The first time I met Annette, a thin, angular woman with an abundance of curly black hair, I was skeptical.
I had landed on her webpage after some desperate late-night Googling and saw that she offered Skype coaching programs to help end compulsive skin picking. Dermatillomania, the formal name for skin picking, is typically characterized as picking that causes serious distress and is time-consuming and disruptive to daily life, work and social events.
For me, dermatillomania was hours in front of a mirror or under a bright light trying to get rid of what I saw as imperfections in my skin. I would go into trance-like states, cut off from anything around me, and proceed to dig until my fingernails were caked in bits of skin and dried blood. I had been doing this for a nearly a decade.
Annette was straightforward during our initial consultation: She was a coach, not a therapist, and this would be coaching, not therapy. There would be no conjuring up of my past and no blaming of my mother for the present. This would be work, and if I did the work, I would be free from my compulsive skin picking.
While we talked, she sat in her office in California and I was sitting on my bed three hours in the future in New Jersey. It was November and dark outside my window but Annette was backlit by the glow of late afternoon sun. Every few minutes or so our Skype video call would pause in an awkward freeze frame, affording me a half second to regroup.
Over the years I had been to several cognitive-behavioral therapists and had heard all kinds of reasons for why I picked. Most of the professionals believed that dermatillomania was a self-soothing mechanism, a symptom of some inner turmoil. I was told that if I healed my relationships with my family over time my skin too would heal. I was told if I walked an hour a day I wouldn’t be so anxious and depressed and the compulsion to pick would fade. I was told to put a rubber band around my wrist and snap it every time an urge surfaced. I was told that if I exfoliated and moisturized religiously that I simply wouldn’t want to ruin my smoothed skin.
So I did all of those things. I opened up the lines of communications slowly with my parents. I started walking all the time and lost some weight. I developed great skincare habits with daily use of exfoliating scrub and coconut oil and the parts of my skin that I did not pick did indeed glow.
I threw away my magnifying mirror and tweezers and sat on my hands when I could and got dressed in the dark to avoid being triggered, but still every few days I would find myself in the shower, shaking and crying as the steaming hot water slowly brought me back into myself and stung the new wounds I had spent hours in a dissociative trance creating.
Therapy left me feeling hopeless rather than empowered. Dermatillomania is not a condition that’s widely talked about, researched, or understood. When I told therapists what I was going through, I was often met with blank stares.
By the time I found Annette, who calls herself the Stop Skin Picking Coach, I no longer believed that skin picking was a symptom of a problem. I saw it -- the urges, the picking, and the shame and secrecy that followed -- as the problem itself. A cycle with no escape.
I believed my skin picking made me unlovable. I believed if anyone ever found out they would be disgusted and horrified. I had fears of getting into a car crash or any kind of situation where I would need emergency surgery and my clothes would be cut off and my scars would be revealed.
Annette believed me when I told her that the skin picking alone had become a self-perpetuating problem; the shame I felt from my secret overshadowed any other accomplishment in my life. I felt immense guilt over my inability to stop picking. I carried around a heaviness from feeling like I had a major secret to hide everyday.
Dermatillomania can go by many different names: Compulsive skin picking, body focused repetitive behavior (BFRB), skin picking disorder, excoriation disorder, and the list goes on. Some believe its related to obsessive-compulsive disorder, others link it to the better known trichotillomania (hair pulling) and other still may dismiss it as a bad habit like occasional nail biting.
To me, dermatillomania had the power to ruin even the best of days. In the summer months, I would hide my skin with long sleeves. After a long picking session, I would be so numb and felt so far away that I would have to cancel plans with friends. There had been times where I had to call out of work because of skin picking. In college I had been late turning in papers because I couldn’t focus long enough on the material without the urge to pick taking over.
A picking session could last anywhere from 10 minutes to three hours, and following I would usually need a long time to come down from the high that I felt from picking.
Most would think that skin picking is painful, but it’s not while in the act. It’s a quick high. A euphoria that sent adrenaline pumping through my veins. The feeling was addicting, and I often wrote in my journal that I felt like an addict.
I picked at my arms mostly but would also target my legs, chest, stomach and back -- areas that could be covered up easily. Following a long session, it would take hours to feel normal again. I would hide under the covers in my bed waiting for the high to fade and the throbbing pain, shame and regret to set in.
There was no need to explain this to Annette, because she herself had suffered from skin picking. My first conversation with her was also the first time I had talked to someone who knew exactly what I was going through. The effects of not feeling so alone in my pain were healing and immediate.
After our initial consultation, we decided to talk twice a month, for four months. Together we set goals. I started keeping logs of when and where I picked, for how long and how I felt before, during and after. I repeated mantras. I visualized my life without the shame of picking.
Some of the stuff I did with Annette felt silly, but some of the techniques she coached, like tapping, broke me open in a way I never could have predicted and left me sobbing with relief.
I’ll end this piece by talking about the least important part of my recovery: I still sometimes pick. It’s not often, but much, much more importantly, I don’t feel the shame and guilt that once interrupted my life. When I do pick, it’s an afterthought of my day, not the driving force.
I felt a true sense of recovery about a year ago. I had just ended my four months of coaching with Annette and was in a new relationship, where for the first time I didn’t cringe if he rubbed his hands on my bare arms. Most days I even forgot dermatillomania was ever part of my life.
The turning point was following my best friend’s wedding, when hundreds of photos went up on Facebook. While all were beautiful, one completely took my breathe away -- a photo of my arm holding a bouquet of flowers. Although I noticed one or two scars, I didn’t feel any anxiety looking at the photo. I had exposed my skin that day without fear, and here was the photographic evidence that I was in recovery.
There are still some situations I won't put myself in for fear of triggering relapse. On days that I’m more tired and stressed and prone to picking, I’ll still get dressed or undressed in the dark. I keep fidget toys in my car, at work, and on my bedside table should I be nervous about idle hands. I’ll typically head to a coffee shop or other public place to read a book because reading alone is a trigger of mine. I’ll never own tweezers or a magnifying mirror. I avoid dressing rooms when clothes shopping if I can. And I have kept up the habits of daily walks and exfoliation and moisturizing. This is what self care looks like for me in a post-dermatillomania life.
During my last session with Annette, I got emotional thanking her for the work she does. Not only because she facilitated a profound shift in my life from intense shame to healing and recovery, but because through her vulnerability in being open about her skin picking, she is giving others permission to do the same.
I can count on one hand the people who know about my dermatillomania. But, like Annette, I have decided to share my experience with the hope that my story will help others to not feel so alone so they too can move from shame to healing.