it's not just a bad habit
Hello and welcome to my Action Project (AP) for my STEAM class called “Disease.” I wanted to start off by emphasizing how much I have enjoyed this unit and AP. For some context, this unit is focused on mental disorders, and our class used the DSM V as the basis for studying Autism, Schizophrenia, and Obsessive-Compulsive Disorder. We also looked at the different parts of the brain to understand how some disorders can impair certain aspects of one’s life. This unit was extremely interesting for me because I hope to work with children and become a child therapist. I was actually going to buy a condensed pamphlet of the DSM V, but in this unit, I was given access to a PDF version. Nonetheless, this AP was focused on a disorder of my choosing, which ended up being Excoriation disorder. There were a few other disorders I was interested in, but I felt that it might be overwhelming or triggering to research some of them. I decided on Excoriation disorder because I would actually like to talk to my doctor about getting a potential diagnosis. The activity I created for this skin-picking disorder is designed to help the reader understand the aspects of life with this disorder, as well as share additional resources. Now that you have some context about the unit and AP, here is some information to know before completing the activity:
The criteria for Excoriation disorder (as stated in the DSM V), is recurrent skin picking, attempts to stop, significant distress from picking, and is not caused by a substance/different medical condition. In addition to these criteria, it might be important to know that “three quarters or more of individuals with the disorder are female,” and “Excoriation disorder is often accompanied by other mental disorders.” I would define excoriation disorder as the compulsion to pick at the skin (healthy skin, scabs, etc) due to stress or other factors, but not a result of substances or other medical conditions. According to Mental Health America, “Excoriation disorder (also referred to as chronic skin-picking or dermatillomania) is a mental illness related to obsessive-compulsive disorder. It is characterized by repeated picking at one’s own skin which results in skin lesions and causes significant disruption in one’s life.”
Another relevant quote I found in a video by the famous YouTuber, Colleen Ballinger. She says, “It is very common to kind of pick at your own skin when you’re nervous or just fidgeting, that’s very common. But what makes this disorder different is I will do it obsessively and for hours until there is tissue damage, scarring, bleeding, gashes, wounds.. I’m emotional right now because it’s embarrassing, I just feel like I can hear the comments, I can hear people say ‘Why would you do that to yourself?’”
She also says, “And something that most people don’t know is that it’s usually accompanied by feelings of comfort, satisfaction.. Which is why it’s so hard to stop because there’s something about it that's satisfying and gratifying. But what sucks about it is the second the picking episode is over, there is an extreme amount of guilt and shame that you feel.”
As I mentioned, in class we studied several parts of the brain in relation to different disorders. In 2016, the National Center for Biotechnology Information conducted MRI tests to compare the brain activity of those who are/are not diagnosed with the “skin-picking disorder” (SPD). They found “abnormalities” primarily “outside the dorsal planning network” of those with SPD. The dorsal planning network, according to Science Direct, has to do with “a region of the frontal lobes that is most typically associated with executive functions..”. It is also “involved in the control of cognitive processes.”
Finally, the idea that excoriation is just a “bad habit” is what can prevent many people from seeking help. The compulsion and obsession surrounding this disorder can not be cured but requires treatment. It is different from not exercising or spending too much time on your phone. Treating this disorder requires different plans for each person, seeing as they have a unique set of “underlying causes” or “co-occurring disorders,” (The Recovery Village).
Sometimes I stare in the mirror and notice a pimple or blemish on my face. Like many other teenagers, I will feel inclined to pop or extract it. But do you ever pick at the small textures, scabs, or even healthy skin? If so, for hours on end, sometimes without thinking about it? People with excoriation disorder spend a significant amount of time doing so, and can’t stop. The sensations from picking at the skin can actually feel good, comforting even. This is because it can sometimes be used to cope with anxiety or other uncomfortable feelings. But afterward, the guilt is overwhelming. And, it can get worse if you tell them to just stop picking. Being a disorder related to OCD, there is an obsession and compulsion to pick at the skin. So when you tell this person to stop, there is still a drive to meet the gratification of picking. This person might even leave the room and continue picking elsewhere. If you decided to compare this disorder to other mental disorders, it might seem almost harmless. But the time that a person spends picking, thinking about picking, or trying to resist picking, can get in the way of school, relationships, and self-esteem. The skin picking itself can leave someone susceptible to infections. Since this disorder can be accompanied by other disorders, it is important to not dismiss it as a “bad habit.” This is what prevents many people from seeking help, and treating this disorder is not just about “stopping,” but rather addressing the cause of the picking and alternative ways to cope.
Works Cited
“8 Myths about Excoriation (Skin Picking Disorder): The Recovery Village.” The Recovery Village Drug and Alcohol Rehab, The Recovery Village Drug and Alcohol Rehab, 16 Apr. 2021, https://www.therecoveryvillage.com/mental-health/excoriation/skin-picking-myths/#:~:text=Myth%20%238%3A%20There%20is%20no,it%27s%20just%20a%20bad%20habit.
Contributors, WebMD Editorial. “Psychotropic Medications: Types, Their Use, and Side Effects.” WebMD, WebMD, https://www.webmd.com/mental-health/what-are-psychotropic-medications#:~:text=There%20are%20five%20main%20types%20of%20psychotropic%20medications%3A%20antidepressants%2C%20anti,many%20different%20types%20of%20antidepressants.
“Dorsolateral Prefrontal Cortex.” Dorsolateral Prefrontal Cortex - an Overview | ScienceDirect Topics, https://www.sciencedirect.com/topics/neuroscience/dorsolateral-prefrontal-cortex#:~:text=The%20dorsolateral%20prefrontal%20cortex%20is,Pathways%20in%20Clinical%20Neuropsychiatry%2C%202016.
“Excoriation Disorder (Skin Picking or Dermatillomania).” Mental Health America, https://mhanational.org/conditions/excoriation-disorder-skin-picking-or-dermatillomania#:~:text=Excoriation%20disorder%20(also%20referred%20to,significant%20disruption%20in%20one%27s%20life.
“Famous People Who Pick Their Skin.” Skin Picking Support, 30 Oct. 2021, https://www.skinpickingsupport.com/blog/famous-people-who-pick-their-skin/.
Georgoulis, Liana. “Break Bad Habits with Habit Reversal Training.” Anxiety.org, 12 Jan. 2017, https://www.anxiety.org/learn-how-to-break-bad-habits-with-habit-reversal-training.
Odlaug, Brian L, et al. “Abnormal Brain Activation in Excoriation (Skin-Picking) Disorder: Evidence from an Executive Planning Fmri Study.” The British Journal of Psychiatry : the Journal of Mental Science, Royal College of Psychiatrists, Feb. 2016, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4837383/.
“Pictures of Groups of People #2068122 (License: Personal Use).” Conversation Clipart - Clip Art Library, http://clipart-library.com/clipart/8iz4eGbip.htm.
“Premium Vector: Hand Drawn Vector Doodle Megaphone Illustration Isolated on White Background.” Freepik, 18 Nov. 2021, https://www.freepik.com/premium-vector/hand-drawn-vector-doodle-megaphone-illustration-isolated-white-background_20484559.htm.
Sasek, Zdenek. “Cartoon Drawing of Crowd of People Running in Panic Away from Man with Empty Sign Stock Vector - Illustration of Cartoon, Fear: 137571284.” Dreamstime, 25 Jan. 2019, https://www.dreamstime.com/cartoon-drawing-crowd-people-running-panic-away-man-empty-sign-cartoon-stick-figure-drawing-illustration-image137571284.
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