When Does Squeezing Spots Become Self-Harm?
It is 2015. A flash of skin is being prodded by latexed hands in a video on your Instagram feed, and if you linger too long, you’ll have a front row seat at the Dr Pimple Popper show – whether you like it or not.
After all, this was the year when, along with the likes of balayage and micellar water, dermatologist Dr Sandra Lee – known as Dr Pimple Popper – became one of beauty’s biggest talking points. Since then, viral clips of her in-clinic extractions helped coax the gross habit out of the privacy of bathrooms and onto our screens in the name of entertainment. To date, she has garnered 4.7 million followers on Instagram, while the hashtag #pimplepopping has logged 19.9 billion views on TikTok. She even has her own television show, and has since inspired a whole host of other similar social media accounts.
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Today, the act of squeezing spots – something we’ve all done – has been almost normalised within skincare routines. Experts may warn against the complexion-scarring risks of taking pimples into your own hands, but there is widespread acknowledgement of the allure. ‘It taps into the brain’s reward system, triggering spurts of the happiness-boosting neurotransmitters dopamine and endorphins that work to mitigate the minor pain,’ says Dr Yusra Alsaadi, head of aesthetics at HUM2N. Specific studies into these areas are sparse, she explains, but research into similar behaviours suggest that the generated ‘high’z provides momentary stress relief. It’s the same satisfying draw behind those stomach-churning clips on social media, with one study showing a spike in brain activity.
The trouble is that, for some, squeezing spots feels… well… too good. ‘The sense of calm it creates can be almost addictive,’ explains consultant dermatologist Dr Angela Tewari, who treats conditions, including acne, in private practice at GetHarley and via the NHS at King’s College Hospital. Indeed, the trajectory of that occasional guilty pleasure in front of the mirror turning into regular pimple-popping after a bad day is one I’m all too familiar with.
While some people wind down by sipping on a mug of chamomile or slipping into child’s pose during candlelit yoga practice, I’ve found that the fastest route to relaxation is by poring over my reflection. It started during my first teenage breakouts and would continue to happen as I got older, particularly during bouts of anxiety triggered by everything from school exams to work deadlines and relationship break-ups.
It turns out there’s a lot going on beneath the surface when it comes to spot-squeezing and stress-relief. ‘We know that the act of focusing on a physical sensation can distract people from emotional distress – offering a brief escape,’ explains Dr Aiza Jamil, a consultant dermatologist at Derm Solutions. That it also brings pleasure from the aforementioned neurotransmitters, she continues, means it’s a habit that can easily become ingrained as an effective way of zapping tension.
However, there’s something even more unique about spots. ‘It’s linked to a sense of control,’ notes Sara Waterman, senior aesthetician at Young LDN. ‘Watching pus ooze from a freshly-extracted pimple is the same as worries being expelled from the mind; it’s like the body is being cleansed of an "imperfection".’
Looking back, I can see the link between how the fingers that frantically trailed my face soothed me in the moments when my world felt as unstable as sand between my toes. What really pinched was my growing realisation that, while an estimated 54% of women over 25 experience breakouts, the majority could – unlike me – touch a bump on their jawline and be able to forget about it. After a picking session, I’d clean away the evidence and so all that was left was my blotchy red face and a feeling of deep shame. I’d then try to conceal my face from others using make-up or even stay inside, and I’d avoid looking at social media because I was so sensitive to the sight of so much ‘perfect’ skin, which did nothing except compound my plummeting self-esteem.
While I’m on the milder end of the scale – I have some faint scarring across my face that’s thankfully easily obscured by my beloved Tarte concealer and NARS foundation – for some people squeezing spots can manifest as something much more severe. Acne excoriée, which is characterised by the compulsive picking of pimples that leads to skin damage, is more common in women. ‘This is thought to be due to hormonal fluctuations and societal pressure related to appearance,’ says Dr Ifeoma Ejikeme, an aesthetic medicine doctor and founder of Adonia Medical Clinic. The condition is estimated to affect 3.1% of the population – but doctors believe it's significantly underreported due to lack a of awareness and the embarrassment of sufferers. Left to fester, it can cause inflammation, scars and pigmentation and has been linked with anxiety and body dysmorphia.
