A Date With Dermatillomania

Driving out of the city on I-376, my iPhone alerted me to a hazard ahead with an irony the device did not understand. Instead, the phone assured me I was still on the fastest route. But I hated the speed of I-376 and particularly the resulting car accidents, which were almost never deadly, but drove me to the brink of panic attacks anyway.

My heart pounded as I approached the brake lights in endless rows ahead. Right hand on the wheel, my left hand flew to my scalp like a hawk diving in to snatch a chipmunk. In this kind of traffic, most concerned people kept both hands on the wheel, attention fixed on the road. But I had lots of practice panicking while driving, and my hawk could confidently go about its business and still avert collisions.

My left hand searched my scalp. The ideal piece of flesh was there, and I would not stop until I found it. At that point there were many options — holes I’d dug into my scalp with my fingernails. Some still oozy from earlier that day, blood crisping around my hair roots. Some scabbed over and reopened and scabbed over so many times they’d become like calluses, layered with scar tissue but still able to be plied and pulled. Some fresh new skin, maybe a raised hair follicle. Any perceived imperfection or tiny ordinary bump was a target. And soon I found all manner of skin to pick.

My hawk has a name: dermatillomania, excoriation, or skin-picking disorder.

That night I was on my way to watch a vampire movie at the home of my — what was he? Romantic interest? Friend? Sex partner? Love? At minimum, I knew he was, as my therapist calls it, a “hair guy.”

That is to say, my romantic-interest-friend-sex-partner-love enjoyed running his hands through my hair. I knew this because in the past, for no reason I can explain, my hawk had not been as aggressive in its intrusion upon my scalp as it was on the highway to Hair Guy’s house. So I had not been self conscious during prior rendezvous with this man. Instead, I’d allowed — even tacitly welcomed — him to touch my hair and head, and felt lusty and not at all humiliated.

But knowing the hazard ahead, seemingly foretold by my phone, that in less than 30 minutes Hair Guy would touch my head again and the horrors I’d feel as he did — his fingers tracing over new and repulsive terrain — wasn’t enough to stop me. I carried on as if I’d found myself at the front of the line at a free all-you-can-pick strawberry patch.

A half hour later, the vampire movie having been sidelined, I was in bed with Hair Guy. As he ran his hands to the back of my head, which, in the two weeks since he’d last felt it, had become cratered and crusted as the moon with bonus lava pits from my handiwork, I had to tell him. I had to give him an out, a chance to suggest we watch that blood-centric film instead.

I bolted upright on his bed, put my hands around his and moved them as gently as I could from my head. “I have dermatillomania,” I cringed. He pulled back, as anyone would. But his voice stayed even, “I don’t know what that is.”

Not surprising.

“It’s more common than you might think,” my therapist had offered in one of my sessions. I suspect she was just trying to make me feel less gross than I do. The Cleveland Clinic estimates a little over 5% of people have the condition. But perhaps dermatillomania is underreported and many more people secretly have it. It seems to me few people would want to admit dermatillomania to a professional, let alone describe an invisible bloodthirsty hawk to their romantic-interest-friend-sex-partner-love while half dressed.

Still in bed with Hair Guy after my admission, I lost my words. I mumbled something about self-harm activating the reward center of the brain, feebly justifying why scraping my scalp until it bled was so hard to quit.

He didn’t recoil. He didn’t even flinch. He said, “This is a safe space, you can tell me anything, good or bad.” Maybe that’s because our pants were already off.

He scooped me back up and kissed me, preventing any more confessions from passing my lips. My embarrassment and momentary cynicism returned to desire. If I could have this man and my skin-picking addiction too, we could be a match divined by the gods. I’d hidden my disorder for so long — telling only my therapist and my mother — it would have been the sweetest relief to never lie again as I’d lied for the past 20 years.

My episodes of skin picking — I say episodes because there were long periods, entire years even, when I inexplicably didn’t touch my scalp except to wash it — began in my teens. They accompanied the onset of severe mood swings that were dismissed as hormonal at the time, but were an early sign of my later diagnosed Bipolar 2 disorder. Dermatillomania can occur with a mental health disorder or alone; one is not a symptom of another. That’s my understanding from therapy and internet searches. And skin picking, or any form of self-harm, can be exacted upon any part of the body. I feel lucky my damage can be hidden by hair.

Through the years, I’ve tried countless methods to break the habit. Cutting my nails short so it was harder to pick, getting a manicure I wouldn’t want to ruin, wearing a hat as a barrier to disrupt the mental zipline down neurological pathways when my hands flew powerlessly to my head. But I always managed to dig with short nails, to put my urge to attack my skin above my desire to protect a manicure, to tear the hat off.

My therapist encouraged me to choose something personal and sacred with which to associate and therefore stop my skin-picking. As a dog mom, I would never pick at my dog’s skin so why would I pick at my own? But it was too complex a thought for me to hold when the compulsion to pick showed up.

Even on my way to haircut appointments, I’d be in the car scratching and slicing, before I realized what I was doing on my way to where I was going. How many hair stylists have I lied to?

“I have psoriasis.” “I have eczema.” “I’m allergic to my new shampoo.” No one bought it. Some asked about the open wounds so they could avoid burning them with hair dye. Others apologized if they accidentally raked their combs over them. I tipped well.

Stress isn’t always a trigger as it was on I-376. Sometimes it’s boredom or an escape from darker thoughts. Other times it has no identifiable trigger at all.

My therapist and I thought maybe, just maybe, when Hair Guy walked into my life, the thought of him touching me would hold my hawk at bay.

It didn’t.

The best defense I can offer is the elation I feel when my nail first slices under the skin; the pain that makes me wince when my skin selection is very new, very large, or very hard to remove; the determination with which I work the skin, because I know the relief that’s coming; the pleasure of tearing that sticky patch out of my scalp and pulling it down along a strand of my hair until it reaches the end. It is loosed, and I am freed.

Hair Guy and I eventually fizzled out — while car accidents often can be avoided, certain human collisions cannot.

Still, I hold onto gratitude for a person who accepted me more than I could accept myself. He no longer has a multihyphenate description, but he is both a Hair Guy and a love. Because it takes at least a small measure of love to hold space for someone’s fear, insecurity, and the demons that haunt them. At least I know the hawk didn’t spook him.

I might never kick my habit. But I can open up about the hawk that will scratch, tear, and pull without warning, remorse, or regard for traffic conditions, until it has been satisfied by its unprovoked and unmitigated bloodshed. Hair Guy showed compassion for the hawk, no matter how vicious the hawk seemed to me.

Now I’m brave enough to call my hawk out of hiding in the forest of my hair, and make its presence known.