In my previous post about dermatillomania, Robert B asks:
“Do you mind sharing what kind of therapies were tried?”
Sure! When I first met with my therapist, I made sure that she used cognitive behavioral therapy, since that’s one of the approaches most supported by scientific evidence. I also made it clear that I was an atheist to make sure she was okay with that (PS – check out the Secular Therapist Project if you’re looking for a secular therapist or want you current therapist to sign up).
The main therapy we did was “mindfulness,” which is pretty much how it sounds. She encouraged me to pay close attention to when I started to pick. For the first couple of weeks I wrote down every time I started picking and what was going on around me. This was partially to see if any specific events triggered the picking, though that wasn’t too enlightening to me. I already knew I picked when I was either very stressed out or very bored, and that’s about what I found.
But it did help me realize how much I picked. And since paying attention to my picking was on my mind, I was much less likely to start absent-mindedly picking during a lecture or a movie. Or if I did start picking, I would realize what I was doing and try my hardest to stop. It didn’t totally solve the problem, but I did pick less. And since I picked less, I had less scraggly skin available to pick, which in turn made me want to pick even less.
The problem was it was really easy to fuck up once, and that derailed the whole process. If I happened to go crazy picking while spaced out and watching a movie, or if an exam was coming up and I went to town, I basically had to start the process all over again. mindfulness worked for a couple of months until it…well, just wasn’t on my mind anymore. It’s hard to constantly think about.
The other thing that was suggested to me was just finding a hobby that could keep my hands busy instead of picking each other. I’ve found random twitchy iPhone games to be great for making me not pick while riding the bus, and that still works reasonably well. The main problem is idle work situations, like sitting in a lecture. She suggested I take up knitting since that’s fairly socially acceptable to do in a lecture hall, but I just never got around to it.
But overall, the treatment for dermatillomania isn’t really well understood. There are a number of proposed drugs that may help (including SSRIs), but we never discussed that option.
This is post 32 of 49 of Blogathon. Donate to the Secular Student Alliance here.
Jen, thanks for sharing the therapies that you tried. I have also tried those with about the same results that you had. :)
A thought occurred to me. The guilt you spoke of when admitting the dermatillomania may have a social component. As a man I am not expected to maintain my physical appearance as much as women are in our society. I apologize if this is old news; I’m a newly minted feminist and sometimes mangle concepts or etiquette.
Thanks again for talking about a far more common disorder then is recognized.
I think you hit the nail on the head here. I used to work in a psychiatric hospital, on a residential unit that treats severe forms of OCD and related disorders (like skin picking). The treatment works, but it requires some changes to one’s lifestyle, as you know. The patients were usually willing to go along with the treatment — because the alternative was a life where they had picked away all their hair and had grotesque scabs covering their bodies.
Treatment isn’t always effective, and of course more work needs to be done to make better treatments. I’ve seen treatment have some efficacy, however. Effective treatment usually includes SSRIs (at higher doses than usually used for depression), mindfulness (so that you realize when you’re picking), and then “habit reversal” (once you realize the picking, or the urge to pick, doing anything with your hands other than picking — like twitchy iPhone games, doodling, or knitting). Like you said, the treatment worked until you stopped doing it.
If you (or anyone reading this blog) are interested in receiving further treatment for dermatillomania (or OCD, trichotillomania, or body dysmorphic disorder), you can find very good, science-based treatment suggestions and treatment providers through the International OCD Foundation (OCFoundation.org).
David, thank you very much for the resources! My picking bothers both my wife and I; it’s time for me to stop.
I have several disorders that might point to SSRIs: social anxiety, mild case of dermatillomania, mild case of OCD, and situational panic attacks (on planes during landing or in any car that’s driven by someone else with the windows closed for a long time, but only when I’m hungry). But then I also have something like cyclothymia which contraindicates SSRIs. According to my wikipedia hypochondriac skills, that is.
After about 10 years with dermatillomania, I haven’t picked in nearly two months, I very seldom feel the urge to do so, and the urges are quite controllable.
I have used the method outlined in this article:
Attention Control is Critical for Changing/Increasing/Altering Motivation
In the article, the method is described using the example of nail biting, but its application to skin-picking is virtually identical.
I don’t guarantee that it would help everyone, but I do feel that it has helped me, and applying the method actually feels easier than just having dermatillomania.
