A fear of being alone triggered my new habit. It was almost the holidays, and another good friend — one of the few left unmarried — became engaged. Immediately, the fear I’d had since childhood of being alone (autophobia) washed over me all over again. Thought spirals took over, denying my ability to be fully happy for my friend who had, despite all odds (i.e., the sh*t hole that is dating apps), found her person.
There, rotting away in bed watching “Gilmore Girls” again, I ripped off some skin on my left arm. The pain felt good in a weird way. Something sinister inside me lit up. It was like the intrusive thought “I’ll always be alone” had fused with picking my skin, and from there, I just couldn’t stop.
I began regularly scanning my body with my hands for anything worth picking at, ripping the skin off from head to toe. Within a few weeks, I was covered in scars, wearing multiple Band-Aids, and spending hundreds on makeup and skin care to try and fix my skin. Within months, I was causing infections and taking antibiotics regularly, which caused yeast infections.
My therapist tried to help. I tried reading up on body-focused repetitive behaviors (BFRBs) and dermatillomania (skin picking disorder), and learning new skills like urge surfing and replacement behaviors, but nothing seemed to help. I was stuck in a cycle of self-harm.
Experts Featured in This Article
Sarah Parker, PhD, is a therapist based in New York.
Michael Maher, PhD, is a therapist based in New York.
“If someone finds that they are spending an amount of time picking or grooming that is emotionally distressing or getting in the way of other activities, talk to a behavioral therapist to understand whether treatment could be helpful,” says therapist Sarah Parker, PhD.
If the impact of picking causes damage like wounds, scarring, or even infections, therapist Michael Maher, PhD, suggests seeking behavioral therapy from an expert. I was already on medications, but they weren’t helping. So, after several months of bleeding, I decided to get a second opinion from a psychiatrist. There, across the screen, I was diagnosed with OCD and ADHD.
At first, I was hopeful, stunned, then scared: What did all of this mean for my daily life? No one provided straight answers about how to move forward while the doctor changed my meds dramatically. Starting to feel suicidal and scared of my own thoughts, I checked myself into a residential program for OCD, anxiety, and depression. In rehab, I began cognitive behavioral therapy and exposure response prevention therapy, both of which are the gold standard treatments for OCD. I also learned skin picking is common with ADHD and executive functioning issues. From there, I slowly started to feel relief — as I became less fearful of my thoughts, I cut down my compulsive skin-picking almost completely.
In my case, skin picking signified a larger problem, which can be a common experience. “People pick their skin for a variety of reasons,” Dr. Parker says. “Sometimes it’s more of a grooming habit, where they are not always aware of it happening, or they might pick if they are bored, or to soothe themselves when they feel a bit stressed.”
People who experience executive functioning difficulties may pick at their skin to feel less bored or help them focus on a task. Or, picking can be a compulsion. “When someone suffers from ‘not just right’ feelings in obsessive-compulsive disorder (OCD) or body dysmorphic disorder (BDD), they may spend a great deal of time scrutinizing their skin for flaws and feel a high level of distress if they find one,” says Dr. Parker. For them, picking is strongly motivated by feelings of anxiety and disgust.
How to Seek Help For Skin-Picking
If skin-picking is becoming a problem for you, there are steps to getting proper care. “Peruse resources for becoming more educated about skin-picking and other body-focused repetitive behaviors, including the Trich Learning Center,” Dr. Parker says. It can be quite helpful to understand that you are not alone and that many people engage in these behaviors and would like to stop them, she adds.
“For people diagnosed with skin picking or excoriation disorder, it’s important to find a therapist who is very experienced in habit reversal therapy (HRT), which is a highly effective treatment for skin picking,” says Dr. Maher. For people with OCD who compulsively pick their skin, finding a therapist experienced in exposure and response prevention and habit reversal therapy would be optimal since treatment typically requires both approaches. “For people with borderline personality disorder, it’s important to find a therapist with expertise in the treatment of BDD using CBT, which includes exposure, response prevention, cognitive therapy as well as HRT.”
Finding the right therapist is crucial. “If you are looking to work with a therapist, that person should be able to describe a fairly concrete approach to helping people stop picking,” Dr. Parker offers. “We know that effective treatment for this problem is quite structured — meaning that there is an agenda for each session, and it usually involves learning something and practicing it, both in session and between sessions.” Accordingly, the first step is about building awareness of the behavior and what happens before and after. “The therapist helps their client build a fairly comprehensive set of skills and strategies for decreasing the behavior over time.”
Now, after several years of treatment under my belt, I feel happy for my friends and content with myself. Though in times of need, I’ve always got my fidget toys and therapy tool kit to dip into.
Sara Radin is a writer and publicist based in Philadelphia. Her writing on internet trends, style, youth culture, mental health, wellness culture, and identity has been published by The New York Times, Glamour, Self, Teen Vogue, Refinery29, Allure, PS, and many others.
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