I was shocked when a number of friends reached out to me after I wrote about my skin picking disorder, saying that they suspect they have a skin picking disorder as well. Some folks who also pick at their faces, others who pick at their arms and legs, a few who tear up and bite the skin around their fingernails.
Maybe you yourself relate to the diagram above, maybe you are confused by it. Even if you are not someone with this or another disorder, if you are engaging in a behavior that you don't want to engage in at all, or at least it's more frequent than you'd like, and you are having trouble stopping, then that is a problem in your life (compulsive cell phone use, anyone??). Plain and inarguably simple. So I hope, as with all topics I write about, that my sharing can help a variety of folks, in some way.
And if your problem is more than just a little one, I recommend that you seek professional help. I've spent countless grueling hours and dollars gaining knowledge and tools from experts and from personal experience, and by all means, rake it in. But what I've received from working directly with doctors and therapists cannot be replaced by any blog. If you think you may truly have a skin picking disorder, or another BFRB (Body-Focused Repetitive Behavior)- which I introduced a bit at the end of a blog entry in the past- or any other habit which you are so caught up in that it is sabotaging parts of your life, please reach out to a medical professional. Truly. I know it can be a lengthy and daunting process to find the right person and maybe meds, and that access to care is not equitable. Perhaps it is some solace, though, that, nine times out of ten, some help is better than none. Also, as I've mentioned, skin picking was recently added to the DSM 5, the American Psychiatric Association's manual of mental disorders, so we know that the medical community is becoming more aware of it, and of related disorders. (It's even being featured in some celebrity-produced popular blogs!)
Important note for allies and supporters: sitting down to help research and call medical professionals is one of the most simple and concrete ways you can help a loved one who has a problem.
It's also important to note that skin picking, for me, is partially about my skin, but is also the output- the observable behavior and condition- that was cooked up with many other issues as the ingredients. These are specific to me (see my graphic above), but not unique (in fact, they are fairly common). You or other people, though, may have skin picking or another BFRB that results from autism, ADHD (Attention Deficit Hyperactivity Disorder), drug use, or hallucinations as a result of some serious mental illnesses. Point is, there's a wide range of folks who suffer from BFRBs, due to a myriad of reasons, and from various backgrounds.
If nothing else in my graphic applies to you, at least the human brain thing does. I'm sure you've experienced the feeling of a behavior providing you with some pleasure and satisfaction. The pleasure center of your brain has been lit up. Chemicals like dopamine and serotonin have rushed in. You've had an urge to repeat that behavior, to experience the pleasure again. Surely, we have to exert some level of control to stop doing almost anything that lights up our pleasure center. Eating potato chips is an example that resonates with a lot of people. And again, phone use. (The latter is an especially powerful one, as experts are specifically designing the hardware and software to manipulate your psyche and to activate that pleasure loop in your brain, and they're getting better at that every day.)
But back to skin picking. Just a few days ago, I heard my coworkers discussing the popularity of the YouTube videos of a dermatologist nicknamed Dr. Pimple Popper. It's just what you think. She records the work she does slicing, squeezing, and bursting all kinds of pussy skin bumps on her patients, and loads it on the Internet for the ogling satisfaction of hundreds of thousands. (Perhaps ironically, I have no interest in watching these). I think the fairly large universality of the appeal of skin picking means that many folks who don't have BFRB can relate to me and my condition a little more than they might relate to hair pulling (Trichotillomania) or even compulsive nail biting. This should make it easier for me to share about this, I guess...?? Anyway, so if satisfaction from skin picking is so normal, how do you know when your enjoyment of squeezing out your blackheads and whiteheads is no longer simply grooming? That's a hard question for me to answer for you, but I'm inclined to say, you'll know. Especially now that you are aware of the existence of these disorders. (When everything began in my teen years, I was not. I was convinced I was a disgusting freak with no self control, unlike anything the world had ever seen. It would have been nice if the Internet was around then, and I'd found blogs like this one).
Body Focused Repetitive Behavior disorders certainly involve a short-lived element of satisfaction and even sometimes enjoyment, (this is what separates them from behaviors associated with Obsessive Compulsive Disorder, which often involve no satisfaction- for instance, a person not being able to leave for work because they have to circle back to their street two dozen times to see if they've left a dead body in the road, because they are certain they heard a thunk when pulling out of their driveway). However, the satisfaction of picking or pulling a hair out is followed by an immediate "I need more", that is overwhelmingly powerful. We'll pick at anything- not just whiteheads and blackheads that are mature and "ready". And once a BRRB sufferer engages in more picking or pulling for a time, a trance-like state develops, during which we lose hours. After coming out of the trance-like state and surveying the blood, the wounds and the scabbing, the shame storm ensues. This stage is marked by horrendous feelings of guilt, panic, and self hatred. This stage can last for days, and is often especially powerful in the morning, when you wake and see a mirror or touch your face, and remember what you've done. This in itself can be a trigger for another picking episode. After awhile, often one can calm down and start making plans to achieve the goal of NEVER picking again. "That time was for sure the last time. I can never and will never do that to my body again." Maybe we'll even exact a punishment on ourselves to solidify the plan, and to feel like we are taking concrete forward steps. My punishments, as I've mentioned, were often "grounding" myself from a social event (which, if I really admitted, I wanted to skip anyway because I didn't want anyone to see my face).
