Skin picking and hair pulling need to be part of the mental health conversation too: ‘It consumed my life’

Trigger warning: Mentions of OCD and descriptions of skin picking and hair pulling.

It’s no surprise that mental health and physical appearance are intrinsically related. The recent self-care movement has taken this relationship to new levels, encouraging people to be open about their mental state and act upon whatever makes them feel better.

But what happens when what makes you feel better is actually only furthering worsening your mental and physical state?

Trichotillomania and dermatillomania, hair pulling and skin picking disorders, respectively, are often formed as coping mechanisms. In a twisted way, these acts trick the brain into releasing dopamine and offer a distraction from stress or boredom but then leave those afflicted further digging themselves into a cycle of anxiety and shame.

Skincare and haircare are often dismissed as being vain or superficial, but to victims of trichotillomania and dermatillomania — who are disproportionately more often male than female — they are a means of climbing out of the cycle.

Trichotillomania is a mental disorder, classified under the subcategory of obsessive-compulsive behavior, which involves the recurrent, irresistible urge to pull hair from the scalp, eyebrows, eyes and other areas. Dermatillomania is characterized as repeatedly picking at your own skin, which can often result in lesions, wounds or scars.

Both people with trichotillomania and dermatillomania report experiencing a deep sense of shame over their appearances and not being able to control themselves. The compulsive behaviors are commonly dismissed as not real indicators of deeper mental health problems. To an outsider, the answer might seem simple: Just stop picking.

Nicole Arzt, a licensed marriage and family therapist who serves on the advisory board for Family Enthusiast, told In The Know that trichotillomania and dermatillomania should be taken seriously and explained how brain chemistry is involved in the process.

“Often, the person suffers from an immense, uncontrollable urge that can only be fixed by picking a specific part of the body or removing hair,” Arzt said. “Pairing these associations time and time again only reinforces the relationship — the more you do it, the more the brain rewards you with feel-good hormones like serotonin and dopamine, both of which strengthen the desire to continue doing it.”

It almost seems counterintuitive that the brain would reward behavior that could be mistaken for self-harm — which trichotillomania and dermatillomania are not. It can certainly cause harm in the aftermath — both physical and mental — but the habits form as a way of coping with anxiety or feeling a lack of control, rather than inflicting intentional pain.

In The Know spoke to Dr. Anna Chacon, a board-certified dermatologist and an advisor for Smart Style Today, who explained how living with trichotillomania and dermatillomania can evolve into a deeper issue.

“[It] can be particularly debilitating and difficult to deal with or hide, particularly if the patient is not seeking or has not sought help,” Dr. Chacon said. “It can definitely make someone’s mental health status even worse, as both of these are physically noticeable to others.”

Reddit forums like IAmA and CompulsiveSkinPicking are positive outlets for people to discuss their struggles with people who truly understand. A big proponent of why these groups are so successful is because, as one user put it, the shame of picking forces most people into hiding their habits and never looking into why they do it. On Reddit, people can post photos and updates about their battles with picking.

Credit: Reddit

“I get so upset with myself, I feel the need to constantly hide my skin,” one person shared in response to a lengthy post about identifying skin picking triggers.

“I generally do it more when I’m stressed … or pretty much anytime when both of my hands aren’t occupied. Sometimes I don’t even know I’m doing it,” another said.

In The Know interviewed a self-proclaimed recovering skin picker, who wishes to remain anonymous. The individual is 25 years old with sensitive, acne-prone skin and has been dealing with dermatillomania since she was a freshman in high school — “maybe even before that, I remember my parents yelling at me to stop picking scabs on my knees when I was really, really young” — but didn’t know it was a diagnosable condition tied to anxiety until she was in college.

“One time out of frustration, after an hour of staring at my skin and poking at my pores with tweezers, I just Googled, ‘Why do I pick my skin,'” she explained. “That’s when a couple of articles about dermatillomania came up. It felt like such a relief. I couldn’t believe there were so many other people who did it too.”

It wasn’t an immediate fix. She said that it still took years after discovering it was a form of OCD to keep it under control. She had to throw out all of her “picking tools” — tweezers, needles, magnified mirrors — and still catches herself leaning over the sink to get a closer look at her skin.

“I really think it consumed my life for a period of time. I couldn’t see my reflection without noticing a flaw,” she said. “I was thinking about it constantly, even without a mirror nearby.”

In 2019, influencer Alyssa Coscarelli opened up about her own struggles with skin picking in an interview with Teen Vogue. Coscarelli — known to her 338,000 followers on Instagram as alyssainthecity — admitted that being a public figure made hiding her skin picking very hard. After years of dermatologist treatments and behavioral therapy, Coscarelli admitted that she’s in a much better place mentally, although she still from time to time feels herself running her fingers over her face to check for anything to pick at.

“When I’m alone and there’s a fresh whitehead, threatening bump, juicy blackhead or flake of skin, I feel triggered,” she told the publication. “I repeat to myself, You are more than your skin. Be kind to your skin and it will be kind back.”

Right now, the chosen method of dealing with trichotillomania and dermatillomania is cognitive behavioral therapy (CBT). Patients are trained to redirect their thoughts and develop new ways to deal with stress and boredom through a series of CBT sessions.

“I felt too embarrassed to even tell dermatologists and therapists,” the recovering 25-year-old told In The Know. “I wanted to scream when someone would tell me, ‘Stop picking!’ It felt like a very lonely battle.”

“Patients should never feel judged by what they need to do to feel better,” Dr. Chacon told In The Know.

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