One of the most challenging skin conditions is called "acne excoriee". It is more than a disease of the skin it is a DIS-EASE that is exhibited through behaviors involving the skin. It represents a dis-ease with your self and your life.
Those who suffer with this condition may or may not have true acne but find they want to "get to the root of the problem", "empty", "release" or "clean-out" the "dirt" and they carry a profoundly personal sense of feeling "gross", "unclean" or a host of other low self-image and self-worth descriptors. They will spend up to 2 hours in a trancelike state. Unconscious of the picking and subconsciously aware of statements like, "You didn't do that well enough today." or You should have done so much better." etc. And then feeling deeply guilty after the damage has been done and covering or "masking" with heavy make-up. The core of this condition is shame based. Shame is defined as a feeling of inadequacy mixed with the fear that some defect may be exposed to others. In this case it is ironically NOT the skin condition which creates the feeling of shame it is something much deeper. A core belief that was ingrained somewhere along your path and the person carrying it believes it MUST BE TAKEN OUT some how. Only they don't know that it is shame, they think it is imperfect/unhealthy skin.
The condition usually starts as a teenager when acne is present/or not and can follow a person through their lives. Some people actually see it throughout generations in a family. The Grandmother, mother and now daughter all admit to the behavior or some related behavior like an eating disorder.
Treatment can range from healthy skin CARE coaching like I do to anti-depressant medications prescribed by a psychiatrist. Sometimes both are required depending on the severity and willingness or more likely unwillingness of the person to want to change their behavior.
Anyone with this condition needs:1) a professional who understands the condition- not all do- even dermatologists have said on "it's just acne" when in fact the patient knew much differently 2) a professional who knows skin and psychology 3) good skin care practices 4) Behavioral and psychological "Tools" to change their behavior (KEY: Tools that work for them specifically.)
Each of us is unique in how we perceive things in our world. One thing to keep in mind is there is no judgement. The condition is a learned coping skill. There are other choices and when you are ready you will find your teacher. And you will STOP picking on YOURSELF.
This WebMD piece helped someone recently perhaps it will help you or someone you care about who has this condition.