The article has also been listed on the national CBSN website here.
Everyone has their own strategies for dealing with stress – some healthy and others less so. According to one Calgary psychologist, 5 to 7 per cent of the population deal with stress by picking their skin.
Dermatillomania, or skin picking disorder, was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in May 2013. It is classified as a body-focused repetitive behaviour, in which those afflicted spend a significant portion of each day picking at their skin to the extent of causing damage. In many cases, the face is the focus but it may involve other parts of the body as well.
Registered psychologist Dr. Corrick Woodfin is one of only three registered psychologists in Canada who openly treats the disorder and other related behaviours such as trichotillomania, or hair-pulling disorder. He says the relatively few methods of treatment and the stigma associated with skin picking disorder are what motivated him to learn more and how to help treat it.
“In a city the size of Calgary, we know that there are 20,000 to 30,000 people that experience skin picking disorder. That’s probably an underrepresentation, because people don’t tend to report it or seek treatment,” says Woodfin. He says that 25 per cent of his current clientele is made up of sufferers of the disorder.
Danielle Roberts, a Calgary-based freelance writer in her late 20s, has suffered from skin picking disorder for 11 years. It was triggered at age 17, when someone pointed out a spot on her shoulder and suggested that she squeeze it. That came during a time of turmoil in her life, and for Roberts, the mental reward and stress relief associated with picking the spot were instant.
“The sensations before picking can range from extreme and intense anxiety to being completely unaware of what I’m doing,” she says.
“While I’m picking, I am extremely focused on the task at hand. I’m remarkably determined to ‘fix’ whatever imperfection I’ve focused on. It feels so relieving when I feel that I’ve ‘fixed’ something, but afterwards, I feel shameful, ugly, and frustrated.
“Logically, I know that I’m not fixing anything and actually making my skin worse, but the impulse and belief are not ones I’ve yet been able to get away from.”
Once thought to have been related to obsessive-compulsive disorder, Woodfin says the origins of skin picking disorder are still being understood.
“The understanding that we’ve got is that it’s far more complex than simply an impulse disorder – in terms of etiology. We know that it likely has a genetic component. With research and our understanding now, this is very much a disorder in its own right,” says Woodfin.
He says that while individuals with obsessive-compulsive disorder hate the process of their impulsive behaviours, those with skin picking disorder find the behaviours pleasurable.
“Another idea is that it tends to run in people who have a propensity for addictions. If we think about the nature of the urges that people with this disorder have, you can argue that it has an addictive component, because the urges themselves are quite addictive in nature.”
Woodfin says that the challenging thing about treating skin picking disorder is that while the behaviour is used as a method of stress management, it can also function as a stress activator.
“It’s a very effective behaviour at managing all sorts of moods, and that in many ways is why it’s very challenging to treat.” At the same time, he adds, that’s why it’s a condition that can stay with an individual for life.
“The impact of body-focused repetitive behaviours like skin picking on the activities of daily life is huge. It can be extremely debilitating for people. The troubling thing is, there is a genetic underpinning to this, and we can’t modify our genetic makeup.”
Woodfin uses various treatments, not to “cure” his clients of the disorder, but to help them manage their behaviour. While historically habit reversal training was used to treat body focused repetitive behaviours, cognitive behavioural therapy is one of Woodfin’s main treatments.
“It takes a great deal of effort from the individual to want to try and manage this, but if they’re willing then what we can work towards is effective management, so that the client is aware of their triggers, they’re aware of what maintains the problem, and they’re aware of how to target it,” he says.
Although she has seen a therapist and was taking medication for a short period of time, Roberts has now learned to effectively manage her disorder through support groups and online resources. Skin picking disorder is still so unknown that the therapists she saw were initially unaware of the behaviour and its causes.
“While none of my therapists knew of the condition, they were extremely diligent in trying to grasp it. It was frustrating though. When you go in for help – especially when you’re paying for it – you shouldn’t have to educate the person you’re paying to help you,” says Roberts.
It was through online resources and forums that Roberts discovered the Canadian BFRB Support Network, a recently developed federally registered non-profit organization based in Toronto. Soon afterward, she began writing for the network because she wanted to raise awareness about the disorder.
She has also attended the network’s monthly support groups, and says that meeting others dealing with the disorder “in the flesh” for the first time recently has allowed her to realize how much in common she has with other sufferers.
“To finally vocalize the frustrations with others who understood, to be able to joke about it and provide hope for others, it was exhilarating,” she says.
“For me, I go to the groups to support others, as I’ve got a reasonable grasp on my condition. I haven’t yet needed the boost from my peers, but it’s great to know that they are there for me.”
Woodfin recognizes not all individuals with skin picking disorders or related behaviours are interested in seeking help from a clinical psychologist. He suggests doing what Roberts has done and says that’s an good way to manage the disorder on a personal level.
“If people think that they’ve got a mental health disorder and that they’re crazy, it’s going to encourage the stigma that people aren’t seeking support. I would direct people to websites and support groups within Calgary, and to really arm themselves with information about what this is and what it isn’t,” suggests Woodfin.
“Part of getting rid of the stigma is recognition that there is information out there that is helpful and supportive, but the first thing is realizing that you’re not alone.”