Thank you again, Jen.
I put my doctor in my dissertation acknowledgements for the care he was able to give me. If it weren’t for cognitive behavioral therapy and SSRIs, I wouldn’t have been able to finish my degree. Anxiety and mild depression (dysthymia). I had gotten into a slump where experiments weren’t working, so I didn’t want to do more. I didn’t have results, which earned scolding from my mentor, which led to avoiding interaction and panic when I saw him at a distance or even heard the phone ring. It probably slowed me down by a year or more.
One of the things you can do, especially if you have a partner that helps you with mindfulness, is have fast acting SSRIs on hand. If you recognize that a specific circumstance is likely to cause an episode, you can take a xanax or other drug, which will help you control and get through it. If you are starting to show signs that you might have trouble, your partner can gently and quietly point it out and see if you are ok, and might need to treat it. That helped me deal with my anxiety a lot. Can’t drink with them, though. Makes people into super drunks and kind of tends to depress your breathing reflex if you fall asleep. Bad stuff.
Slow acting SSRIs for maintenance can also be pretty useful, but the first one you try doesn’t always work, and can make you feel worse. That happened to me and my doctor quickly was able to switch me to something else. If one doesn’t work, usually, something else will.
Good luck!
Your story sounds so familiar! It’s always nice to be reminded that I’m not the only one. I pick the skin around my fingers… just like you, when I am stressed or occasionally bored. Mostly stressed. My husband can basically pinpoint my stress level without having to ask by checking the state of my hands. At this point, the skin around my fingernails is always slightly shiny and red. When I was a teenager (a closeted atheist living with very religious parents), I also went through a period where I picked out my eyelashes and eyebrows. That was probably the most emotionally stressful time of my life. Once I got out of the house, I stopped picking hair and haven’t ever felt the compulsion again.
I’ve considered therapy, but at this point I don’t think it’s worth it. I pick the top layer of skin off all around my nails, but basically never to the point that it my hands are painful or bleeding, and frankly, I don’t care how my hands look.
Occasionally while holding hands with my partner, I’ll absentmindedly pick at the skin around her nails.
Never intentionally, of course. Only ever when I really want to pick at my nails and have run out of bits to pick.
I have a problem picking the skin around my face, and I never thought it was a problem before a year ago when I started writing my dissertation. What I learned from it is that it was a way to help me cope with an anxiety disorder that I’ve had (or developed) during graduate school. I looked at therapy as a way not just to stop picking, but to learn how to cope with anxiety in less self-destructive and more constructive ways. Because of this, I feel much less stressed (even when stressful things happen), and I am enjoying my job and life more because of therapy.
So maybe therapy could help you with picking and any related anxiety or stress you might have that could be motivating the behavior. I am very glad I decided to get help for my picking!
I’ve read up a bit about this as well as I have always been a scab-picker and in my teens also developed a mild trichotillomania focused on my eyebrows. Both enough to be occasionally noticed and to be embarrassed by it. Between reading and experimenting on my own, I developed a similar approach to what they call “mindfulness”. I jot notes in my tiny paper day planner (which I refer to every day for to-do lists) on how many days I’ve gone without pulling an eyebrow hair that should not be pulled. I still give myself credit for the day if I pull only one or two but stop myself there. Yes, there are still the go-to-town days but I manage to get longer gaps between them.
Another thing to try that may help redirect your fingers. It’s odd but I’ve always had this related compulsion to run the seam of a pillow or pillow case (some work, some don’t depending on how they are sown, you need a little lip) underneath my short fingernails. It gives the same soothing aspect without damaging yourself. The strip of the seam will eventually tear apart, however :) But by the time that starts happening, it’s usually broken in nicely enough to be an inviting diversion for your fingers. If you can develop that as an alternative, it might help. I’ve always suspected that this action has a hand in helping me wind down at bedtime and for the fact that I rarely have trouble falling asleep. Also, for why my trich didn’t become worse than it is.
I have a similar problem where I fiddle with everything. Fortunately I don’t damage my skin very much. I do bite the inside of my lips a lot. And play with my toenails and fingernails. And fiddle things. And crochet.
I have ADHD. I know that there is no treatment which would get me to stop picking and biting and playing and fiddling unless it were targeting the ADHD itself, not my behavior. But guess who doesn’t have health insurance? Woot.