One of our clients with Skin Picking Disorder ( aka Dermatillomania ) recently wrote this essay about her long-standing issues with her dermatologist. She has asked to remain anonymous.
A skin picker’s relationship with their dermatologist is, to put it lightly, fraught.
It’s a vicious cycle:
The skin picker picks their skin.
The skin picker is unhappy with the way their skin looks.
The skin picker goes to the dermatologist.
The dermatologist, with the medical authority of a white lab coat, tells the picker:
The picker spirals into shame.
Next time there is a problem, the picker avoids the dermatologist.
Then, maybe, the picker’s picking results in an infection.
The picker remembers:
Those words ring in the picker’s head.
No way is the picker going back there.
All that waits at the dermatologist is more humiliation.
The picker puts it off.
So the infection gets worse.
This leads to more stress.
Which leads to more picking.
And on and on, down a deep dark hole of guilt and anxiety.
Not that I’ve ever done this. Of course not. A competent, intelligent person like me would never do something so irrational. But that’s what excoriation disorder does: it makes an otherwise rational person afraid of someone as benign as a dermatologist. I mean, these are the people to administer Botox to half of Los Angeles. How scary can they be?
Oh, by the way: I have done this. Many times. But I recently had the best dermatologist experience of my god-for-picking life.
It started with a couple of pus-filled whiteheads in my armpit. This was abnormal, but it was only a couple little guys so I didn’t think much of it. And naturally, I popped them. More sprouted. I popped those. They stung, they itched, they burned, and I kept popping them anyway. For every one I popped, three new ones would appear. I went on like this for weeks, avoiding tank tops and, of course, the dermatologist.
But I was in the middle of Cognitive Behavioral Therapy (CBT), working on being proactive about my picking and my health. So I bit the bullet and made an appointment. Then, I prepared for battle. I was not going to let this acne-slayer defeat me as I had been so many times before. I was strong, I was ready, and I was gonna go get those antibiotics, damn it!
It only took two changes to turn my appointment from a hell-scape to, you know, a regular doctor’s appointment:
- On my medical intake forms, I confessed that I was a skin picker. This wasn’t easy. I’d been accustomed to writing something vague about anxiety, glossing over the truth. But this time, I wrote something along the lines of “I struggle with compulsive skin picking / excoriation disorder / dermatillomania and have for years. I am currently undergoing CBT for it.” Boom. Done. Writing it down felt like the down coat in the blizzard I was about to weather.
- I brought up my skin picking first thing in the appointment. When the doctor asked me why I had made the appointment, I responded right away with something like: “I struggle with skin picking disorder. It’s something I’m in therapy to help, but I need you to know this: I know picking my skin is bad. I am trying to stop. But it is inevitably going to happen.”
To my doctor’s credit, she really listened to me. And because I spoke up, she was able to shape my treatment around the reality of my situation, rather than a wishful version of it. She treated me, not a person who could hear “don’t pick” and just stop picking.
In the past, I would omit the elements of my circumstance that I felt embarrassed about. And with nothing else to go on, the doctor would prescribe based on the story I told them. But this time I did not hold back. I told the truth, the whole truth, and nothing but the truth. And because my dermatologist had all of the information, she was able to prescribe medication that helped my actual situation, not the situation I wished I could be in if I wasn’t a picker in the first place.
It’s shocking that dermatologists are so uneducated about this disorder. I mean, all they need to do is a little googling. Come on! But given this fact, it’s up to the picker to do the work. My armpits (and my mind) are now free and clear because I educated them. I left the office feeling powerful. In the past, the dermatologist was guaranteed to send me into a spiral of shame. But this time was different. No spiral. No shame. This time, I came prepared, and it paid off.
•The OCD Center of Los Angeles is a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) and related conditions, including Hoarding. In addition to individual therapy, the center offers six weekly therapy groups, as well as online therapy, telephone therapy, and intensive outpatient treatment. To contact the OCD Center of Los Angeles, click here.