Dermatillomania, also known as skin-picking disorder, has a remission rate of under 30 percent.
This reinforces the notion that dermatillomania is a hard-to-break, serious mental illness rather than just a bad habit. However, just because it's difficult to break out of the incessant cycle of picking, doesn't mean it's impossible for a strong-willed, committed individual with a strong support system to do so.
In this article, Picking Me Foundation intern Alyssa Debock will thoroughly outline several methods she has used to prevent and mitigate her dermatillomania.
Barriers
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Before getting ready for bed, try putting on gloves before entering the bathroom and using a makeup wipe. Make sure to wash the gloves regularly. You can also put on disposable silicone gloves before entering the bathroom and wash your face with them on. Wearing two pairs of the silicone gloves may further prevent you from feeling any triggering textures on your face.
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Depending on the fit, reusable silicone finger gloves may fall off while washing your face. What may help, however, is keeping them with you at all times, and forming a habit of putting them on when the urge to pick strikes.
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Putting bandages on usual picking sites and perceived imperfections can help prevent picking. Putting bandages on already-picked areas can help prevent further injury.
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Makeup wipes help prevent picking in a few ways. First, makeup wipes allow you to touch your face, but not directly, making the wipe a barrier. Rubbing the wipe on the face is also stimulating, which is beneficial for people who find relief or pleasure from the sensation of picking. Makeup wipes eliminate the need for a mirror, and can be used before entering trigger spaces. Makeup wipes are also commonly used, so when staying at a friend’s house, there is no need to feel uncomfortable. While there should be no shame in using any kind of coping mechanism, sometimes it is nice to avoid questions, or avoid worrying about having to explain anything.
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Face masks provide a dual benefit. Face masks do not allow one to directly touch the skin once applied, and also have the potential to improve the health of the skin. In addition to these benefits, self-care increases feelings of well-being.
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Thick scrubs can decrease the likelihood that you will feel bumps or other triggering textures on your skin. Scrubs also provide a competing stimulus, so you can focus on the feeling of the scrub rather than scanning for imperfections. Remember to choose a scrub that is safe for daily use because excessive exfoliation can be harmful.
Makeup
Wearing full coverage foundation is helpful even on days when you are just staying at home. While makeup can boost your confidence when you go out, it can also help you feel good while you are at home. After a picking episode, it can be discouraging to constantly see the effects. If the wounds are open, it is best to keep the skin moisturized and free of makeup. If the wounds are closed; however, foundation can be applied. One of the most important benefits of wearing foundation is that it conceals triggers. Not being able to see the imperfections decreases the likelihood that a picking bout will occur. In this way, the makeup acts as a barrier. Many people believe foundation increases clogged pores and acne, which would then cause an increase in picking. While this is true of some makeup, there are many non comedogenic foundations and concealers available. In addition to not clogging pores, a lot of makeup has ingredients that improve the health of skin. For example, many foundations contain SPF, which will help protect your skin. Sun exposure darkens marks from acne and picking, and increases the chance of scarring. Another benefit of applying makeup is the tactile quality. When applying foundation with a brush or sponge, a feeling is produced. While it may not be the same feeling as the one derived from picking, there is still stimulation that may provide some pleasure or relief.
Nails
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While picking is still possible with this method, keeping nails short can decrease the severity of the injury. Having long nails can help as well. If you are able, growing nails out to a very long length can deter picking for two reasons. Growing long, beautiful nails takes time and care. Therefore, when you begin picking with your long nails, feel them bend, and realize they may break, this may help bring you back to the present and stop picking. The second reason is that some people find that picking with very long nails is more difficult. When attempting to extract something from the skin, it is difficult to achieve with long nails that will break from too much force.
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Artificial nails can decrease damage from picking because the thick edge of the nail makes it more difficult to break the skin. It is also harder to extract anything from the skin or pick off skin because the nails make grabbing small things difficult.
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Another method involving nails is to paint nails when the urge to pick surfaces. Clear nail polish is helpful if you do not like the look of nail polish (this applies to many men) or you are not skilled at painting nails. If your nails extend past your fingertips, also try painting some of the underside of the nail. By increasing the chance that the polish will get on your skin if you pick, the behavior becomes more aversive.
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Consider applying nail or cuticle oil. For example, before entering the bathroom at night, apply nail or cuticle oil. The nail and cuticle oils best suited for our purposes are those with a strong smell. The idea is that if you begin to pick, the feeling of the oil on your skin, or the strong smell of the oil will break the trance you are in, possibly allowing you to stop the behavior.
Competing Stimuli
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Fidget toys can be extremely helpful in preventing picking. Picking Me has a 21-piece bag of fidget toys. Each item provides a different sensation, and there is likely at least one item that can serve as an effective competing stimulus for each individual. Having 21 pieces to try is also helpful because if one piece no longer provides enough stimulation, another can be used.
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Another option is to use your own hands to produce a stimulus that will distract you. For example, you could try rubbing each finger against your thumb five times, and moving on to the next finger, maybe beginning with the pinkie on the left hand. This way, you can keep your hands busy and still feel something.
Reducing visibility
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Dimming or turning off lights in picking areas is helpful because if you are unable to see skin you would normally pick at, you are less likely to pick. Unscrewing light bulbs in the bathroom is also an option if you have multiple lights, but do not have a dimmer switch. This method is also helpful if you think your urge to pick will cause you to flip the light switch back on. Combining this with a trick to decrease your ability to feel bumps on the skin (gloves, fingertip covers, etc.) can help even more.
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If you feel the urge to pick, and you need to wash your face, try washing your face in the shower and avoiding the mirror before and after showering.
Time
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To take the previous idea a step further, try getting ready while the mirror is foggy after showering. The goal is to finish doing everything you need to do in the bathroom before the mirror becomes clear again. This will direct your focus to the challenge rather than the picking behavior. Less time in the bathroom (a common trigger area for those with dermatillomania) can translate into less time picking.
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Another way to use time to your advantage is to time yourself when getting ready for bed and washing your face. Each day, you can set a new goal. Maybe begin with a realistic goal like thirty minutes and gradually reduce the time. Each day you successfully reduce the time, you can reward yourself with something small and eventually reward yourself in a larger way when you have made a substantial amount of progress. The key is to value even small improvements. Starting with a goal of five minutes when ordinarily you have spent hours in the bathroom is unrealistic. Being patient with yourself and being able to forgive yourself when you pick again is crucial.
Managing Picking Tools
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When not in a picking state of mind, it can be helpful to write down triggers. After creating this list, try to manipulate your environment to help further your progress. Specifically, eliminate objects that may encourage picking or are directly used for picking. For example, evaluate if you really need that sewing kit. If you are using the needles in the sewing kit to pick far more often than you are using them to repair clothing, maybe you should get rid of it. If you need tweezers for your eyebrows, but you also find yourself using them as a tool to pick, maybe keep the tweezers in a different room. Maybe keep them in a drawer and only pluck your brows when someone is with you in your room in order to make sure the tweezers are only used for that purpose.
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Although it can be scary to tell someone that you struggle with a BFRB, talking to someone you trust and asking for help can go a long way in furthering your progress. For example, if you live with someone, maybe ask them to knock on the door if they notice you have been in the bathroom for a long time. That knock on the door could break the trance you are in. Maybe ask that they keep the tweezers or scissors from you. This also ensures that you will follow through with the aforementioned goal of only using these potentially harmful objects in front of them and for their intended uses.
