YOU ARE NOT ALONE - A companion online community discussion board for The Mental Illness Happy Hour podcast with Paul Gilmartin

I was listening to episode 277 with Hillary A. and she and Paul briefly spoke about the experience of Trichotillomania.

At one point Paul asked her "Does it feel good?"
No. No it doesn't feel good.
"Does it feel bad?" He asks.
No. No it doesn't feel bad.

And she is right. It is hard to describe because it doesn't feel good and it doesn't feel bad. It doesn't feel.

I came to this board expecting to find other people describing their experience with Trichotillomania or Dermatillomania, and was initially surprised to see that there are none posted here. I have struggled with dermatillomania for most of my life, and I have personally known many others who have struggled with trichotillomania. Which means there are others out there too.

Then I thought about how I have discussed it with my therapists when it has come up. Usually it is in the initial interview listed along with a slew of other compulsive behaviors.

"Oh, and I pick at my skin."
"How Frequently do you do that?"
The same question asked about counting, showering, etc.
"Usually right before or after a shower. Often when I go to the bathroom."
"Do you use any tools?" They ask.
"No." I say. Its a lie. I have used a metal comb with nice sharp teeth too it, tweezers, and on two occasions needles. Not to mention my own teeth when it comes to my hands.

My non-committal answers will push the topic further down the list of topics needing to be discussed. I won't bring it up again. I guess that is the same reason there are no posts about it on this board. Because while we wear our skin and hair on constant display, it always seems to avoid direct conversation. So I am going to write down as honest and as true an answer as I can about it. It gets a bit graphic.

When I go into the bathroom it is as if I were a clock piece stuck in a groove that pulls me along towards the mirror. Maybe I stop to turn on the shower first, maybe I don't. I take off my shift and just look at myself in the mirror for a long moment. My eyes travel across my body searching for imperfections. There are plenty. Moles, zits, scars created from picking at my body. My nails are a tortured mess: the nails short box like strips, the cuticles reaching up in protest of constantly being jammed back down, the nail beds tattered and red.

On my right arm I bear a small scar I have had since I was a kid. I remember it because it is from the first time I remember picking. I got the chicken pox real bad, and I just couldn't stop scratching. I scratched and scratched and scratched. I remember that spot, a large blister. I remember dreaming that there were worms living inside of it, and that if I peeled it open I could pull the worm out. It ruptured and pus filtered out and I scrubbed it clean and it was a relief.

When I look up into the mirror of the bathroom and begin to pick it is like slipping into a trance. As I pick bits of skin fall away into the sink, and drops of blood drip down my cheeks and chin, staining my beard before falling in spattered circles. Sometimes I mumble a little to myself "Oh that is good." "Errrr" "No, that is bad." "Oh, mmm".

Does it feel good? Does it feel bad? No. But you don't feel anything either.

It is a bit like that scene from "The Shinning", when the kid is looking into the bathroom mirror. At first he is drawn into it, the mirror opening up to him as he is called into it.There is an elevator, its doors open and out rushes blood. Blood filling the lobby, a sound like blood in your ears, his body stiffens and you see him for a moment frozen in horror. Yet, when he wakes up he doesn't remember any of it. It is as if everything in that mirror never happened, and only the experience of the trance lingers.

I live in a world of fear most days. My brain constantly sending me messages about me being unlovable, those that I care for dying, losing my job, my apartment, not being successful. All of it bombarding me constantly.

But when I pick I don't feel any of it. I don't think. I suppose those thoughts are still there, driving the words that escape my lips, but I'm not conscious of them. It is this complete absence of thought that drives me to continue doing it. It is also the reason I am not likely to bring it up. I am distressed by my fears throughout the day, and yes at times I see the damage picking as done and that can distress me. But the act of picking itself? That is nothing. Blissful nothing.

Clip From the Shining- https://youtu.be/5jO_fhpNuKo

I am most definitely one of those people who have started many times to post about my dermatillomania in this forum and never followed through. As I type, I can see my red, swollen fingers. Thanks for being the first I share your tendency to gloss over my picking. I also told my therapist in our initial apppointment but have never brought it up again, even though I would like to stop. And I also would say that it doesn't feel good or bad while I'm picking. It is very much like a trance. Good description! Hopefully your post won't be alone for much longer and I will add my own. Thank you so much for sharing!

