A Pound of Flesh: Discovering & Coping with Dermatillomania

My hand at rest with flowers.

I remember when it happened; I remember the moment I put my fingertips to my lips and bit down. In the beginning, it wasn’t the brown flesh around my nails but the nail itself, hard and almost always bare. I was coming in from recess as a child and noticed the little girl who would grow to eventually become my bully biting her nails in line. I don’t know why but I copied her and in a very childish game of monkey-see, monkey-do I started to bite my nails as well. Years later, I have no clue if she stuck with that habit but I do know mine evolved. I was no longer interested in slowly chipping away at the nails on my fingers, after all, I eventually wanted them to look good. I wanted them to grow, to be painted and slathered with polish. So I moved on and began attacking the skin around it, the skin I have been attacking for years. Excoriation Disorder or Dermatillomania is a mental and impulse control disorder that goes by a slew of names; skin-picking disorder, compulsive skin picking, psychogenic excoriation, and my personal favorite wolf biting. No matter what name you attach to it the outcome remains the same; the skin, your skin, will never be the same.

Occasional picking at cuticles, acne, scabs, calluses or other skin irregularities is a very common human behavior; however, research indicates that 2% — 5% of the population picks their skin to the extent that it causes noticeable tissue damage and marked distress or impairment in daily functioning. 75% of people affected are female. The behavior typically begins in early adolescence, although skin picking disorder can begin at any age. -bfrb.org

I have never had to think about my hands as much as I do now; like a palm reader fixated on one individual, obsessed with every line on a client’s palm, I know my thumbs quite literally in and out. “I hate seeing you harm yourself,” my ex-boyfriend tells me as he watches my fingers fall in and out of autopilot. The funny thing is, I have never considered this condition to be self-harm; we are told cutting is self-harm but this, this is merely another nasty part of myself. A wicked habit, one that requires several bandages and ointments to cover up. I am grateful it can be covered up at all; unlike my anxiety which I believe is high functioning (and something I have often tried very hard to hide from others), wolf biting is a beast that spills out from those hidden depths. It is a constant activity if you will, something I focus on and obsess over until I have gone too far and pulled too hard, giving the phrase “rough around the edges” a bloody new meaning. This ladies and gentlemen is how you tear yourself apart. This is how band-aids become a second skin. For years I was told it was nervous energy manifesting, giving a subconscious new life to my fingers and this made sense; after all I was almost always nervous. But what I didn’t understand was why my body would turn against itself in this way. Science tells us that energy can be neither created nor destroyed, meaning I must have always had this lingering nervousness and that it isn’t going away.

If you have not already guessed the following I will save you a further read now; this piece will offer no solutions. I simply do not have one, though I wish I did. I wish the silly putty, thinking putty, stress balls, worry stones and Band-Aids worked but they only provide a temporary relief and for a while you feel normal. Your fingers have something else to focus on and pull apart for a while. There are days I look down at my thumbs and the little pile of skin nearby and think “this is so gross, and you are not trying hard enough to quit.” Perhaps I am not trying hard enough, perhaps I just have to stop. In between writing this I have taken several breaks to pull at my skin and most of the time I am fully aware of what is happening. I think a common misconception about Dermatillomania is that the people who cope with it don’t realize what is happening. Like we are under a spell of some sort, one we have cast on ourselves that caused this. This is not to say that I never have days where I zone out and pick but, personally, I know how gross it is, how “cringe worthy” I must look. I am often embarrassed, but I can’t stop. There is no off switch, trust me if there was it would have been flipped years ago. Compulsive picking is never a want, no one wants their fingers to look like little piranhas have wreaked havoc on them. Looking down at your own skin and seeing something wrong with it, something flawed that you need to fix becomes a need.

My therapist has suggested I start asking myself why; why do I pick, what purpose does it serve? Questions I have never asked myself before, answers that have evaded me. I sometimes keep them covered (another suggestion) but that only draws more attention to the very thing I want to shrink away from. Unlike hiding my problem in plain sight, (admittedly a flawed plan but one that has worked in my favor) wrapping your thumbs can be just as gross as the act of pulling itself. We all know what flesh looks like after a Band-Aid, the word that is coming to me now is raw. It’s the prune skin from the water that took hold of you in the tub or during a long swim. Only this time there is no water to blame anything on. Earlier I stated that there will be no solution in this piece and I don’t take that back, I have not found anything that works for me yet. However, I can and will offer some advice to people who know someone suffering from wolf biting and a few ways they can help.

1. Telling someone to simply stop is counterproductive.

I know I need to stop, I know how bad it looks and feels (That sea salt body scrub you just bought? Yeah it stings and don’t even get me started on wearing gloves). Saying you need to stop does nothing and can often make the person feel worse than they already do because it is a unwarranted reminder that they are lacking self-control.

2. Be Gentle

If you are in a relationship with someone who has dermatillomania try to find gentle ways to postpone the inevitable. Hold a friend’s hand, carry band-aids, etc.

3. Know your limits

Getting treatment is ultimately up to the person going through it and sometimes that person is too embarrassed to seek help or show anyone. Helping them find ways to cope and encouraging them to seek help is a great start but understand that you alone cannot stop it.

4. Don’t make it a huge deal

Being visibly grossed out can cause more shame while pointing it out every time you hang out with a wolf biter can sound like a broken record. I have accepted this disorder as a part of myself and you should, too.

And to my fellow compulsive pickers, my werewolves who only hurt themselves, know that you are not alone or gross in any way. I am currently doing more research into this disorder to gain a better understanding and by writing about this I not only get to share something that only a few friends and family members know, but the act of typing keeps my fingers busy and the beast at bay. I will be ok and so will you.

Thank you to everyone who has ever shared their story, @littlemousedeer for editing and Aaron Stewart-Ahn for your kind words and thoughts.