Compulsive Behaviors Expert Forum
Skin/Face picking
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Questions in the Compulsive Behaviors forum are answered by Ted A Grossbart, Ph.D. from Harvard Medical School.

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Skin/Face picking

What can be done about skin picking - alwasy looking for a new bump to pop, squeeze, literally dig out - with tweezers.  Am I nuts?  I notice I only do it when stressed - can go days/weeks without, then can spend 2 hours at a time at mirror.  Why?  Used to bite my nails as a child, don't know due to the wonders of acrylics!  I know it's an OCD thing and I take Cymbalta (30mg) daily now.  Any other recommendations?  Anybody else do this or am I the only one?  My hubby thinks I'm a nut job and is very critical.
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You have lots of company!  I think there is a hidden epidemic of CSP out there.  Here is a summary of what works from my site http://grossbart.com.  For some people it is an OCD thing, others not.  Your husband and you both pick on you.


How To Stop Compulsive Skin Picking, Scratching, and Hair Pulling

Everyone pulls off the odd bit of skin or squeezes a random pimple. But for some people the squeezing, scratching, or picking becomes an absolutely monstrous compulsive behavior that threatens to take over their lives. Concealing what they are doing and its impact, can trigger desperate attempts at camouflage and the avoidance of activities and relationships. 

As a practicing skin psychologist for 30 years, I have seen a huge recent increase in people coming in with skin picking and scratching problems. Some have an underlying skin disease, but the behavior itself may be the whole story. Feeling great shame, people become isolated, rarely talking to friends and neighbors about their problem. This makes it hard for them to connect with others for support. The Internet may become their key source of support and information.

Pickers and scratchers range from very emotionally troubled, to otherwise quite healthy and successful people. Picking problems that look the same from the outside can be very different on the inside. Treatment needs to be carefully individualized--simple formulas and stock programs are often not enough. The treatment approach MUST be matched to both what is fueling the picking and the individual’s personal psychology.

Many different paths can lead to a picking problem. Any area may be the target, some people use tweezers or nail files and produce deep permanent scars. Many people describe looking for self-soothing, and go into a trance-like daze when they pick. Some people do most of their picking when they are bored, reading, or watching a movie, and little is going on. For others as the stress ratchets up, so does their picking. For yet another group, what starts as a well-intentioned attempt to smooth out or improve an area of skin may quickly turn destructive when it combines with a relentless perfectionism.

Deep guilt and shame can easily compound the problem. Sarah G. told me, "Over the years I have gradually shared all my secrets with my husband except one. Ever since college I have been disappearing into the bathroom to tear at my skin. I don't know if he suspects or not. I feel like a freak, I know I should tell him, but..." For her, ‘coming out’ was a critical step. Probably no treatment approach would have worked without it.

Not seeing their problem as a serious "real" disorder, some deny themselves serious treatment. Picking can become a major focus of life and can seriously erode relationships, work, and leisure and really make people feel crazy and out of control. People who are hard on their skin are typically also hard on themselves about it. Fiona O. put it sharply, "I'm doing it to myself, so I deserve what I get." 

When Julia B. got out her magnifying mirror and bright light she knew trouble was coming. Deep scaring, recurrent skin infections and and an overwhelming sense of shame were no match for her compulsion to keep digging deeply at the skin on her arms. At first picking would bring her a blissful, trancelike sense of peace, and then as the blood flowed this would change into revulsion and self-reproach.

Intriguingly, a high percentage of pickers I’ve work with were picked on by others when they were growing up. They may have been scapegoated at school or the the victim of critical, perfectionistic parents. Being picked on then becomes a pattern that people loyally continue by internalizing the problem and picking on themselves. 

Emma L. described her erratic parents and chaotic childhood, "Picking was the one stable thing I could depend on." As she was able to build a more solid identity and sense of herself in therapy, she was able to let go of the picking.

Natalie M.’s focus on her picking as part of a lifelong pattern of obsessions and compulsions let her use medication and behavior therapy very effectively. The very specific prescriptive style worked very well for her. In contrast Brent L. came to think of his picking as an “addiction without a substance” and adapted parts of the AA 12-step approach. He found he could stop picking if he was able to focus on, and sit with, the emotional pain that it was masking.

For others really pushing to get at the emotions that are lurking when picking starts is key. Picking can be an angry act, as I suggested to Brad K., if he did to someone in the street what he did to himself, they would put him in jail. Anne R. usually picked only in private, but when she got a cell phone call in a crowded car telling her that her boy friend was also dating someone else, the picking started and her blood started to flow. Her skin took the beating she wished she could have delivered to him. People like Anne and Brad need help to feel their feelings in their hearts instead of in their skins. 

Treatment: What Works
I have been most impressed with the effectiveness of three treatment tools:

1.) MEDICATION: Antidepressants (SSRI’s) and mood stabilizers have been very helpful for some of my patients, and a disappointment for others. If you want to go this route it is important to be persistent and expect to experiment with different drugs and dosages.

