I'm going to be gross for a moment.
For those of you who regularly read my posts and open threads, this may not come as a shock. But a few minutes ago, before I started writing this, I looked at my hands and wondered in earnest: "How much of my own skin have I torn off over the years? Pounds? Like a ham's worth? A small game bird?"
I thought this while my ring finger eagerly tore at the carnage which is my thumb. My thumb is my favorite finger to pick at.
It's (still) Dermatillomania.
Dermatillomania: an impulse control disorder characterized by the repeated urge to pick at one's own skin, often to the extent that damage is caused.
I first wrote about "the Derm" in March of 2013, almost exactly three years ago. At the time, it was a relatively new discovery for me that the thing that plagued me ACTUALLY HAD A NAME, was a real thing, and that thing was something that tons of other people suffered from too.
The comments section in that first post was a chorus of "ME TOO!" and "I CAN'T BELIEVE I'M NOT THE ONLY ONE!". If nothing else, it was a relief to know that I wasn't alone — that we aren't alone.
So why am I writing about this again now? I'm obviously still tearing at my fingers.
I wanted to open the discussion again because, nearly every week since I wrote that first post, I get emails from fellow sufferers of Dermatillomania or Dermatophagia (chewing one's skin out of compulsion — and yes I do that too) asking if I've had any success in curtailing my compulsion. I try to answer those emails, but I can't always get to all of them.
The truth is I've had periods of great success and periods of... not so great success. I've found tricks that work for me, but they are just that, "tricks." I haven't "fixed" this problem. I'm no "Derm Wizard" (worst Middle-Earth character ever) or expert. I just know the deep embarrassment, even shame, that picking yourself to a bloody pulp can bring about.
That being said, I want to share what I've learned about myself. What has worked for me to some degree, and how I continue to deal with Dermatillomania and friends. Maybe something in my experience will ring true to yours.
Plus, who knows? Maybe in the time since the first post, some of you out there have found the key to stopping Dermatillomania. If so, I hope you'll share with us in the comments.
So what has worked for me?
When I'm really on a rampage with my fingers and cuticles and lips and scalp and eyebrows (that's a new one), the one thing that grounds me and gives me some control over my actions is counting my picks. Instead of going into this haze of self-satisfaction/self-harm, I come back to the moment.
Yes, I literally count every pick or bite.
For me, and I suspect that many skin pickers/chewers feel the same way, when life gets really stressful and scary, there is relief in allowing your anxiety to literally tear at your skin — your skin shares the burden with your brain. You go on autopilot, it's soothing, unfeeling.
But by counting every time my ring finger stabs at my thumb or every time I go back to bite at my pointer finger, I can somehow shake myself from that haze and reflect on what I'm doing. For a moment I feel the pain of every pick, and I think about how embarrassed I might be — not to mention how bad my fingers will hurt — in the near future.
I thought long and hard about sharing this tactic, because it kind of feeds another anxiety-related compulsion of mine, counting things. However, when the counting is working, the two seem to cancel each other out. One, two, three, four, five... I get to a point where each pick horrifies me and I can't bear to continue.
In that moment.
I'd be lying if I said I didn't catch myself going back. If I catch myself going back, I don't always. But the more I try to count, and remind myself of what I'm doing, the whole endeavor becomes a chore.
For me, and I can only speak for myself, I've removed some of the satisfaction from my picking. Even if I start picking and think, "Meh... I won't count this time," it bothers me (obedient perfectionist that I am) that I'm not doing something I "ought" to be doing. The obsessive cycle becomes exhausting to me, so I quit.
At least for a little while (do you see a pattern?).
I wouldn't call this a recommendation, as it it's sort of like fighting giant cockroaches with little cockroaches. If anyone has ever had a cockroach infestation, you know that while the giant ones are HORRIBLE and destroying them first is the knee-jerk reaction, it's the little ones you have to worry about. Little cockroaches mean you have a bigger problem, that there are more of them breeding in your walls.
Is counting, a sign of my anxiety, the little cockroach? And by sicking it on the giant cockroach, the Derm, am I really just feeding the anxiety that grew that giant skin-picking cockroach in the first place? Furthermore, am I doing myself a disservice by stressing about counting/not counting?
Having attempted Cognitive Behavioral Therapy before, under the guidance of a therapist (it didn't really work), I can't help but wonder if I've devised some screwed up "Louise version" of CBT?
Is your head swimming yet? Mine is. Plus, you know, "giant skin-picking cockroach" — enjoy that visual.
But while my approach is not perfect, what it has done is make me more aware of the picking, more aware of a behavior I want to change, and more aware of when I do it. If nothing else, I'm more aware of situations that could cause me to pick or chew. When faced with those situations, I can now consciously think to myself, "Okay, Hung. Remember your fingers."
So what's the payoff? After all trudging through all of the above, I can honestly say I've found myself enjoying days, even whole weeks where my skin is almost healed.
The first time I realized that my left hand was almost "normal," I couldn't stop staring at it. There has never been a time in my life where I didn't feel some level of shame over my hands, that they betray some sort of inner weakness in me. Even during good times, I'd have telltale scabs dotting my hands.
But when I saw my hand, mostly smooth with no raw, tender spots, that's when it hit home for me: I didn't have to be at the mercy of my own compulsions.
Does that mean that I free of them? Far from it. One revelation does not undo a lifetime of behavior.
But instead of thinking, "Please, Oh Great Dermatillomania, please let my hands be not be horrific when I meet all those people this week," I can think, "Okay. It's going to suck, but I am capable of doing this. I'll pay attention, and remember my fingers."
Maybe "it's going to suck" isn't the best way of approaching things, but it acknowledges how difficult not picking is for me.
Sometimes the Derm wins, sometimes I do. But I'm learning that it doesn't have to be all or nothing. I'll take the small victories.
I don't know if this was the Dermatillomania/Dermatophagia post you were looking for. My goal wasn't to offer answers, I just wanted to offer some hope. Maybe some little piece of my experience will point to a solution for you. Maybe it's just nice to know that someone else shares your struggle.
How do you deal with Dermatillomania or Dermatophagia? What works for you? Sometimes? All the time? Does nothing work? Has this been a life-long issue for you?
Most importantly, know that you're not alone.