As a teenager, I struggled with moderate acne. Like many people with blemishes, I started picking at them. But what happened as a bit of a bad habit or an idle grooming activity turned out to be compulsive, repetitive, and consuming.

I often locked the bathroom door and sought release from an anxious day at school, heartbreak, or college application stress by hacking at my skin with my fingers until it bled. I also became obsessed with each and every blemish, learning its contours and digging into it with a vengeance. My scars became deeper and deeper until a dermatologist said they might become permanent (luckily, they didn’t), and the worse my skin got, the more I picked at it to relieve the tension.

Over time, I developed elaborate rituals to hide the scarring, and my behavior, as much as possible. Mirrors were the enemy; I closed my eyes while I washed my hands in public. I cancelled sleepovers so my friends would not see my scars and ask me about them. I rushed to the bathroom. I avoided late-night parties, group exercise, and dance classes where sweating might have been revealed my blemishes.

I also had a strict rule against photographs, as they might reflect the ugly truth about my skin, and my mental health , back to me. I even began to avoid watching television, because splashy, feel-good commercials for facial cleansers and creams were enough to send me. I felt out of control, and even worse, everyone could literally see it on my face.

Soon enough, every strong negative emotion became a trigger for a compulsive episode. Whether I was bored or anxious, depressed or angry, skin picking sent me into a sort of trance that offered a mild high and a chance to "purge myself" of what I felt was wrong with me. And because, as a depressed teenager, I was already dealing with low self-esteem as well as acne, my bouts of skin. / 47

I would struggle with compulsive skin picking to some degree for the next decade.

As a teenager, I was diagnosed with a skin-picking disorder called dermatillomania.

My parents were baffled by what they perceived as a simple bad habit, but still, they took me to a local therapist. I was diagnosed with excoriation (skin-picking) disorder, also known as dermatillomania. Dermatillomania is classified as one of several body-focused repetitive behaviors-a category of compulsive self-grooming activities that also includes trichotillomania, or hair pulling, and nail biting, among others. "Excoriation disorder / dermatillomania is a skin-picking disorder in which people are compulsively picking at their skin to the point where there is bleeding, irritation, and even scarring," says Catherine Silver, LCSW, an NYC-based psychotherapist.

Dermatillomania falls within the umbrella category of obsessive-compulsive and related disorders. In fact, about half of people with excoriation disorder also have obsessive-compulsive disorder (OCD), as I do. “Excoriation disorder is categorized as an obsessive compulsive behavior,” says Silver. “So there is a lot of overlap—mainly that there are compulsive behaviors that momentarily relieve stress or anxiety (even if it leads to more anxiety/stress down the road) and ultimately impact the person's quality of life.” Most dermatillomania patients are women, and many also suffer from body dysmorphic disorder (BDD).

Skin-picking episodes are often triggered by anxiety, stress, depression, or boredom, but also often lead to or exacerbate existing social anxiety, explains Silver. "Dermatillomania can contribute to social anxiety, because many people who struggle with skin picking also feel a sense of shame around it," says Silver. "They could avoid certain social settings (think going to the beach) or avoid getting into romantic relationships for fear of how people will respond to seeing these marks or scars."

There are many possible treatments for excoriation disorder, most notably cognitive-behavioral therapy (CBT) .

CBT for dermatillomania, according to the OCD and Related Disorders Program at the Massachusetts General Hospital / Harvard Medical School, might bring relaxation techniques for reducing stress and potential triggers for skin picking, (such as fist clenching) to excoriation.

Therapy may also include stimulus control, which focuses on making shifts in your immediate environment that will soothe your impulse to pick at your skin. For example, wearing gloves to prevent picking or playing with a fidget spinner to keep your hands busy. Developing mindfulness, too, can help, as many compulsive skin pickers go into a trancelike state or use skin picking to dull their senses (and their pain).