I am wicked afraid that I am turning my nose into looking like I am a crack addict - there is a scab in my nose from a cut that I pick at constantly - and its not really my nose I want to pick at its that scab - and it is constant and it is almost an obsessive thought - and I am trying so hard not to - I can go most of the morning without doing it - but when I drive and when its the afternoon closer to when I go home it gets worse - I have not gone a single day without doing it - I do it publically and I am ashamed that I cannot stop myself - so much awful shame and I am angry that it gets brought up a lot - duh - I know its gross - I know its so gross and disgusting - I so wish I plucked my eyebrows instead - that would be less humiliating -

I try concentrating on my work - I try being mindful of my body and my movemtns - I try cutting my fingernails really short - I try having fake nails or pretty nails - I try coloring and having my hands busy - nothing has worked - I don't think anything will until I can get the depression and anxiety and my dumb stupid messed up brain in check - God I wish I was OCD about cleaning instead or washed myself 80 times a day - why does it have to be this?

wretching inwardly at my disgusing self

I am pretty sure no one else does this - I am pretty sure I am the only one -

but tthe trance is real - and sometimes relief when I pull skin out - it hurts but not badly it feels like I got it - like it might finally stop being something I have to pick - but it never does end

Hey Y'all,

Booknerd, that is so interesting that you also don't bring it up to your therapist a lot! I wonder what it is about the picking. It is odd that something that is right on the surfaces is so hard to talk about. After reading your responses I realized after reading that I haven't ever really talked about dermatillomania experience with anyone in an in depth way. I felt a huge relief when you both said you identify with the "trance" like feeling that comes over us. I have discussed mental illness, in particular the feeling of anxiety with other people before, but I don't think I have ever connected with others bout the feeling specifically produced from picking. It really is different from my other compulsions.


Imissmysun I also constantly fear that people think I am a meth head because of how tortured my skin is. I sometimes also pick in public unconciously and start to bleed which creates a huge amount of shame. Since I work in a medical facility I am constantly afraid that my supervisors will one day bring it up, either thinking I do drugs or afraid because of the bleeding that I may pose an infection risk (though I always try to excuse myself to the bathroom and always always wash my hands before handling patients). But I have been working here three years now with no such conversation, which leads me to believe that it might be less noticeable than I think it is like most of my other compulsions.

Welp

I don't think face/fingernail/body skin picking is as noticeable as nose picking - if they think that you just have bad skin no one is going to sit you down to have a conversation - they may think that you are sensitive about it - which you are but not for the reasons they think - the only time they would sit you down is if they thought you had a hygeine problem - which only would be noticeable if there was a body odor - and generally skin picking is associated with wanting to be clean - so it won't be talked about -

I also only brought up my picking once - its embarassing that the compulsion cannot be controlled - I have not been able to go one whole day without doing it for years - I have tried but when I daze out in the car I pick - and even when I notice I am doing it - I will not stop myself - I could but its like there is a magnet and I just need to get that one piece of skin or blockage and it will be perfect and i can stop - (but there is always more later - it doesn't go away - and I feel like I have to get that new piece of skin blockage or I can't breath right) and it is specifically my right nostril - I am right handed - my right hand has a mind of its own - it just wants to clear a path - and so I have bloody noses daily - I have to be wearing away the skin that keeps my nostrils separate - I have to be making scar tissue - I just can't see it - no noe can - but they can see me being gross and not understanding that I want to stop I really do and I don't want to pick publically - I just want to breath -

I just wish I knew what trigerred the picking so I could control that - because I can't seem to control the urge to pick - if any of you have found anything helpful please - please let me know - because physical blockers dont help (i.e. notes not to pick, longer nails, bandaids, I am thinking of getting a nose piercing to physically block my nostril and make it harder - maybe I have to do all of them - I don't know - but it effects every part of my life -

My fiance is not as attracted to me because of this - I am brought in at work because of this (and ostracized) - I need help and its so hard to ask - seriously its such a disturbing habit - like I said I wish I picked myself bald instead

Hello Imissmysun,

I wish I could be of more help, but I haven't been able to really control my picking either. I have struggled with OCD and I have been able to cut back on some of my other compulsions with the help of CBT and have successfully stopped my counting and pacing and a lot of my thought obsessions, but here I am still picking away. One of the things that is different about my picking from my other compulsions is that automatic aspect of the picking you described when you are in your car. It is especially hard to avoid it when I'm tired, which I feel is related.

