Here at CBSN, we often talk about the stigma that comes with BFRBs. Spread the Word. Break the Stigma. That’s one of our main taglines, but while we talk about stigma a lot, we don’t really speak about the different kinds of stigma.

I remember at one peer support meeting I attended, we were talking about this. Specifically how the stigma of skin picking is different than that of hair pulling. Not how it’s better or worse, just how it’s different. I remember the people there being shocked that there was such a stark difference in the stigma we face.

For instance, when it comes to hair pullers, people often assume at first glance that a person is a cancer patient or has alopecia. Don’t get me wrong, that sucks and is embarrassing because ultimately people are still staring and making assumptions, but it almost seems like, for the most part, people would feel more concern for someone in that situation.

For skin pickers, it is so much different. When people look at our marred skin they assume we’re drug users. While society has painted hair loss as being a symptom of cancer, society also paints picked up skin as being a symptom of someone on drugs hallucinating about something they need to tear out of their skin. Either that or the symptom of some disease that is seen as contagious.

Society doesn’t make it any easier when the beauty ideal is clear, perfect skin. Even the “real woman” advertisements exclude women with scarred or wounded skin. Freckles and moles are one thing, but scars and wounds are entirely another. We’re bombarded with skin care products, for both men and women, and words that tell us that anything less than smooth and even toned is unacceptable.

Over the 19 years that I’ve been personally dealing with dermatillomania, all the sideways glances at my skin have been burned in my mind. Even my most confident days can be ruined by someone looking just a bit too long. I feel the judgment searing into me, and wonder which option they’ve chosen for me: diseased or drugged.

In all honesty, it’s a sick feeling. It ruins the day, my mood, and especially my self-image. Most of the time I would rather just wear pants or long sleeves, regardless of the weather, to avoid it (although then people start asking about why I wear long clothing in the summer…).

What’s worse is that people have no filters or sense of boundaries. “What’s wrong with your skin?” has been asked of me more times that I can and care to count. If they can get past the disgust, if there is any (usually is), then comes the advice. Try this product. Use that method. See this doctor. Whether we’ve divulged the reason our skin is like this or not, these people have suddenly become experts in something they don’t understand. It can be anywhere from uncomfortable to irritating being stuck in that situation.

And if they’re the ones who don’t get over the disgust, then they avoid us. I can’t remember many instances of being outright made fun of for my skin and picking when I was younger, but I remember feeling ostracized because of it. I was the nice girl that everyone liked, but who no one seemed to want to be around. I wrote a lot of poetry in those days, and in too many of them I described people avoiding me as if I were diseased. Those thoughts destroyed me every day. This was before I even knew what dermatillomania was, and it became my internal dialogue.

Oftentimes, stigma feels external—something that is being imposed upon us. The truth is we can fall into that stigma trap, too, especially when we’re just as unknowledgeable as everyone else, and sometimes even when we are armed with the facts.

To this day, despite how much I’ve grown and learned, I still feel the stigma and shrink from it to some degree. People staring at the dark scars and Band-Aids makes my heart and stomach plummet. Like I said, which option have they picked for me: drugged or diseased? Which fate have they chosen for me?

Being on drugs or being diseased each carries their own sets of stigma; both more often than not are seen in a negative light. For drug users, we think rehab, relapse, lowlife, lost cause. For diseased, we think contagious, dangerous, incurable. The stigma that comes with cancer and alopecia is that these people need treatment, help, support, a cure. We run races for them and raise money. That’s what I mean about the difference between the hair-pulling and skin-picking stigma.

But in the end, we all face stigma with BFRBs. In all cases, we can be shunned, embarrassed, heartbroken and downtrodden. We can be spoken down to and negatively of because people just don’t understand. They all come with bullying and self-hate.

When we say break the stigma, we mean all stigma. The stigma that each of use faces with each of these disorders. The stigma that we’ve all shrunk under and cried over. The stigma that has the power to destroy us.

This is why we need to break the stigma. This is why we need awareness.