Some experts believe that repeatedly squeezing spots can even amount to self-harm – the pure definition of which is the direct injury of one's own skin tissues, often as a coping mechanism. ‘Although it’s at the milder end of the scale, it parallels other, more well-known forms of self-harm through its psychological underpinnings and the need for emotional relief,’ explains Dr Alsaadi. Some experts also put skin picking, called dermatillomania, in this category.
Exacerbating matters further is that taking a DIY approach to pimple-popping can risk worsening breakouts, in turn creating a vicious cycle that gets you further from a blemish-free complexion. ‘It fuels the sense of a lack of control,’ notes Dr Daniel Glazer, a clinical psychologist working in both NHS and private practice, with a special interest in trauma.
The sticking point is that if popping pimples is societally accepted as a guilty pleasure we all get up to in private, at what point does it border on problematic? ‘Occasionally squeezing a spot won’t cause significant harm,’ confirms Dr Ejikeme. ‘But frequent and compulsive squeezing can be a cause for concern – with skin damage a key warning sign, along with excessive time spent in front of mirrors and feeling emotional distress related to skin imperfections.’ The red flags that I now realise I was experiencing included an inability to resist the urge to pick my spots, secrecy around my behaviour and a reliance on it as a coping mechanism for stress.
‘It’s important to recognise and address behaviour like this early, in order to prevent long-term skin and psychological harm,’ insists Dr Alsaadi. A helpful first step is to try to understand the patterns of what’s prompting your over-squeezing in the first place. ‘Cognitive behavioural therapy has been shown to be effective in helping identify emotional triggers,’ explains Dr Glazer. ‘Self-awareness can help break the cycle.’ For instance, he notes that reducing stress through lifestyle changes can be invaluable – and I’ve found my compulsions have faded during times when I’ve prioritised a better work-life balance.
The next step is to develop healthier coping skills. ‘These are self-care rituals that meet the same emotional needs,’ continues Dr Glazer. For example, meditation, stretching and going for a walk are now glowing elements in my unlikely clear-skin toolkit. ‘If you feel the urge, count to ten first and you might find that the sensation has passed,’ suggests Dr Tewari. ‘I also find pimple stickers can be really helpful.’ What’s really important, adds Dr Glazer, is understanding that the road to recovery will be bumpy, and it’s important to practice self-compassion. ‘The goal is not perfection, but progress,’ he explains, pointing out that self-judgement will only fuel anxiety and make changes harder.
The healing process also, of course, involves the skin. Microneedling – enhanced with radio frequency and LED light therapy – can help reduce the appearance of scarring, says Dr Alsaadi. Then it’s about tweaking your routine to limit breakouts as much as possible, she says, with a tailored skincare regime that features gentle products. Some of Dr Ejikeme’s heroes in this regard include La Roche-Posay Effaclar Duo+, £20.90, Dermaquest DermaClear Pads, £33, The Ordinary Niacinamide 10% + Zinc 1%, £5, and Paula's Choice Skin Perfecting 2% BHA Liquid Exfoliant, £12.
I’ve been enjoying better skin thanks to thorough cleansing, plenty of hydration (hyaluronic acid has been a game-changer for me), a non-comedogenic SPF that won’t block my pores and acne-targeting ingredients like niacinamide and salicylic acid on ‘problem’ areas. Importantly, given that experts warn against at-home self-extractions full stop, I try not to squeeze at all. ‘It should be done professionally in a clinical setting, following sterile protocols,’ explains Dr Alsaadi. Just like I now leave my hair and nails in the trusted hands, it seems pretty spot on to give my face the same treatment.
After finally building a healthier relationship with my complexion and coming out the other side, I’m now viewing the skin-mind connection in a fresh new light. ‘Over-squeezing spots is just one of the things that underscores the intricate link between skin health and psychological factors,’ highlights Dr Alsaadi. The compelling evidence about the impact of stress on things like collagen levels and elasticity in terms of the ageing process may be of particular focus right now, but what feels just as pertinent to me is how the multiplying pressures of daily life can culminate in the compulsive popping of pimples before you know it – because, while it may seem small, the painful truth is that it can be hiding something far bigger.
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