2.) PSYCHOTHERAPY: With literally hundreds of different approaches, it is hard to be an educated consumer. Look for good personal chemistry: someone you feel ‘gets’ you. Look for a depth of experience working with picking and scratching. Someone can be a great therapist for people with other problems, yet ignorant and ineffective in this area. Ideally a therapist should be competent to address behavior change, cognitive (thinking) issues, and also the emotional side of the problem. A therapist who is too strictly committed to one approach or technique may have major blind spots.

3.) HYPNOSIS and SELF-HYPNOSIS: These adjunctive techniques are best taught by a qualified psychotherapist. With an impressive record of success for habit control, these approaches are especially useful for people who go into a spacey trance state when they pick. You can learn to turn this “inadvertent negative hypnosis” into an effective treatment technique



For more information see the Skin Deep chapter: Breaking The Itch/Scratch Cycle on the site.
6 Comments
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Avatar_f_tn
Thank you for leaving this comment to mamatuck.

I makes me want to cry because i know the deep down reason why ive obsessivly picked and still do. Ive also throughout the years have cut myself, drugged myself, straved myself, worked myself, stuffed myself, made myself puke, and hated myself.

This helps out alot. I need help.

But currently im on a challenge not to pick for a week.
Im starting out with a week. Actually started today. Ha.
Wish me luck, who ever may read this.
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Avatar_n_tn
Hello.  I have an older sister who I believe is picking herself to death. She says it's some mysterious infectious disease, and is now blaming it on her diabetes medication. (the flavor of the month)  She has been wearing those BIG, skin colored band aids (2"x3" size, the real fabric-y ones) for about three years now!  It started as one place on her cheek where she had a persistant cyst that she often picked at and complained that it wouldn't go away. I didn't see her for a year or two, and when I did, she had a big inch and a half, DEEP scar on her cheek. The next time I saw her, a year later, she had two more of these on her other cheek, and some smaller ones on her chin. All deep.  She kept them covered, touching them often, to make sure they were on good. I finally convinced her to let me see under them, and though I put on a good 'face', I was dying inside for her, and wanted to cry on the spot. She was once very beautiful!  She has told me many times in our 20's and 30's how picking made her feel "sort of in a trance, and it just FEELS GOOD!"  She said she could pick for hours even sometimes nearly til light out.  She said she just could not stop, and then the next day couldn't believe what she'd done, having to call in sick and so forth.  Becky also was is still a heavy smoker, since 14 yrs., then drugs moving to heroine until she was an addict and went to treatment twice. She became an alcoholic, (more treatment). She attempted suicide in a drunken state twice. She became obese during all of this, and now suffers from Diabetes type two, and also has Hepatitis C. She hourdes, lives as a recluse, and does crazy things...(stalking, lying,...trying to control people etc)  Our parents are 'nuts' in my opinion, and were extremely perfectionistic and critical as well as physically, verbally, mentally abusive. Some of her counselor's even suspected early sexual abuse, though neither of us remembers any.  She won't seek help. She gets some disability and our folks support her financially.(Hush money) She lives alone with lots of cats and smelly conditions with all of her junk that is mostly in packed boxes that line the walls making 'cow paths' through her duplex.  She was evicted several times, sueing her in court!
I know she needs psychiatric help, but I am asking specifically about her face. She is disfigured now, and is STILL doing it.  What type of drug do they prescribe for this particular part of her many 'illness'. I'm afraid for when she 'wakes up' and realizes that she has no FACE LEFT!  What can be done?  I leave this message for others who are afflicted and seeking help.  I've watched her do this our entire lives, starting with just a little picking as teenagers. She is 55 now. Our mother did it to, but not to this degree. STOP before you are DISFIGURED!  How do we help someone we love get help, when they are an adult?   Any help at all would be SO VERY appreciated!   Thank you, Cindy
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Avatar_f_tn
I found this forum while looking up something completely different but, I think I must have this disorder. . . I pick and scratch at my skin a lot. I pick off scabs and and bumps until I bleed. It started when I was about 7. Early on I would only scratch my scalp and pick off scabs, but when I developed acne in my early teens I quickly switched to picking at any flaw in my skin. I'm 18 now and I always have scabs on my face, back and chest that I pick at all the time. I even catch myself doing it in public sometimes. I think I'm getting more obsessive because I would never do it in public before. I really want to stop before it takes over my life and I get permanent scarring. Right now I am studying abroad so professional help would be difficult to get and un-realistic. What are some options that I could do myself until I get home and can talk to my psychiatrist. (I was seeing a psychiatrist for depression, so the scratching/picking is probably related to that.)
-Clio
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716143_tn?1232351325
Cindy,

What a terribly sad story.  The most common drugs for picking are the SSRI's.  They sometimes help but the statistics are not impressive.

Clio,

The Skin Deep website (http://grossbart.com and book have a bunch of things you can get started on on your own.  See also trich.org (they also do picking).  I have been doing more and more work on the phone with people around the world.  Your psychiatrist may be open to that and if they have experience with CSP that would be a good way to start.

tg



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Avatar_f_tn
Thank you! I'll try out some of the methods and see if I can find a good match for me. I'll have to ask my psychiatrist if she has experience with CSP, but it would be hard to do phone consultations because of the time difference so I will see how far I can get on my own. Thank you again for the suggestions!
-Clio
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