BFRB Awareness!

I have picked at my skin for as long as I can remember, but it has escalated in recent years. It is hard for me to pinpoint exactly when occasional pimple popping turned into compulsive skin picking, especially since I lacked an understanding of the underlying disorder for so long. Excoriation disorder, also known as dermatilomania or skin picking disorder (SPD), falls in the category of body-focused repetitive behaviors (BFRBs), a group of disorders characterized by excessive, repetitive self-grooming behaviors that often cause physical harm and/or distress. Along with excoriation disorder, other BFRBs include trichotillomania (hair-pulling disorder) and nail-biting, among others. BFRBs are considered OCD-related disorders, because of their compulsive nature. Many people with BFRBs also have OCD, including myself, but there are people with BFRBs who don’t have OCD too. It is thought that up to 1 in every 20 people struggle with BFRBs, which is way more than the number of people aware of and diagnosed with these disorders. Awareness of these disorders is extremely lacking, even in the therapeutic world.

Picking at your skin isn’t a problem in itself. Lots of people scratch at scabs or pop the occasional pimple. It becomes an issue when this picking takes up significant amounts of time and causes significant distress. Compulsive skin picking has markedly impacted my confidence and fills me with so much guilt on a daily basis. The shame was even greater when I couldn’t even pinpoint what was actually wrong with me. I would promise myself every night that I would stop, that this would be the last picking episode, but it never was. Day after day, I created scars and scabs leaving my face swollen and throbbing. I couldn’t leave the house without spending significant time applying makeup and color corrector to cover up the damage I had caused. Skin picking makes it harder to focus in class or on homework, keeps me up at night, delays me in the morning, and just overall takes up a lot of time.

There are two different categories of skin-picking behaviors - focused picking and automatic picking. Focused picking is exactly what it sounds like, repeated picking in one specific area. Automatic picking often happens without conscious thought. It is sometimes referred to as “scanning” and involves running your hands/fingertips across your skin looking for imperfections, texture, etc. This might then turn into focused picking. I engage in a lot of automatic picking throughout the day and have urges almost constantly. Often at night, or other times when I am at home, I’ll engage in focused picking. This might be standing in front of the mirror and squeezing or scratching at one area/bump for minutes or even hours. It is so hard to stop once I have started picking. The thought of leveling or removing the imperfection is almost all I can think about.

I have done a lot of work to improve my skin picking, from trying countless strategies to behavior tracking to talking about it with my therapists. I have slowly noticed improvements in my skin and my ability to resist urges. Ultimately, it is a long, hard process, and I still have a long way to go. Self-compassion has been key for me. It’s really easy to get mad at yourself when you slip, but recognizing that recovery isn’t linear or perfect is super helpful. Being hard on myself only leads to discouragement and increased overall picking most of the time.

It has definitely comforted me to know that this is a real thing people struggle with. It is hard, and I’m not crazy for having so much trouble with it. My hope in sharing is to bring awareness to this disorder that so many people know so little about. If you relate to any of this, my messages are always open and there is help out there for you. You are stronger than even the strongest urges and compulsions.

A focused picking spot

Around when my skin picking was at its worst

My skin without makeup today. I still struggle with picking everyday but am doing a lot better than before!