picking for pleasure and pain: part 2

You:
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:

• Notable absences or tardiness. Skin picking and the aftermath eats up a TON of time. (I had near-perfect attendance in school all my life until the onset of this disorder, in 9th grade. I loved school and loved being social, but Dermatillomania caused me to miss a lot of both. It still does.)
• Of course, visible signs, like lesions or scabs on the skin, torn skin around the fingernails, bald spots on the head or missing eyebrows or even eyelashes. I myself tend to pick at my face, but some folks can hide their evidence much better, because their target area is their arms or legs. For hair-pullers, they may wear a hat they refuse to take off.
• Evidence of other mental health issues. Folks often have related disorders. For me, some friends and family members recognized my depression or anxiety or even BDD (Body Dysmorphic Disorder) before they ever knew about my Dermatillomania. They noticed I was in bed during the day a lot, for instance, and didn't know I'd been up all night picking. Or that I spoke less, looked downward a lot, etc. So they'd see depression. If they walked in on a panic attack (which was almost never, other than for my parents or partner), they might see me hyperventilating in a ball on the bathroom floor, but didn't know about the picking session prior. So they'd see the anxiety, but not the Dermatillomania. As far as the BDD, a few folks picked up on a comment I'd made "I look so awful" or "Don't look at me!" or "My skin is disgusting today". I'll never forget the time, years ago, eating lunch after a presentation at work, I talked with a coworker friend and tried to make a joke about how grateful I was that folks were willing to look past how large my head is and how masculine my features are and still listen to my presentation (yeah, I know, NOT healthy nor fun). My coworker looked at me, surprised. She said flat out, "You have Body Dysmorphic Disorder." I almost choked. I assumed no one else even knew what that was, let alone my secret. I mean, self hateful speech about one's appearance is so common among women, that it's become normalized. So most folks hardly even blinked when I said something like that. (See: "Society and the Patriarchy" in Diagram 1.) But, sexism and body image are topics for another post. And I still have part 3 to do of this one. Sigh. Ok. I'm pretty scared to post this now. I'm not going to lie. I have to keep reminding myself of my reasons: this can help someone else, this can help my own healing, vulnerability and authenticity are necessary to live fully.

​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.)