As for me, my skin-picking compulsions stubbornly persisted all my college years, but for the time being, OCD and my acne cleared with age. Still, I'd never had much of a skin-care routine, given that I was aware of anything to do with my face with emotional and physical pain. My relationship to my skin remained tense and awkward, marked by avoidance-like we were estranged co-parents rather than loving partners. Usually, I'd just swipe at my skin morning and night with a cleansing pad and look away as much as possible. Mirrors still activated memories of the obsessive pit I have fallen in for almost a decade.

Several years after the peak of my dermatillomania, I came across an article about 10-step Korean skin-care regimens. Given that I am prone to rituals and routines, I impulsively decided to give K beauty a go.

I was drawn to K beauty in part because of her reputation as in-depth and elaborate, a daily degree of rituals. I started my first Korean skin-care regimen with the basic mainstays of double cleansing, moisturizing, and sun protection. I used an oil cleanser, followed by a foam cleanser, essence, and SPF application. After seeing immediate results (brighter, smoother skin), I quickly graduated to full 10-step routine morning and night, adding toner, sheet masks, several different serums, face cream, and eye cream. I experimented with exfoliants and serums several times a week, and the sheet masks became a soothing bathtime treat. My skin is healthy and radiant for the first time in years.

This elaborate skin-care ritual, at first just a beauty experiment, suddenly changed my relationship with my skin in a visceral way. After years of doing the bare minimum in order to avoid painful memories of the worst of my depression or anxiety, and in order to evade the temptation to fall into my old repetitive behaviors. Instead of feeling like I was using creams or cleansers for the sake of having for me worsened my skin's imperfections in the first place, I felt like I was gaining some control over the look and feel of my skin. What's more, this was a ritual that was actually soothing and productive rather than destructive and triggered by anxiety.

As it turns out, this wasn’t just a fluke: Developing healthy self-care rituals actually makes a lot of sense, psychologists claim, when it comes to managing symptoms of excoriation disorder.

Silver explains, "When you are caring for your skin, rather than picking at it, it can feel like something you are investing in and want to take care of. It is also breaking the pattern of behavior and putting in a new behavior. For example, if someone finds that they tend to skin pick for 30 minutes at night, they might find it helpful to replace this ritual with a different, healthier ritual. "

Jana Scrivani, Psy.D., a licensed clinical psychologist with expertise in OCD and anxiety disorders, agrees, explaining that self-love can be essential to the healing of out-of-control body-focused repetitive behaviors. "Engaging in skin care might be an act of self-soothing for some, that would be helpful to manage an anxiety or boredom that could trigger a picking episode," says Scrivani. "For others, a skin-care routine might serve to increase their mindful awareness of their behavior towards their skin. Skin care is also an act of self-kindness and self-compassion. When people treat themselves kindly, they lead to further self-compassionate behaviors. "

Anna Prudovski, MA, a clinical psychologist and the clinical director of 70 Turning Point Psychological Services, adds that there are three potential benefits to a skin-care ritual for dermatillomania patients specifically. First, it can be a competing response. "A competing response training includes choosing a behavior or a situation that does not allow a person to pick," says Prudovski. Second, for many dermatillomania sufferers, a cycle develops. "The more the person picks, the more scabs / imperfections are formed; and the more imperfections the skin has, the stronger is the urge to pick, "says Prudovski. A steady skin-care routine can help improve skin, breaking this cycle by minimizing the imperfections and eventually the picking. Lastly, Prudovski says, "For me, that hope was everything.

As a teen and young adult, I never could have imagined having a positive relationship with my skin. Therapy and a regular K beauty. I had my skin-picking disorder.

In my early 20s, even the sight of my own skin was a reminder that something was “wrong” with me. K beauty made my skin into a canvas to paint on and a part of myself that deserved nurturing attention, not something to punish or scan for problems. In part due to my K beauty routine, I’m very rarely tempted to pick at my skin now, though I know that it’s crucial to manage my overall depression and anxiety—the underlying causes for my excoriation disorder—effectively in order to avoid falling into that behavior again. Skin-care rituals aren’t a cure-all for OCD or any other mental health issue, but for me, they did launch me on a journey of thinking more about how I can take care of myself rather than dwell on my existing flaws.