Content note: this article contains descriptions of skin picking and suicidal thoughts that readers may find upsetting. 

I have been scratching and picking my skin since I was five years old, but I didn’t know there was a name for it until I watched Rebecca Jane Brown’s videos on body-focused repetitive behaviours (BFRBs) – repetitive self-grooming disorders that lead to physical injury and damage to one’s body – when I was in college. 

Being told “the more you scratch, the worse it’ll get”, throughout my life, although logically true, was not (and still isn’t) emotionally helpful for me. If anything, my dermatillomania (also known as excoriation disorder) conjoined with my obsessive-compulsive disorder (OCD) – an anxiety disorder focused on specific thoughts or fears that lead to compulsive behaviours – led to a self-talk cycle of: this will fix it. My skin won’t be fixed unless this scab is nicked off. I won’t be fixed unless this scab is nicked off.

There’s a lot of shame surrounding this type of compulsive self-injury. The shame of it feeling good to scrape at my skin, especially if it’s a tougher abrasion to remove that would require a longer fingernail or a sharper tool – say, a safety pin or tweezer – to flick it off. The shame of watching the blood flow on my skin or the mark getting deeper or bigger. The shame of being wasteful with Band-Aids, tissues and stain remover for my clothes. 

As I got older, I thought the urge to pick at my skin would stop. When it didn’t, I felt awful for not growing out of it the way I should have. I tried to go days or weeks without scratching by clipping my fingernails or wearing specific jewellery that would distract me, only for the picking and scratching to become more severe due to restraining myself for so long.

Religion-related trauma came into play for my OCD whenever I internalised that how I felt on the inside reflected what was on my outside. If my outside wasn’t pure, what did that mean for my inside? Cleanliness is next to Godliness, right?

The more anxious I am, the more I scratch. In my pre- to early teens, I was struggling a lot with low self-esteem and suicidal ideation. When there was the pressure to wear more stylish and revealing clothes, it certainly didn’t help my self-esteem. 

During my mum’s second marriage, in my later teens, I was living in a stressful environment where domestic violence was present, and in a house with an occasional flea problem leading to flea bites – crater-like sores covered my arms and legs regularly.

There are still days in my adult life when I may not realise I’m scratching, but I know that I’m nervous in my body to the point where I need a repetitive movement that grounds me, and scratching becomes the first or last resort depending on the day. There have been bouts of suicidal ideation as an adult because I did not want to be alive in the mind and body that I occupy. The correlation between my dermatillomania and my OCD being at its most active when I am at my most suicidal is not a coincidence.

I can understand some people’s need to keep the two disorders separated. Not everyone with dermatillomania has OCD; some people pick their skin as a connection with body dysmorphia or attention deficit disorder (ADHD). Not everyone with OCD has dermatillomania or any one of the other BFRBs. However, for me, it is important that I don’t compartmentalise the two because I don’t want to place my mental health in a binary. Doing that forces a linear narrative of “first there’s A, and now there’s B” to make my mental wellness journey palatable for able-bodied and/or neurotypical people to understand, and that isn’t fair.

I am not cured of my excoriation disorder or OCD by any means. I am only learning how to live with it and manage it. 

Taking more of an ‘it is what it is’ approach has helped me to scratch less over time. A lot of my former sores have healed as lighter, or even nonexistent, scars.

I have three tattoos on different parts of my body, and an important rule for the tattoos to heal properly is not to scratch. Because these are very permanent aesthetic scars on my body with a lot of meaning to me – a cross with a dove in the middle, the phrase “carpe diem” with a semi colon next to it; and the phrase “…I’m still working on maintaining the will to stay alive for myself” – I considered it good practice to sit with the urges each time they arose.

I have found activities that are really sensory and make me have a positive relationship with my skin such as massage therapy and shaving. Well, shaving feels good as long as I don’t accidentally cut myself. That might spike my excoriation, but mostly in a way that makes me laugh. I’m inspired by people like Allison Raskin, who uses humour to talk about her relationship with her body and mental wellness. 

Finally, attending therapy biweekly and praying as a spiritual grounding technique rather than a tool to further repress my feelings helps me mitigate the interactions of my dermatillomania and OCD the most.

I’m going to be living with these disorders for a long time. And because life is long, I’m going to discover new things about myself or obtain new information about myself. I have recently been diagnosed with endometriosis, a pelvic disease that comes from abnormal tissue outside the uterus. That compounds my dermatillomania when I feel pain and anxiety, and compounds my OCD when I feel shame about the part of my body affected by my ovarian health. 

But as I continue to live with these parts of myself, I need to remind myself that these are not who I am. I can acknowledge what is there, but I am not my OCD or my dermatillomania. I am someone who is trying to stay alive in a world that has convinced me many times to die. I am someone who matters and who is still here feeling the feelings I need to feel. I am someone with a body that deserves love, support and respect. 

Frame Of Mind is Stylist’s home for all things mental health and the mind. From expert advice on the small changes you can make to improve your wellbeing to first-person essays and features on topics ranging from autism to antidepressants, we’ll be exploring mental health in all its forms. You can check out the series home page to get started.

Images: Kyle Warnock; Clarice Williams; Tadin Brego; Johnathan Hinman