of other emotions. It is pointless to treat only visible manifestations (damage or scars) if the behavior remains unchanged and the person will resort to the same way of responding every time.

It can be difficult to notice obsessive behavior, especially when it brings illusory comfort and is perceived as the only chance to cope with difficult emotions. But recognizing the disorder is the first and important step.

“I first learned about dermatillomania from the book “The Skin We Live In.” I was very surprised that this was a disease, and not just a bad habit,” recalls Inna (25 years old).

“Overcoming” the disorder in the usual sense will not work—the symptom cannot simply be removed from your head, like an annoying app on your iPhone. But it is quite possible to work with the disorder and find out what is hidden behind self-harmful behavior.

Some psychotherapeutic techniques have proven their effectiveness in the treatment of dermatillomania, for example, the dialectical behavioral approach or the habit reversal therapy method, borrowed from cognitive behavioral therapy.

Diagnostics

It should be noted that not every person who squeezes pimples is mentally ill. Dermatillomania can also be a separate pathology.

By seeking help from a specialist at the first stage of the disease, there is a chance to get rid of the problem in a short time. But this does not mean that any itching of the skin is already dermatillomania. In some cases, this is a simple manifestation of an allergy.

To accurately diagnose the disease, you should consult several doctors, for example:

• therapist;
• dermatologist;
• psychologist;
• psychiatrist.

After conducting the necessary examinations, doctors will make a general diagnosis.

How would people with dermatillomania want to be treated?

Environmental support is an important factor in dealing with any disorder. Dermatillomania has always been a taboo topic: it is not so easy in the era of eternal improvement and striving for the ideal to admit one’s imperfection.

“I would like at least someone to care what happens to me. So that close people who would notice that I have problems would try to find a solution with me (for example, support me in finding a psychotherapist). At the same time, I can’t blame those who think it’s just a bad habit. I myself once thought so, because little attention is paid to this disorder,” shares Inna.

Preventing HPV infection

Condylomas must be prevented by preventive measures:

• use of contraceptives during sexual relations;
• increasing immunity;
• proper balanced nutrition;
• taking vitamins;
• compliance with hygiene standards;
• fight against bad habits;
• increasing stress resistance.

Regular visits to the doctor are a good preventative measure. The use of antiviral ointments, as well as vaccination against HPV, is prevention that will make people’s lives full.