In short, the stages are not subtle. The triggers can be a stressful day, a put-down from someone, the existence of a pimple, some alone time to process some thoughts about a long day, even a good day that causes excitement or nervous energy, and thus the need to perfect everything to make the day even better. But the other parts of the cycle usually aren't subtle. My pattern, which is a common one, looks like this:
If this pattern is not recognizable to you, though, and you still are worried that you or someone you know may have a BFRB, other red flags can include:
Also, this damn thing has been living in the draft folder for awhile, and needs to be set free. Monsters only live in the dark, right? Time to shed some more light on this sucker. (Note: Yeah, I've noticed that red line under "Dermatillomania" in the second diagram, that I forgot to get rid of. I'm going to leave it. An exercise in embracing imperfection seems appropriate here.)
Many of us humans spend an inordinate amount of time bellyaching over small decisions. We also spend a lot of time making the same mistakes over and over, having to spiral back to the same lessons repeatedly until we learn them. Allow me to free you from at least one issue tied up in both of these problems: Buy the damn concert tickets.
Just buy them.
This topic is a bit of a departure from my other posts, I know, and I'm sure you are all just dying to read part two of my skin picking story, but indulge me here. Because the universe is whispering "Buy the damn concert tickets" into my ear every day lately, even louder than it usually does. And so I'd like you, dear readers, to also benefit from that lesson.
Why should you buy the concert tickets? (Or gather around the street musician, or bring the guitar or the karaoke machine out onto your stoop, or go to the free outdoor show, or go to the sing-along musical at the movie theater, or go to the dance party at the festival, or go to the bar where your friend is spinning records).
Yesterday on my bike ride to work, I was listening to social worker and researcher Brené Brown's new book, Braving the Wilderness, which is basically a fiercely honest roadmap of the only way we might be able to dig humanity out of the mess of divisiveness we're in. I highly recommend it. I was listening with thoughts still lingering in my mind of my weekend of two amazing live shows- one of which culminated in the audience standing and singing We Shall Not Be Moved and Gracias a La Vida with Joan Baez and Lila Downs. (Not lying. I couldn't make that shit up.) It was a purely magical experience. I'd been thinking all weekend about how amazingly alive and connected I feel at shows. So much so that I was inspired on Sunday to commit a lot of money and travel a lot of miles to go with my friends to see Tori Amos play in Oregon in November. So I was riding my bike on Monday, and Brené's talking in my ear about the importance of connecting with strangers, now more than ever. The bridges that we can build with simple but emotional experiences. Then, like she's reading my mind, she begins talking about concerts. About all the studies indicating that experiencing music with others is one of the fastest, most powerful ways to build those connections. Music is so immediately visceral, it's no wonder it's one of the best and easiest ways to connect with strangers. To name and unearth our pain, and to experience joy. This information rings so true, because our hearts have always known it. Emotionally connecting with ourselves and each other is why humans make and share music in the first place, isn't it?
Soon after I arrived at work, I learned of Tom Petty's death. I thought of my brother and my friend who both saw him in concert recently, realizing a dream they'd long had. Of my friend's initial hemming and hawing over the price of the ticket, and how glad she was that she'd decided to buy it. (Even before he'd passed, but now more than ever.) I thought again of how I felt when Prince died, but mostly, of how I felt when he lived. Because he was truly alive. And he helped me and everyone around me to truly be alive.
And it was not lost on me that the Las Vegas tragedy was during a concert. The horror of it all. Was it made better or worse for people because they had experienced a heightened sense of love and connection with strangers, right before the violent hatred? Only the survivors can tell us. My hope is that their belief in humanity is kept afloat partly by some of the beautiful experiences they had, even immediately before they had one of the worst experiences imaginable.
I know that my own belief in humanity involves- requires, actually- dancing and singing and smiling and embracing. And all of that comes much more naturally when there is music.
So, buy the damn concert tickets. Buy them to support artists. Buy them because watching You Tube alone at home shouldn't be the only way you experience music. Buy them because it's called live music for a reason. Buy them because having something on the calendar to anticipate will immediately spike your happiness. Buy the tickets to the show because it is in line with your values of spending on experiences over material goods. Buy them because, of all the things you regret spending money on, going to a concert has never been one of them.
So, just buy the damn concert tickets.
Literally, for humans' sakes, buy them.
is a health-seeker and health educator living in the US in San Francisco, California. She is also a former (and maybe future) high school English teacher, and she loves words. Maybe health seeker looks better with a hyphen, or maybe it doesn't. You should just get over it. Even if she cannot.