Dermatillomania is a Skin-Picking Disorder, but for Me it Was a Form of Self- Harm

Trigger warning: This article contains descriptions of self harm.

"Where did you learn to do that?" my mother asked. "Do what?" I answered, biting the nail on my pinky finger. She pointed at the finger between my teeth. For as long as I can remember, I've picked and bit my nails. Growing up, I didn't know how to cope with the stress I faced in a healthy way. Nail-biting was the only thing I knew to do — but over the years, my anxious habit spiraled out of control.

I’ve tried all the tricks in the book to combat my nail-biting and picking. When I briefly stopped gnawing at my nails in middle school, using a special polish to deter myself, my habit transferred to my scalp — I dug my newly long nails into where my hair grew. I also began picking at dry skin around my cuticles. Although I wasn't tearing away at my fingernails, the urge to pick was still there.

Symptoms, treatment options, and personal experiences for various physical, mental, and health conditions and concerns.

And the urge didn’t go away. In high school, I developed a new obsession with popping blemishes all over my face and body in front of the bathroom mirror, which evolved into picking at my face in general. During stressful periods in college, I'd wake up to find I was picking calluses from the bottom of my heels.

For most of my life, I thought nail-biting and picking was just a gross habit, like sneezing inside your shirt or picking your nose. After all, everyone has some kind of bad habit that would gross someone else out, right? And I knew other people were grossed out by mine — but no one was as disgusted as I was with myself. However, I now see this habit as more than just a gross one. For me, it crossed over into a compulsive and intentionally self-harming one.

I'd wake up to find I was picking calluses from the bottom of my heels.

In therapy, my urge to pick at my skin was identified as dermatillomania, or skin-picking disorder. As Suzanne Mouton-Odum, a Houston-based psychologist and scientific advisory board member of The TLC Foundation for Body-Focused Repetitive Behaviors previously told ishonest, in order to be diagnosed with dermatillomania, an individual must cause themselves repetitive injury to the skin through scratching, picking, or biting that results in an injury, with an inability to stop.

Once I recognized that I'm a trauma survivor dealing with anxiety, it's easier to see how I developed the behavior. The realization came in a therapy session, when my therapist noticed I couldn't stop twisting my ankle to the side against the leg of the lounge chair in her office.

"When I was younger, my parents sometimes fought while we all ate dinner," I explained when she pointed it out. "I’d twist my ankle inwards against the spindle of a dining chair."

I twisted my ankle, I realized, to give myself something else to focus on, to escape a distressing moment. I wanted to feel pain. Growing up, I thought it was my fault when my parents fought; I reasoned that they wouldn't have a reason to stay together if I didn't exist. They may not have been punishing me, but somewhere inside, I decided I needed to be hurt anyway. And unlike the pain I experienced through childhood trauma, I could be in control of this pain — like when I picked at my skin until it bled.

Dermatillomania and self-harm are not at all the same, but for me, understanding my behavior meant understanding the place where they overlapped.

"In dermatillomania, there is distress and inner tension, which results in a strong need to relieve the self from these feelings," Michaela Chatzimanoli, a counseling expert at skinpick.com, explained to me. "Touching oneself biologically, can bring relief, as part of grooming behaviors." The National Alliance on Mental Illness defines self-harm (NAMI), meanwhile, as "hurting yourself on purpose." According to NAMI, those most at risk for self-harm are people who have experienced some type of trauma, neglect, or abuse, and it's more common in adolescents and young adults.

Intent is the operative characteristic here; not everyone who struggles with dermatillomania means to inflict pain on themselves. "Someone can be riding the subway and picking at their forearm and not be conscious of what they're doing," Brittany Sherwood, a psychiatric mental-health nurse practitioner with Mental Calm, pointed out to me. "They don’t have the thought that, 'Oh, if I bite my nails, I am going to be less anxious.' But then, if they do bite their nails, they become a little less anxious through that habit. It's self-soothing."

While many of those who engage in skin- and nail-picking aren't mindful of their behaviors, often, I was — and I was trying to hurt myself with them. During low periods in my high school and college years, when I was overwhelmed with self- doubt and hatred, I'd pick and bite with bleeding as the end goal. Bleeding gave me an adrenaline rush like nothing else could; I consciously craved it, and the pain felt like an escape. Once I started bleeding, I didn’t know how to stop until all of the skin was picked or bitten away. People who self-harm with objects such as razor blades or scissors may struggle with an urge to keep going, much as I feel compelled to keep picking and biting.

The dominant narrative of self-harm often revolves around cutting, but once I saw nail-biting and picking through the lens of self-harm, it opened my eyes to other ways in which people can harm themselves. The College of Human Ecology at Cornell University says carving of the skin, subdermal tissue-scratching, burning oneself, banging or punching objects with the intention of hurting oneself, and embedding objects such as safety pins under the skin can all be considered nonsuicidal self-harming behaviors.

Once I saw nail biting and picking through the lens of self-harm, it opened my eyes to other ways in which people can harm themselves

I know I'm not alone: According to the American Federation for Suicide Prevention, in 2015, more than nearly half a million people visited hospitals for injuries caused by self-harm. To this day, I still struggle not to revert to self-harm habits, even though I now rarely intend to hurt myself. I know that there is hope, and that those who self-harm can heal. Mental Health America recommends medication, cognitive behavioral therapy, and interpersonal therapy as possible treatments for self-harm. I've found all three to be extremely helpful, but no single treatment is an end-all cure.

Understanding dermatillomania through the lens of self-harm has helped me become more conscious of my body and mind, as well as how I take care of both. When I feel the urge to pick or bite, I ask myself, "Why am I doing this? Is something bothering me?" This awareness is the first step toward choosing to do something else.

If you struggle with dermatillomania, self-harming behaviors, or both, help is available. In an emergency situation, call the National Suicide Prevention Hotline at 1-800-273-8255 or text “HOME” to the Crisis Text Line at 741741.

Additionally, Sherwood stresses that those who pick and bite their skin are more prone to infections since they are more likely to have open wounds. See your primary care doctor if you are concerned about any possible infections. Additionally, be sure to keep your wounds cared for and covered using basic first aid techniques.

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Now for a very different form of self-care:

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