'Help! I Can't Stop Picking At My Pimples!'

The next installment of Ask Ugly, my monthly beauty advice column for the Guardian, is here! Hi Ugly, I tend to get pimples, especially around my period. This is fine and normal. What’s not fine is that I cannot stop picking at them, making my skin irritated and red. It’s important to me to let go of beauty ideals: I don’t buy into the idea that skin has to be perfectly smooth to be beautiful, and I don’t mind pimples – but I do mind that I keep breaking my skin over and over, putting myself at risk for infections. And because it’s on my face, people can see this weird pseudo-mutilation. How can I stop picking? – Picky For the past 20 years – since I was 16 – I’ve compulsively picked out my eyebrow hairs one by one, trying to soothe some phantom pain in my follicles. My brain says the pain will stop once I pick the right hair, but then it turns out that there is no right hair, or maybe the right hair is simply the last hair. So I pick and pick and pick until my brow bones are nearly bald and sometimes bloody. Then I pick at the skin. And the scabs. And when the hairs grow back, I do it all over again. Which is to say, you’ve either come to the exact right person or exact wrong person for advice. I’ve tried to stop, of course. Iced the area to numb the urge. Basted my brows with Vaseline (maybe if the hairs are too slippery to pull…?). I’ve bought self-help books and fidget toys and joined a 30-day habit-breaking group online. If wanting and willpower were enough, I’d look like Brooke Shields from the forehead up. But I don’t, because the kind of picking I do isn’t a bad habit. It’s a mental illness. The condition I’ve been diagnosed with, trichotillomania, is a body-focused repetitive behavior (BFRB), a category of compulsive self-grooming actions that result in injury. What does all this have to do with you? Maybe nothing! But there is a related skin picking condition called dermatillomania. Obviously, I can’t diagnose you over the internet. (I’m an advice columnist, not a psychiatrist.) You say you “cannot stop” picking though, so it might be helpful to visit a professional and discuss your symptoms. BRFBs also include nail biting and cheek biting compulsions, and “can be on the spectrum of anxiety disorder”, explains Dr Amy Wechsler, a dermatologist and psychiatrist based in New York. They typically manifest “during periods of a lot of stress”, she says. Dermatillomania affects an estimated 2-5% of the population. For context, you probably know twice as many skin pickers as natural redheads – maybe more, since the shame surrounding self-harm often keeps pickers from reporting their symptoms. Diagnosis depends on frequency, severity and damage. Picking that’s sporadic or easily stopped is probably just “a bad habit”, Wechsler says. It enters disorder territory when the patient is “drawing blood, leaving scars or picking at an area that other people can see”, or if the behavior is uncontrollable and “getting in the way of their life in any way, socially or professionally or at school”. Whether your picking is a temporary habit or something more serious, meditation can probably help. (I personally go longer between brow-plucking attacks when I consistently practice deep breathing.) Talk therapy or cognitive behavioral therapy with a mental health professional can help manage stress too, says Wechsler, and anxiety medication is also an option. As far as surface-level solutions, Wechsler recommends treating the underlying acne that triggers the skin picking, since most patients in your position “will not pick if there’s nothing there”, she says. This might be an uncomfortable concept for someone who cares, as you do, about divesting from toxic beauty standards. But beauty culture is complex. Appearance ideals are never only appearance ideals; they intersect with health and hygiene, class and power, expression and autonomy. Addressing persistent acne, in this case, isn’t about submitting to someone else’s standard of “beauty”. It’s about reducing the harm – to your skin and psyche – of a condition you’re struggling to control on your own. The rest of my answer includes: hormonal acne treatment options how visible symptoms of illness can affect mental health the potential benefits of “restorative beauty,” according to NYC-based aesthetician Delphine Breyne my own experience with brow microblading as a “cosmetic coping mechanism” and more! Click through to the Guardian to read the full article (and if you decide to share it with friends or on social media or whatever, please share it via the Guardian link). Bonus! Here are some extra tidbits that didn’t make the final edit: I like to think of BFRBs as signs of a strong brain-skin connection. “On seeing the effects of our deepest thoughts seeping through our skin, Carl Jung, the legendary Swiss psychoanalyst, is said to have exclaimed: ‘Aha! A looking glass into the unconscious!’” Monty Lyman writes in The Remarkable Life of the Skin. Isn’t that lovely? GLP-1s like Ozempic and Zepbound are “being studied for just about everything,” Dr. Wechsler told me, including compulsive behaviors like BFRBs. Evidence of efficacy — empirical, anecdotal — is debatable, and I hesitate to suggest treating an anxiety disorder with what’s been compared to “an injectable eating disorder”, but it is another potential path for compulsive pickers to discuss with their medical teams.