Some bad habits get a little respect

  • Article by: MELISSA DRIBBEN , Philadelphia Inquirer
  • Updated: January 27, 2014 - 5:10 PM

People who twist their hair and bite their cuticles now have an official disorder, and more help in treating it.


Illustration by Mike Rice,

Photo: Mike Rice, Star Tribune

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Do you pick your skin? Bite your nails? Tear the calluses off your heels?

Then you’ve won a small, if bittersweet, victory.

Your condition, now known as “excoriation disorder,” made it into the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

The upside?

With this published acknowledgment, sufferers may now be eligible for health insurance coverage for the cost of treatment. However, they also run the risk of feeling pathologized for behavior that may fall within the range of normal.

When stressed or bored, it is natural to engage in some sort of self-soothing behavior such as twisting a lock of hair or biting a ragged cuticle.

“Any type of repetitive motor movement can calm people down,” said Doug Woods, director of the department of psychology at Texas A&M University and a national expert on body-focused repetitive behaviors.

Just how many people suffer from excoriation disorder isn’t known. A 2006 study of 1,300 college students at the University of Delaware found nearly 15 percent pulled their hair occasionally and more than 30 percent picked their skin, with women far more likely than men to report the behavior.

At least 4 percent of the population takes these habits to an extreme, said Woods, who noted the number could be higher because many are too embarrassed and ashamed to seek help.

“It’s a disorder. You keep quiet,” said Abby Shaine, 23, an aesthetician from Somerdale, N.J. Until recently, Shaine, who started picking at her face when she was 16, had never met anyone who shared the problem.

Incrementally, with help from social media, support networks, and references in the public sphere, Shaine and others are feeling less alone — and less odd.

“It’s way more common than people think,” said Shaine, who has found hundreds of kindred souls on Facebook pages such as the Dermatillomania Support Group.

Unlike those who cut themselves, people who pick and pull are not intentionally trying to punish or inflict pain on themselves, Woods said. Until these activities begin to hurt, they feel good.

There is a primal satisfaction in evening out the rough edge of a nail or peeling off dead skin. This behavior, Woods said, is similar to hair-pulling, or trichotillomania, another disorder in the DSM, the psychiatrists’ manual. You get tactile pleasure from the feeling of tugging on your hair, having the hair in your fingers, he said.

For some people, it’s unconscious. They may be watching television or reading a book and not realize their hands have been busily plucking until they see a pile of hair on the floor.

Pleasure, not harm

Others, Woods said, are fully aware and give themselves permission to indulge, even if they are conflicted about the outcome. “They may be feeling a negative emotion and wanting the pleasure.”

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