Is skin picking a habit or disorder?

Some people take issue with me calling skin picking or hair pulling a habit.  They say these are disorders, not habits.  Often their intention is to increase visibility of the problems, so they get medical research attention and so sufferers realize they are far from alone.  I see their point in that they want to make sure we know a) a body-focused repetitive behavior (BFRB) is more serious of a bad habit than leaving dirty dishes in the sink, and b) you shouldn’t blame yourself if you do not know how to stop yourself.  I agree with both of those statements.

However, skin picking, hair pulling, cheek and nail biting behaviors do also fit the definitions of a habit.  True, they usually have the added intense nature of a compulsion, but so do many other things.  If cheese doodles are in my house, I feel compelled to eat them.  Okay, I realize that’s not a true compulsive behavior (for me), but my point is that a compulsion could simply be a very strongly entrenched habit.

Mental health professionals need to label BFRBs as disorders in order to discuss them scientifically, to get research money to study them, and to get medical insurance coverage for their patients or clients.  However, we can also call them something else if we want to.  Why would we want to call them something else?  Because of the nocebo effect.  The nocebo effect is the opposite of its better known relative, the placebo effect, which is when sick people get better, or feel less pain (whatever the medicine they are given is supposed to be doing), even if the medicine is a sugar pill with no healing properties.  The nocebo effect is when people get worse simply because they are told they are sick.  (Or when they get the "possible side effects", even when they are in the control group taking only a sugar pill.)  It has been shown over and over again in scientific studies to be a real effect.  For example, patients who are told they have heart disease die at a greater rate from it than those who have not been told.

There are many people who have been diagnosed with trichotillomania (hair pulling) or dermatillomania (skin picking).  I believe that many of these patients, in the absence of sufficient treatment (antidepressant medicine is not an example of sufficient treatment) feel more powerless than they did before they "knew they had a disorder", probably to the extent that their behavior gets worse just from being told something is "officially wrong" with them.

Do you need help stopping your habit, disorder, or whatever you want to call it? Check out my coaching programs.

Love and support,

Annette