With my other compulsions I feel this building anxiety usually focusing around anxiety relating to people being disgusted with me or (thanks to growing up in the bible belt) religious thoughts. If I avoid the compulsion my obsession grows and grows, but at least then I can work on it.

But the picking? No thoughts. Just motion, and this odd trance. At one point I think it was based off of a fear of being perceived as "unclean" but now I don't feel the initial anxiety just numbness. Sometimes when I am listening to the podcast and people describe bulimia it sounds sort of like that? Maybe folks who have struggled with that might have some advice for us.

I will say I'm not sure the nose piercing will help. I had to have surgery a little while ago and had a big scar. At first the incision stopped me from picking because it drew my attention to it and stopped the automatic behavior. But as the incision healed into a fresh scar my picking around it got even worse. I would worry that a nose piercing would be a similar experience for you.


Welp

Hi guys!

I'm new to this forum but oh so glad I found it! Unfortunately I cannot offer any real solutions to our problem with dermatillomania either. :/
I've been picking my skin for as long as I can remember and totally relate to that feeling of being in trance. My hand moves up towards my face without me even noticing it and whoops: there goes the scab!
I kind of divide my dermatillomania into three different actions:

1. compulsive skin picking
2. compulsive lip chewing (I also chew on the inside of my mouth which causes me to pull particularly awkward faces)
3. compulsive (but slow) head scratching

Can anyone else relate to these other two? All of these kind of go hand-in-hand, depending on the level of stress/anxiety or boredom/concentration that I am experiencing in that moment. My family know that I'm doing it, and will gently slap my hand away from my face to remind me to not touch it etc but that of course doesn't help. Neither with getting rid of the mechanism nor of the guilt and shame. My Little sister has got the same lip chwing habit as I do, and I fear that she had picked it up from me when she was little..she does not pick her skin as compulsively as I do though, so...

I've really been trying to get to the bottom of this as it's getting on my nerves..and that in turn leads to more stress and picking... I can only speak for myself here but I think (my) dermatillomania is a coping mechanism that I can neither stop nor replace, but fall back on time and again. I'm basically addicted to this fucking coping mechanism. I wish I could "just" replace it with something else. Maybe get a stress ball and start squeezing it relentlessly, which would make me look just as much of a freak..?

What I think I will have to do is really think about WHY I do it WHEN I do it...am I bored, axious, stressed, upset? ...rather than letting a wave of shame and guilt wash over me like it usually does, I want to take my time and take a breath to tell myself that there is NO need to pick at my skin in THAT particular moment (I'll probably have to repeat that like some kind of mantra over and over again). One thing my short-term therapist told me to do when falling into compulsive negative thinking (we hadn't discussed the dermatillomania) is to "consciously postpone" it. If this strategy was applied to our struggles with dermatillomania, it would sound something like this: I WILL NOT PICK AT MY SKIN NOW. THE SCAB WILL STILL BE THERE WHEN I GET HOME AT 7PM: I CAN PICK AT IT THEN, IF I STILL WANT TO. - The idea is to have forgotten about it when the time has actually come.

I'll try to give this a go over the next few days..

As for the bulimia comparison...there' definitely some important crossovers between the two. The compulsiveness, the (sometimes) trance-like state and automatism, using it to cope....I would argue however, that purging is usually more carefully PLANNED...it's more of an event. E.g. the food is bought/gathered/cooked/stolen,..excuses are made, showers are turned on to override the sound (and so you ultimately have to pretend to have taken a shower as well)..etc etc. Whilst of course it can happen that a bulimic person goes on to purge without having planned it beforehand (e.g. they have been triggered by something whilst eating), dermatillomania is (in my eyes) more automatic and absent-minded, though by no means any less distressing..

