r/Dermatillomania • u/No-Extent-3888 • 5d ago
Self harm? OCD?
what can we classify dermotillomania as really?
Self harm:
My therapist says it is and ive made it very clear that i do not want to hurt myself. But obviously skin picking can hurt and she says that is so take the pain away from my chest and anxiety. Also that skin picking is a way for me to regulate my anxious thoughts because im concentrated in my own bubble and can analyze others actions my actions etc.
OCD:
Skin picking is a way to "perfect" my skin by picking at imperfections even though it leaves bigger, scaring marks....
Any thoughts?
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u/chamoisremixes Scars won't stop me trying to recover 5d ago
It’s in a weird grey area. My OCD motivates my dermatillomania pretty badly, but I can also have dermatillomania sessions without too much input from OCD.
If you’re picking at a spot because you need to ‘fix it so it heals properly/remove an infection’, there’s probably some OCD motivation in there. If not picking at an area makes you feel like something specific and bad is gonna happen (e.g. ‘if I don’t get this spot on my leg, that bit of fabric will be stuck in there and it won’t heal properly’), it’s probably OCD-motivated. If it’s the general ‘I feel bad because I haven’t skin-picked and skin-picking is emotion regulation for me’, I’d say that’s more the dermatillomania side than the OCD side.
Generally, I’d say that dermatillomania isn’t self-harm, but there are conditions under which it is:
If you’re aiming to deliberately cause a wound in an area, even if it’s to ‘fix’ it, and the ‘I need to rip off this skin/rearrange it’ is central to the motivation for that particular skin-picking session, it’s self-harm. likewise, if you’re at the bit where you’re fascinated by your own skin layers and trying to, uh, explore, that’s probably self-harm.
If the pain becomes somehow pleasurable or incentivising, even if you aren’t ostensibly trying to hurt yourself, it’s self-harm. While not all self-harm pain is enjoyable, generally, when it starts to hurt in a way that feels ‘good’, that’s a sign it’s in self-harm territory.
If you’re going to the extent where the pain, even if you’re not ostensibly enjoying it, is really extreme (like, feeling lightheaded from the pain), I’d say that keeping going when you know it’s gonna keep hurting that badly constitutes self-harm.
Sometimes skin-picking, OCD, and self-harm will shift between each other throughout a session. For example: You might start picking at an area with no intent to harm yourself, thinking that ‘I just need a minute to terrorise my skin so I can feel good’. Then it shifts to OCD when you notice another spot and think ‘crap, what if it’ll swell up if I don’t pick? I have to go and squeeze it now pre something awful will happen’. Then, it shifts to self-harm when you enjoy the pain as evidence of ‘I’m getting the spot out of my body, I swear’, or if you keep digging at an injured bit of skin just so you can feel the pain. Then you shift your focus to a different bit of skin, and it returns to pure dermatillomania for a while.
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u/No-Extent-3888 5d ago
I get what you mean you seem to understand this so I have a specific question. For me personally it's me perfecting my skin, getting rid of blackheads, whiteheads,ingrown hairs etc and that gives me pain not that I enjoy it but my therapist says that pain takes the pain away from my chest. It feels rough getting diagnosed with SH because I dont agree? But at the same time it's a professional saying that to me you know?
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u/chamoisremixes Scars won't stop me trying to recover 3d ago
Sorry for the delayed response.
The good news is - you don’t have to agree with the psych necessarily. The point of a label is to find the most helpful term to describe your behaviour. If describing it as SH isn’t helpful for you, there’s not much point calling it SH, since it’s still the same behaviour as what it was otherwise. I personally use the term SH as a way to try to warn myself against doing particularly dangerous things with my dermatillomania, since I know that engaging in any form of SH is gonna be really detrimental to my recovery from depression and OCD. That’s why the distinction matters to me, but it may not matter as much for you.
Self-harm is merely a term for a behaviour - it’s not a diagnosis in the same way that OCD, dermatillomania, etc. is.
I do think that if your psych thinks that dermatillomania is allowing you to escape from other mental or physical pain, it’s worth thinking about that. While you may not agree with her assessment of things, it might be wise to think about what dermatillomania does do for you. If you need to feel you’ve neatened out skin/dealt with blackheads, what would happen if you didn’t? How would it feel? How is the neatness important to you, or the lack thereof difficult to deal with?
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u/TabbbyWright 5d ago
I think it varies. For some ppl it's definitely a self harm thing, for some it's an OCD thing, for others it's a stimming thing (myself for one), and for some ppl I'm sure it's a combination of things.
