I can understand why people would think dermatillomania is self-harm. Back when I was first trying to figure out this skin picking thing, I though it must be self-harm, too, but now I understand it differently. I used to think it must be self-harm since, really, what I’m doing is physically damaging. How could it be anything different?
What I understand now is that the two are not the same because the intent is different—the mental process behind each disorder is what differentiates them despite their many shared similarities.
Even the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, has the two as separate disorders, with dermatillomania being listed as Excoriation (Skin Picking) Disorder under the category of Obsessive-Compulsive and Related Disorders, and self-harm listed as Nonsuicidal Self-Injury under Conditions for Future Study (meaning it doesn’t have its own full-fledged diagnosis yet, but it is acknowledged that it needs one). When it comes to dermatillomania’s diagnostic criteria in the DSM-5, it says, “The skin picking is not better explained by symptoms of another mental disorder (e.g., […] intention to harm oneself in non-suicidal self-injury)” and the criteria for self-harm says much the same: “The behavior is not better explained by another mental disorder or medical condition (e.g., […] excoriation [skin picking] disorder).” In both cases, it is acknowledged that one is not the other even with any overlap there may be.
That’s because when it comes to dermatillomania, the intention isn’t to hurt oneself, whereas with self-harm it is. The injuries that come with dermatillomania are a by-product of the behaviour, which is actually trying to achieve something else. When aware of the picking behaviour (since it can also be done absent-mindedly), skin pickers are trying to get rid of an imperfection, like a bump, scab, pimple, blackhead, or even just a part of the skin that doesn’t look “right.” Self-harm is about the actual harm in order to try to feel better, feel something, or escape uncomfortable thoughts and feelings.
True, this can all get confusing since dermafolk pick their skin sometimes to escape these negative feelings or to negate them, but the picking still focuses on something “not right” with the skin and the feeling that somehow fixing that “not right” area will help improve things as a whole (or at least distract from whatever is going on). In this sense, both behaviours are coping mechanisms, albeit flawed ones.
It can get even more confusing because websites that post about self-harm, even medical websites, list skin picking as a form of self-harm (hair pulling, too, actually), but keep in mind, these websites are broad strokes in the discussion of these issues, that fail to specify the differences between self-injury and these body-focused repetitive behavioural disorders. They’re just lists without explanation or clarification, which can be and is misleading.
While the end results of self-harm and skin picking behaviours are similar—open wounds, a mess to clean up and feelings of shame and regret—self-harm and dermatillomania are ultimately different. If you’re picking for the sake of harming yourself alone, it may not be the case that you have dermatillomania after all.
If the line isn’t clear for you own personal situation and if you want proper diagnosis (since I’m just a blogger with dermatillomania and a copy of the DSM-5, not a physician/psychologist) then I’d suggest bring one or both of these behaviours to your doctor’s attention to try and get it sorted out.