Why Your Face-Picking Could Be a Deeper Psychological Issue

I have a dirty little secret, and it's not a pretty one to admit as a beauty editor. Often, I find myself nuzzled up to my bathroom mirror, nails clawing at the tiny whiteheads on my face or pressing aggressively against the "lurkers," those pesky, deep pimples that form under the skin. I've even gone after ingrown hairs. Sometimes, I play a game in the elevator of my building: how quickly can I extract pus from my zit as I travel from the eighth floor to the lobby?

After these face-picking sessions, I am left with a war zone: bleeding, scabs, and eventually scars. I don't even have acne. It's not about getting clear skin, as I am often going after clogged pores too small for a casual observer to notice. When my fiancé moved in and realized what I've been doing behind closed bathroom doors, he gently pointed out that I should try to quit the habit.

So I reached out to my dermatologist, Dr. Amy Wechsler, who is board-certified in dermatology and psychiatry. She's one of the only women in the country with these dual specialties — pretty badass! She helped make sense of why we do this, what it means for us emotionally, and how to stop.

"There are some people who are pickers," she explained. "They have something on their skin that is not typically there, so they try to pick or pop it off. Mosquito bites, scabs, pimples. Other people never touch anything on their skin. That seems to be something stable throughout someone's life — whether they are a picker or not."

Why do we do it? The short answer: "A lot of lives are relatively out of control," she said. "If there is something you can do to control your body or your life, intelligent people try to do it." She added that the habit is often linked to anxiety.

If you ask around or do a quick Google search, you'll discover how vast this issue is. POPSUGAR Beauty editor Emily Orofino admitted to me: "I'll spend hours sitting on the bathroom counter digging holes into my face. I've used tweezers and blackhead extractors to stab myself until something comes out. I don't feel successful until I am bleeding, usually. I've done some messed up things to myself to make me feel better, and I don't think it's just about skin."

POPSUGAR intern Ashley Cooke also opened up about her chronic skin-picking issue. "I have the OCD of picking my fingers," she said. "I have never known a time when I haven't had this issue. I have crazy scars and bumps on my cuticles and a bit of nerve damage. I have to wear gloves in bed, because I do it in my sleep. And I always have Band-Aids on me as it's the only thing that keeps me from scratching at my fingers."

Pimple-popping videos, showcasing pus oozing out of infected megazits, have been going viral on the Internet for the past year. Dr. Sandra Lee (aka Dr. Pimple Popper) has over a million fans on her YouTube page. There is a mass fixation around this sensitive topic.

"I think it's pretty strange," Dr. Wechsler said of the trend. "On the other hand, it's satisfying as a doctor to drain a big pimple, because you know you're helping the person." She prefers that her clients watch these videos rather than take on the task of doing it at home. "If they're getting vicarious satisfaction watching a big pimple pop, by all means . . . if it keeps you from popping your own."

Right after I got engaged, there was a very brief period of anxiety during which my fiancé and our families wondered: where and when will we have this wedding? It's one of the biggest decisions (besides choosing a partner) that the couple has to make. During that time, you can bet I had to use extra concealer to hide the damage I did to my face.

"When people excessively do something to their own skin, it gets them out of their head, so to speak," Dr. Wechsler said. "They get into a trance, a zone where they aren't 100 percent conscious or fully aware of the world around them. I've heard many patients say to me that they feel like they've been in the bathroom picking in a magnifying mirror for five minutes when it's been two hours."

Picking is a result of anxiety, and it can be a chronic, cyclical issue. "During times of anxiety and stress, they start picking more," she said. "And when the stress goes away or gets better, they stop. When the stress flares again — it could be months or weeks later — they do it again."

The pattern causes people to feel dejected, and it can damage self-esteem. "What's wrong with me?" is a common phrase Dr. Wechsler hears. "Afterwards, people feel so bad, like, 'I can't believe I did this to myself. I made my skin worse. It was healing. Now, I have anxiety plus this.'"

There are a slew of anxiety disorders linked to skin picking, including obsessive compulsive disorder and panic disorder. "It can also go along with depression or psychosis," she added. "Sometimes people are picking their skin because they believe bugs are in their skin, which is relatively rare. It's called delusions of parasitosis."

Good news: this is not an incurable issue, and Dr. Wechsler has actionable suggestions. "All of these different ways have helped so many people," she said. "I want people to know that they're not alone. This is not something most people who have a picking problem share with people in their lives. So they feel very isolated."

If it is an extreme case, she will send a patient to get cognitive behavioral therapy with a psychologist. This goal-oriented form of therapy helps people work through the underlying issues and change the way they think about situations.

But before you start calling your health insurance, there are at-home approaches to try. Dr. Wechsler recommends enlisting someone who you live with — a roommate, a family member, or a significant other — to make sure you're not locked in the bathroom scabbing up your skin. "The person doesn't have to be judgmental or mean," she said. "Just say to them, 'If I'm going to the bathroom, please time it and get me out. Knock on the door. This is my problem, and I need help.'"

If you live alone, put sticky notes in the bathroom — on the mirror or on the walls — with phrases like "Don't pick!" and "Keep my hands off my face!" According to Dr. Wechsler, it can jolt you out of your picking. You can also set a timer when you go into the restroom to remind yourself to get out quickly.

Dr. Wechsler also advises to throw out your magnifying mirror. "No one's skin looks great in a magnifying mirror," she said. "You see all kinds of things that aren't visible to the naked eye. A lot of pickers who have a real problem go after things you can only see with a magnifying mirror. That's so unhealthy and so bad for you. I had a patient once take a video of her throwing her magnifying mirror down the garbage shoot, which was great. She was showing me that she was doing better and taking the steps to really try to stop."

So you went after a few blackheads, and now your face is a crime scene. Dr. Wechsler offers next steps: "If you're already bleeding, make sure your hands are clean. Use tissues to pat the area dry, and then apply some sort of antibiotic, topical, hydrogen peroxide, clean your skin a bit. Don't use rubbing alcohol, it stings like crazy." Pick up some Neosporin at your local drugstore, and put it on the spot.

If you absolutely have to get pus out of a zit, try this method. First, make sure your skin is soft by taking a shower, washing your face, or putting a warm compress on it. Then, says Dr. Wechsler, "take two Q-tips and apply even, gentle pressure on either side of the pimple. You cannot hurt yourself with the Q-tip. If you apply too much pressure, you will break the Q-tips. If they break, just stop." But do not start with cotton swabs and then move onto your fingers. Putting tissues over your nails isn't a solution either. "Your fingernail is strong and hard," she warned.

While breaking this habit is not easy (trust me, I know), think about what it is doing to your skin in the long term. Investing in laser treatments and expensive brightening serums to remedy scars is costly and time-consuming. And if you think you have a deeper issue, contact your doctor or a mental-health professional for help.