I would say that I have "conquered" my bulimic tendencies/Phase mostly..I struggled with it for about 8 years, on and off. I never thought it was that bad and I know it could've been much worse, but listening to a few people talk about it on the Podcast, I've realised that it's definitely something I should've gotten help with, especially as it was only part of a number of struggles. But as life has it, I didn't want to make a fuss/admit my struggle/upset my family/feel like an attention-seeking teenager/etc. and so I kept it mostly to myself and let it go on until it slowly waned. Now I am on a diet instead.

Truth is: I don't think these coping mechanisms will ever leave us if we ask them nicely. They are so engrained in us and our behaviour that we really need to work hard to get rid of them or replace them with something better. I think the reason why we find it so hard to stop or suppress dermatillomania is because it not only satisfies our need to get rid of a scab or spot, but because it SATISFIES and PROVES the horrible perception we have of ourselves. LOOK AT ME BLEEDING: I'M A FUCKING LOSER. GROSS. UGLY. TRASHY, etc.. What we're trying to change here is the CONDITIONING of our brain to think that we're not good enough/a failure/ugly....but good luck trying that with a stress ball or short nails..
Problem is that even though we really and truly want to get rid of this behaviour, 99% of attempts will fail. Because we love failing and we love realising that we have failed. And we love thinking that others have noticed us failing. And even better: every failed attempt will make the next attempt even more likely to fail because it's (quite literally) all chipping away at us bit by bit..

First, we need to become fully aware of WHEN and WHY we do what we do, and then ACCEPT these mechanisms as part of our CURRENT identity so that we can then try to heal/bid farewell to this part of our identity and leave it in the past.

My new to-do List:

1. Find a therapist and tell her about my issues with dermatillomania AND low self-esteem/anxiety/BDD. Call it by ist name, otherwise it WILL get pushed aside for something more 'pressing'.
2. Make sure that we look at-, and work on everything together: my dermatillomania AND my low self-esteem/anxiety/BDD - the SYMPTOM and the CAUSE
3. Every time I pick my skin/chew my lips/scratch my head...notice what I do, become aware of it, how do I feel, what am I thinking, am I calm or anxious, bored or distraught,...(maybe even write this down?)
4. Try to postpone the behaviour until a time later in the day that is dedicated exclusively to that behaviour. "I will pick at this scab later"

--> If anybody is interested, maybe we could find a day/time where we can try to do this simultaneously: see if it helps that somebody else on the other side of the world is trying to deal with this issue at the same time?

Anyhow I've written a whole chapter here: shitty structure and probably lots of mistakes, I'm sorry. My dad's computer's got a German keyboard and every single word has got a red underscore..

I would love to hear how everybody is getting on and if anybody might be up for trying to go through a day with increased dermatillomania-mindfulness and sharing our experiences

All the best and much love,

Krautpleaser

Ps: I don't pick at my skin because I'm happy, but because I'm NOT....so I think that's what I need to change in order for the picking to vanish...

I've been leaning hard on this dermatillomania lately. I have open sores on my face & torso & my fingers & toes look like they've been nibbled by mice. Anybody else feel like their nails are foreign bodies? My lips are ok for now; I've been exfoliating my mouth with an electric toothbrush after I brush my teeth.

Things I might try that could help:

1) exercise (start small)
2) cutting back coffee/drink green tea instead
3) make a list of healthy coping mechanisms to try in place of picking

24 hours no picking. I've been able to do this before. The real test is in about 3-5 days. I cried this morning. Mom thought the dog ran away but he was just in the vegetable garden. I cried from relief/gratitude. I've read crying excretes stress hormones & releases endorphins. I limited my coffee to one cup this morning. Another helpful thing might be to see about those bike tires &/or take shower.

48 hours no picking.

3 things I could try today that might help:

1) biore pore strip
2) call provider clinic
3) break down goals