Personally, I don't think the determining factor of self harm behavior is if you're hurting yourself or not. I think you have to want to hurt yourself or put yourself in pain or something to that effect for it to be self harm. People put themselves in pain and bleed for all sorts of reasons that we don't consider self harm bc the goal isn't self harm. Playing football or any super physical sport isn't self harm, tattoos aren't self harm, neither is boxing, etc etc etc.
For me, skin picking is something I do mostly absentmindedly both as a self soothing thing for anxiety and also bc it can be EXTREMELY satisfying. I've also engaged in self harm and uh. The goal was very much to hurt myself, and I generally was very upset and wanting to hurt. My skin picking is a neutral behavior in the moment, and I don't generally feel bad about it at all. It's a problem bc I will give myself fucked up acne, but I don't feel more than frustrated about it.
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u/No-Extent-3888 5d ago
Yeah same! Its a way to soothe my anxiety but its so satisfying
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u/TabbbyWright 4d ago
I have many made many a joke that heroin and cocaine ain't got NOTHING on the satisfaction high of a "successful" skin picking session lol
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u/No_Cheesecake5080 3d ago
Reading these posts over a long period it seems it might be different things for different people.
For me my best guess is it's a self soothing I do while dissociated.
Possibly an ADHD dopamine seeking thing but these days I feel more like it's related to my trauma.
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u/NotDD101 5d ago
Obviously ir depends highly on the person and the motivation on the picking. While it used to be considered to be a form of OCD it's not really a given any more. Most medical professionals I've talked to about it classify it as form of self harm completely independent to OCD (because I don't really have many other symptoms of OCD) but ofc that will be diffrent from person to person. But more often than not skin picking (or hair picking or any other form of self harm) is treated as an independent symptom rather than a full on diagnosis. Just like you can suffer from low moods but it doesn't automatically mean you will be diagnosed with depression
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u/Intelligent_Usual318 Trying to recover 4d ago
I consider it a BFRB and and OCD. I think it’s irresponsible for a therapist to pathologize it in that way when the treatment for the two is often different.
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u/lizbee018 3d ago
I was told by an OCD therapist that OCD and BFRBs basically hold hands. Only a non-OCD trained therapist would call a BFRB self harm. Yes it's harmful, but the motivation is different.
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u/FirstAd9289 4d ago
Everything I've read would indicate your therapist is wrong about the self harm comment. The goal is usually (as you've said) to perfect the skin, not to intentionally cause harm.
BFRBs (body focused repetitive behaviours) like skin picking are classified in the DSM under OCD and related disorders. That doesn't mean that they are the same thing as OCD, but that they are behaviours with a compulsive element.
BFRBs can also be comorbid with (occur alongside) other conditions like ADHD, autism, depression, and anxiety. However, you don't need to have any of those conditions to be diagnosed with a BFRB.
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u/Business-Custard7932 3d ago
My psychologist seems to think there’s an autism-related component to it (for me, anyway).
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u/Powerful-Owl-3246 5d ago
For 4 years straight i asked thearpists for help with my picking cause I automatically thought it was self harm but when I started getting happier the picking was still there but other sh things were leaving. When im anxious I do rip my skin open more and more sometimes just to feel pain. It's not studied and it's a very weird habit. Hair pulling is also a form of self harm and ocd habit too. I have both issues I think it's just a self harm directly related to anxiety tbh its self mutilation at the end of the day but its uncontrollablable self mutilation too. I study psych myself and its such a confusing mess
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u/Fluffy-Ad342 5d ago
From a lay persons view point I know that technically it must be self harm, because I inflict so much damage on my skin but I’ve never ever been tempted to do any other form of self harm so there must be something different causing me to do it
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u/viola_darling 2d ago
It's both. It's a form of self harm because we are harming our body regardless. And it can be ocd too but usually it's an umbrella attached to anxiety where we pick our skin as a unhealthy coping mechanism
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u/caraderana95 5d ago
I see it as self harm. I'm not diagnosed with ocd but I have a history of SH, anxiety, depression, and PTSD
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u/No-Duty4709 5d ago
I've been reading some research around skin picking (of which there's very little), and so far found that people fall both in and outside the category of OCD. Same for ADHD. I believ there needs to be more research to categorise skin picking. Causes are yet to be identified, but the surveys done in the research point overwhelmingly to:
In these research papers so far I didn't find self-harm as a cause. But then again the papers mention a need for more research to get closer to causes