Are You OCD About Your Skin?

You can't even see it — well, not really. It's a stealth invader hiding out on my chin where my lower lip casts a shadow and conceals it from the casual observer. But I know it's there, a throbbing bump that takes over my identity so that I feel like I am the zit. My fingers itch to touch it, and I think, A scab might be more noticeable, but somehow, might it also be better?

Still, I know — I know — that there's nothing productive to be done here. So instead of doing what I really want to do — squeeze that sucker into submission — I play by the rules: I wash and exfoliate my face. I slather on a healing mask with calendula and mint, which tingles in a good way, and follow it with an anti-redness serum and a brightening cream. My skin is now layered with agents of goodness that will do battle against the blemish for me.

And yet, my now-idle hands still twitch to take action, to go for the easy victory.

I've always been a picker. When I was younger, I was ruthless in my assault on scabs and bug bites, cuticles and callouses. Once, I bit off a wart on my thumb. As I got older, I moved on to pimples and pores, stray hairs and ingrown follicles. In an unfortunate eyebrow incident in college, I got overzealous with a pair of tweezers and had to suffer through months of appearing in a constant state of surprise.

But my picking wasn't something I gave much thought to until about a year ago, when an aesthetician gently suggested my tendency to squeeze and scratch at zits real and imagined might be something more than habit.

Medically speaking, compulsive skin-picking is known as dermatillomania. Holistic New York facialist Elena Rubin calls it skinorexia. "When an anorexic person looks in the mirror," says Rubin, "she actually thinks she's overweight." In the same way, "when someone is looking at her pores, she actually thinks there is something there" — debris, pus, bacteria — even when there's not.

It's this idea of distortion that really intrigues me — perhaps because I'm one of those annoying women who actually has fairly good skin. Even as a teenager, save the occasional angry red spot, I was blessed with a clear complexion. But when I look in the mirror, I don't see a glowy, healthy face; I see red blotches and dry patches, blackheads taking over my T-zone, and an army of tiny white bumps on my chin. And then I plan my attack, squeezing until my face is a puffy, scabby war zone.

And so I wondered: Was Rubin right about me and my skin scrutiny? Certainly, I'm not at the extreme end of the spectrum. I don't own one of those scary magnifying mirrors that makes normal-size pores look like ditches or count staring at my face among my daily activities. Still, I have difficulty leaving alone even the tiniest blemish, and an itsy-bitsy pimple can affect my feeling of self-worth — I feel less pretty but also less smart, somehow, if I wake up in the morning to find a pimple has set up camp on my nose.

Rubin's advice was to approach my skin from a position of love rather than hate, to honor my skin and, in so doing, honor myself. The first step was to see my skin as not just wrapping paper but as a miraculous organ (the body's largest), responsible for protecting against disease, regulating temperature, and flushing out toxins.

Phase two was to listen to what my skin was telling me: The small white bumps on my chin, Rubin speculated, were probably the result of warm weather, which causes oil glands to go into overdrive, producing congestion. The dark circles under my eyes meant that I needed more sleep — and less wine — and that red mark on my forehead, she explained, was on my bladder meridian, a sign that my body was fighting a urinary tract infection. (And she was right, as my general practitioner confirmed shortly after my visit.)

Once I stopped seeing my face as a battlefield and instead as a map for which I now had the key (or at least some semblance of one), my focus was to start healing my skin, saturating it with nutrients and vitamins instead of causing trauma by picking.

To get some more insight into my picking problem, I turned to Dr. Amy Wechsler, a dermatologist, psychiatrist, and author of The Mind-Beauty Connection, who argues that picking doesn't necessarily mean you have a distorted self-image — but if you do it every day, do it alone, create scabs, and cause bleeding, or if thoughts about it distract you from your daily life, you're dealing with something more than a bad habit. In these extreme cases, picking could be a symptom of something deeper: anxiety, OCD, depression, body dysmorphic disorder, or even psychosis.

For Wechsler, treatments run the gamut from sticky notes in the bathroom that say "Don't pick!" to therapy. In my case, she suggested countering breakouts with a proactive dermatological regimen — a response that would eventually mean fewer pimples, and, in the meantime, would make me feel better just by taking action. She also added that seeing a therapist wouldn't hurt.

Newly equipped with an arsenal of tools to fight my picking problem, I decided to give it all a go. Over the next few weeks, I took long bubble baths, gave myself at-home facials, and made a point to moisturize my entire body. I settled into a (mostly) regular beauty routine involving a variety of sumptuous serums and creams for day and night. I tried to understand what my skin was telling me — paying attention, for example, to how cutting out dairy and coffee from my diet affected not just my energy levels and digestion but also my skin. I made time for regular spa facials and I started seeing a healer — not a therapist, per se, but someone I could talk with about self-image as well as the anxiety, anger, and sometime depression that, nearly a year after I separated from my husband, persisted.

It didn't work right away. Often, I got lazy and skipped my morning ritual; several times, I started to pick and had to give myself a mental slap, followed (naturally!) by a mental hug. But I didn't ever let myself go full-on Jack the Ripper on my face.

Perhaps most important, I noticed a correlation between how I treated my skin and how I felt about it. If I stayed out late and stumbled home to bed, waking up with smudged mascara and smears of tinted moisturizer on my pillow, I knew I was going to have a "bad face day." A half-hour of pampering with scrubs and serums and tingly creams didn't ever get rid of the pimple, but when I looked in the mirror, I felt better: Prettier and, yes, smarter, too.