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compulsive skin picking

I spend approximately 4-5 hours on a "bad" day picking all over my body.  Today I went crazy on some ingrown hairs on my pubic area and now it is painful open sores that and leaking clear fluid.  It has been a few hours and they are still pretty painful, i put hybaclens on the wounds and covered them up with neosporin but this is just one of many times i wonder if ive gone too far. the wounds are definately infected, but i am too ashamed to get myself antibiotics or even be seen by my primary care dr.no matter how bad it seems. i know im one of many people suffering from this, but there is no way i am going to show my dr. what i've done to myself-i went in a few months ago for a wound i created but came up with some crazy excuse because that one really seriously scared me.  he gave me a tetanus shot and no antibiotics and i guess its healing however it should be.  but these constant infections that i create scare me sometimes.   what are the chances that ive given myseslf a serious infection such as mrsa or something that results in sepsis?  i have a few deep wounds but most of them are pretty surface-like, just really really picked and scratched at with inflammation around the edges/center.  i also have a few csyt like scars/scabs that never seem to be completely healed.  they are always tender and raised, with really thick skin around the circumfrence of the old wound.  i can pop them open from time to time to relieve the pressure but all that comes out is either dark blood or watery blood followed by scabbing and then usually the process repeats every so often if the scab gets picked off or scraped off (either by me intentionally doing it or unintentially in the shower or something) and there it is again all tender under pressure until i cant take it anymore and i try to either pop it or pull some ingronw hairs out of it.  please answer any and all of my questions i would so much appreciate it i am so lost and alone. thank you
1 Responses
716143 tn?1232351325
MEDICAL PROFESSIONAL
Here is a good start from my Skin Deep site (grossbart.com).  See also trich.org.  You really have to push yourself to get good medical care.  The source of the wounds os irrelevant.
 

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

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