Content warning: Disordered thinking, compulsive behaviors, blood, self-harm adjacent material.
It is the middle of class and I am bleeding again.
I didn’t notice until I reached up to push my hair out of my eyes and felt a sting on my forehead, my fingers coming back slick and bright red. I do not remember the scratch. I don’t remember splitting open the scab again. All I can tell is that I am bleeding, unable to hide or run to the bathroom to wipe away the evidence.
For as long as I can remember, this constant urge to rip at my skin is something I’ve struggled with. When I was thirteen, I fell off a skateboard and scraped my knee badly enough to warrant stitches, though my mom just plastered a Band-Aid on it and sent me to soccer practice that night. For the next several months, I would continually rip off the scab as it healed. To this day, I have a massive scar on my right knee because of the months it took for the wound to heel.
No one seemed to understand that I didn’t enjoy the pain. I didn’t enjoy slowly covering my body in tiny scars. I didn’t enjoy having dried blood under my nails. I didn’t enjoy it, and I couldn’t stop.
***
Dermatillomania, formally known as “excoriation disorder” per the DSM-5, is a mental health disorder unfamiliar to many due to its lack of visibility and representation. The main symptom of the disorder is the inability to stop picking at your skin, which can lead to cuts, bleeding and scabbing, or the dreaded arrival of “skin lesions.” People will pick at any imperfection on their skin including freckles, scars, scrapes or scabs. In my current experience, as an adult, it usually starts with acne or blackheads and spirals from there.
A similar and more familiar disorder in the same category is trichotillomania, or hair-pulling disorder. This disorder is characterized by compulsive hair pulling. The two disorders can often overlap and coincide with other mental health conditions, such as anxiety.
Both are categorized as body-focused repetitive behavior (BFRB), which are further classified under obsessive-compulsive disorders. Notably, however, these disorders are not simply a manifestation of OCD, but rather separate disorders within the same category of compulsive disorders.
They typically manifest themselves during childhood or early teenage years, but I’ve had it for as long as I can remember. I remember my mother slapping my hands away from any of my cuts and scrapes since I was a kid. She sang a near constant refrain of “stop picking!” as my fingers edged closer to wounds that wouldn’t heal — that I wouldn’t let heal.
What distinguishes these disorders from typical scratching or skin picking that anyone can experience from time to time is that they are a compulsive, repetitive behavior that can cause clinically-significant stress. This means that I cannot stop myself from picking at my skin, even though I am aware it can cause scarring. Even though every time I do it, I feel a well of guilt and shame building up inside of me.
***
Recently, I got a haircut. I went from shoulder length hair to Emilia Clark-post-Game of Thrones hair in one sitting. What I didn’t know before going into the appointment was that at this particular salon, they wash your hair before they cut it — something different from my hometown hairdresser.
Horror slashed through my stomach when I realized what the hairdresser would see. Two bright red spots on the crown of my head that had been dry patches only a week ago, spots that I scratched at until they bled and scabbed and bled again and again. The entire time she cut my hair, it was all I could think about.
This stranger who was helping me change my entire appearance was going to see my most shameful secret. We share a lot of secrets with our hairdressers; they occupy an interesting place of intimacy with their clients. But I didn’t want a person I’d just met to know about this.
Luckily, she said nothing about it. Instead, she asked me about school, about graduation and about living in Ann Arbor. Still, I knew she saw the splotches, and I couldn’t subdue the shame and embarrassment I felt the entire appointment.
***
Dermatillomania is not a disorder we talk about. It is ugly and it is embarrassing, and we hide our wounds behind clothing or hair or anything that will prevent anyone from seeing.
In my entire life, I’ve only ever seen it represented in one novel — “The Damage” by Caitlin Wahrer — and even then, it was simply a stress-induced coping mechanism rather than the disorder itself. This severe lack of visibility has caused years of shame for me because I never knew there was a word for the compulsions I was feeling.
