How COVID-19 has exacerbated symptoms for those with excoriation disorder.
By Anne Kuckertz
We all remember when we were hit with some of the first safety recommendations back in March of 2020, wash your hands frequently, keep a distance of 6ft, don’t touch your face. And of course, the internet found a measure of pleasure from videos of public health officials warning against touching one’s face, and then--touch their face. We lightheartedly commiserated over our face touching struggles. But this public health recommendation holds more significance for some. For those suffering from excoriation disorder this warning was especially distressing.
Excoriation disorder (ED), also known as dermatillomania, is characterized by obsessive skin picking. Unfortunately, excessive skin picking can cause permanent damage to the skin. It puts one at a higher risk of infection, sometimes even resulting in hospitalization. Not to mention the psychological stress scarring can wreak. Sufferers may experience feelings of shame or fear of stigma so intense that they miss social events or call in sick for work. But for people with excoriation disorder, picking at their blemishes is a self-soothing behavior. There’s often a relaxed state one falls into when picking, like meditation or taking a bubble bath. Skin pickers frequently don’t even realize they’re doing it. They may absentmindedly pick, like fiddling with a necklace. Now add in a constant reminder to about touching one’s face, and the urge can become overwhelming. It’s like telling people not to think about a purple polar bear. Now we’re all thinking about the bear. Kayla Feldman, a woman who suffers from the disorder said that, as a person with excoriation disorder, being told to not touch her face was “pretty much the equivalent of asking a person with hay fever to refrain from sneezing.” So, asking people with excoriation to stop touching their face, (a place where people often pick) is an especially tall order.
And refraining from touching their face isn’t the only challenge Covid -19 presented to those with ED. Increased time spent at home means increased time exposed to common triggers. These are things that make the compulsion to pick stronger. It often can be as compelling as scratching an itch. Things commonly found at home like mirrors can trigger picking. It’s easy to catch a glimpse of a blemish in the mirror and be hit by on overwhelming urge to pick. Excoriation symptoms are also made worse by boredom and stress. Two things that are more than abundant during a lockdown or quarantine.
Another thing that became abundant due to covid was acne caused by masks, or “maskne”. This may simply be an annoyance to some, but to a person with excoriation disorder this is extremely disruptive. Every new blemish is a possible trigger. A point of permanent skin damage. And having open wounds while a virus that has killed over four million people, is never a good idea.
None of this is to say that we should stop wearing masks when needed or quarantining when sick. The benefits of lives saved far outweigh the costs. But what is needed is something that was lacking even before the pandemic, more research. Excoriation disorder affects at least 1% of the population (scientists believe it is underreported due to lack of awareness and associated shame). And yet, there still is no FDA approved treatment. Habit reversal training can help by increasing a person’s awareness of when/why they are picking and then working to address those causes. But there are still many unknowns when it comes to excoriation disorder. With severity of symptoms increasing, now more than ever we need to find better treatment options for those with excoriation disorder.
But while one waits for large scale research one should seek treatment based off the knowledge we currently have. If one has the resources, seeking a psychologist who specializes in excoriation disorder, seeing as there are still medical professionals who have never even heard of it, is a good idea. And with the rise of telehealth, geography isn’t necessarily a limiting factor. In addition to treatment, reducing triggers can also help. This might include covering mirrors and trying to find ways to safely spend time outside of the home as much as possible. Lauren McKeaney is the CEO and founder of PickingMe foundation, an organization that works to raise awareness about excoriation disorder. As a sufferer herself, she provides many resources including helpful tips. She even runs a virtual support group twice a month.
Despite determined efforts from advocates like McKeaney, the pandemic increased the toll y excoriation disorder. And has forced us to ask many with hay fever to refrain from sneezing.
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