'MY SKIN PICKING FEELS UNSPEAKABLE'

Nail biting, hair pulling, skin picking – if you think these are just bad habits, think again. Here, one writer explains how it feels when your body becomes your battleground

On one wrist, I have a birthmark; on the other is a scab. It started as a mosquito bite, I think. I’d picked it until it bled, until it turned my brown flesh pink. Then, one day, I left my scab alone. And again the day after that. I left it until new skin grew over it. But this new skin is leathery and rugged; it has ridges and contours. My index finger pokes and prods roughness. I realise what’s about to happen but cannot stop it. ‘Please, don’t,’ I tell my nails as they angle themselves against my scar. ‘Not again,’ I whisper, as they pierce flesh. I close my eyes and work my nails under and around, pulling and twisting until the darkened leather comes loose and blood breaks free.

It wasn’t until my early twenties that I learned my compulsion to pick at my skin had a name. Skin picking disorder (also known as dermatillomania or excoriation disorder) is part of the family of body-focused repetitive behaviours (BFRBs), which includes hair pulling (trichotillomania) and biting your nails, lips or cheeks. There are few reliable statistics for their prevalence, but it’s thought that as many as one in 20 suffer – with skin-picking and hairpulling the most common. More women have them than men, while research suggests people of colour have more severe symptoms than white people; people of colour who pick their skin are more likely to have hyperpigmentation and keloid scarring, making the consequences of their picking more visible.

That this umbrella term features the word ‘behaviour’ means it’s all too easy to write BFRBs off as just that; bad habits, compulsions or tics. But from the physical scars left behind to the shame that accompanies an inability to prevent yourself from doing something that harms you, the repercussions can be debilitating. And yet, while I’ve managed to be vocal about my anxiety and depression, my skin picking disorder has always felt unspeakable. But if we’ve learned anything at all about stigma and mental health, it’s that it thrives in silence.

I want to understand what’s happening in my brain when I feel that urge to pick; to know what impact it’s having on my body and mind; and, crucially, if it’s possible to unlearn a habit that’s clawed itself deep into my unconscious mind.

The shame game

My earliest memories of skinpicking are shrouded in shame. ‘You are fearfully and wonderfully made,’ my mother would tell me, quoting the scripture about how we are delicately and purposefully crafted in the image of God. But as innocuous insect bites became raw wounds and hormonal spots became painful sores, my mother’s recital of that once comforting Psalm became a source of selfpunishment. God made me beautif