That being said, in recent years mental illness has often been romanticized or glamorized for audience enjoyment. A character in a TV show can only be struggling if they are doing it beautifully. The messy, painful and often ugly side of mental illness is hardly ever portrayed because it is not digestible to an audience.
And there is nothing glamorous or beautiful about ripping at your skin until you bleed.
And while these sorts of depictions are often baseless and shallow, we still see depression and anxiety being portrayed more often. We see depictions, though frequently misguided, of OCD and ADHD. While tainted by painful misconceptions, these disorders are visible nonetheless. They’ve entered a sphere of consciousness. But dermatillomania remains unknown and invisible.
***
One of the key characteristics of this disorder that separates it from everyday urges to rip off a hangnail or itch at a scab is the immediate and ever-fleeting endorphin boost we get after each go. Research suggests that, despite the physical pain the disorder can cause, picking the skin can result in feelings of euphoria or even pain relief in people who experience it.
On a personal level, this is something I can absolutely attest to. There are very few feelings comparable to what I experience when I successfully pick away a bit of skin — especially if it doesn’t bleed afterward. Picking at a tattoo in the process of healing, a sunburn peeling, or a freshly healed papercut all give me an emotional boost in the moment. But as soon as that moment is over, shame floods me again.
And yet, because it felt good for a moment, it reinforces the behavior. The cycle continues.
***
In April of 2021, I got a rather large tattoo as part of a half sleeve I’m working on along my forearm. Even though I’ve collected quite a few at this point, tattoos are hard for me. It is a dermatillomania gold mine.
As tattoos heal, they start scabbing over after about a week. Sometimes, if you’re lucky, the scabbing and peeling only lasts a few days. Sometimes, it can last more than a week. For this tattoo, because of the scab’s size, it lasted longer than any of my previous ones.
I knew when I got the tattoo that it was going to be difficult to resist the urge to pick at the healing skin. For most of the time, I tried to cover it with sleeves — it was early enough in the spring that long sleeves were still acceptable for Michigan weather. But a healing tattoo itches, and you forget that it’s there. You forget until you are absently scratching away lines of newly placed ink, black flakes suddenly under your nails.
Frankly, this is dangerous. Touching a tattoo that is in the process of healing like this can so easily result in infection. The tattoo becomes damaged, as does your skin. I knew this. I knew that my body doesn’t heal tattoos very easily and that infection was certainly likely. And yet I couldn’t stop myself from peeling away the healing skin.
Luckily, I didn’t get infected, but I did damage the tattoo. As a result of not letting it heal on its own, I have blowout — places where the ink has seeped out of the lines and pools under the skin — in two areas. I also have scarring — small areas where the tattoo is raised and does not sit within the skin, but on top of it. I love the tattoo, but I can’t look at it without remembering how I damaged it.
***
The areas I choose to attack change constantly. During this past summer, my face took the brunt of it. I have archived photos from Instagram, because no matter how many filters I layer over the image, you can see four red marks on my forehead and across my cheeks. During my first week of work back at the University of Michigan Slavic Department, I had three gashes across my forehead when I meet my new boss. I was wearing a mask, covering the additional marks around my chin and mouth, marks that only I knew were there.
But recently, I’ve gravitated toward my shoulders and back, an area never seen and easily covered. And maybe that makes this easier to discuss now. No one would know, just by looking at me, that the previous night I spent an hour meticulously scratching at tiny areas along my shoulder blades and down my spine.
Maybe it is because, for the majority of any given day, I don’t physically have access to most areas of my face. Wearing a mask, despite the inconveniences, has seemed to have a positive impact on this aspect of my life. Like many other people, I can hide away physical insecurities, which for me can sometimes include angry red spots on my chin or cheeks. Sometimes, it also means spots I’ve picked at can have a chance to heal before I have the chance to rip them open again.
And maybe, because I currently don’t have any bleeding spots on my face, I can think about this critically. I can write about it without feeling as much fear and judgment that I might otherwise have. But still, the shame persists, even when I wish it wouldn’t.
Statement Columnist Mackenzie Hubbard can be reached at mdhubb@umich.edu