Psychiatry’s New Diagnostic Manual: “Don’t Buy It. Don’t Use It. Don’t Teach It.”

While at the TLC conference last month, a speaker said that dermatillomania (and other BFRBs) are a disorder of isolation. There are millions of us, all over the world, struggling with skin picking and trich. Many of us are just sitting at home alone, desperately trying not to pick. Or actually sitting alone at home and picking or pulling.

Derma and trich affect people of all kinds, all around the world. Yet we are struggling alone, isolated. The power to heal comes from sharing, talking openly and coming together. Fighting the stigma and the lack of awareness are part of this isolation. 

Millions of people, of all races, religions, body types, in every country are affected. And how far back in human history have people been affected by this? Just thinking about people in the past and how they must have been bewildered by all of this is very earth-shattering and kind of bewildering. Only in the last 20 years are we coming closer to understanding BFRBs and finding treatments that work. That’s a long time in the course of human existence, isn’t it? 

Progress has sure been slow, but things are changing. More research and treatment options will start as trich and derma get more attention. People won’t be isolated anywhere. They won’t think they’re alone, or a freak. 

So I know this post is very “Whoa, dude” but just wanted to point out the isolation factor. And sometime to remember for all of us, is that we need to minimize this isolation. That means getting out of the house, or getting out of our rooms where we pick and pull with no one watching over us, and no one stopping us.

Get out of the house, and get rid of that isolation. See some old friends, go to the library or a cafe. Go to the park. You get the point. Don’t isolate yourself. You’re really not alone.

realityhitme:

I know for me one of the biggest frustrations in seeing tips for resisting/stopping picking is when I see things involving mirrors. I don’t need mirrors to pick. I’m not the kind of picker that holes up in front of the bathroom mirror for hours picking away at my skin. I can and do pick anywhere, anytime and so a tip like, “cover the mirrors” or “dim the lights” just doesn’t work for me.

Lately, I’ve seen a number of others expressing the same distress about those kinds of tips not helping, and I finally came to the conclusion that instead of continuing to wait for someone else to post tips that might help us that I would try to put one together. I imagine this list won’t be complete, and I’ll probably update it at some point later, but here’s a start. If anyone has any suggestions that have worked for them, too, feel free to add it or send me a message and I’ll add it. Hopefully some of these will help.

These are tips that I’ve either heard of or have tried myself. Not all of them have worked for me, but that doesn’t mean they won’t work for you! These can of course be geared towards pickers in general, but I’ve tried to think specifically beyond the whole mirror and light standards that we typically see.

Don’t touch your skin.
Easier said than done, right? I have a lot of trouble with this one myself, and usually don’t succeed for long, but any amount of time in which you can resist touching a scab or scar, or even just a bump on the skin should be celebrated. And who knows, maybe eventually you will be able to resist for longer and longer periods of time.

Don’t look.
We may not use mirrors, but we do still scan our skin sometimes, right? I know I do. Whether it’s to look at how well something is healing, or to see if there is a mark or something there that I didn’t notice before, I look. Resisting the temptation to look is sometimes really difficult for me, but I find the longer I can go without looking at something, the longer I can resist picking it because there are times when the sheer sight of the mark/scab will make me want to pick at it.

Wear gloves.
Can’t say I’ve ever really tried this one, mostly because I’m not a fan of gloves or mittens or anything, but I’ve heard other people have had some success with this one.

Fake nails.
I imagine this one would be more geared towards females. I had fake nails several years ago, not to stop picking, but just to get them. I personally don’t remember it helping with the picking, but again, I’ve heard that it has helped others.

Cut your nails.
Again, this one hasn’t helped so much with me. I find that even with short nails I manage to pick, and sometimes it can even cause more damage. It does make it more difficult to pick though, so maybe you’ll get fed up with trying.

Paint your nails.
Maybe more female-geared, too, but some find that they don’t want to mess up the nail polish. I used to paint my nails all the time when I was younger, and I don’t remember whether that deterred my picking or not, but maybe it’s worth a shot for you!

Use bandaids.
Covering a mark can help me forget about it for a while, and make it more difficult to pick. As someone who is allergic to the bandaid adhesive though, I know that this is not always possible or a good idea. Sometimes I end up with picking because the bandaid adhesive irritated my skin so much and I itched it raw. However, an alternative I would suggest is gauze and medical tape. Although medical tape can also annoy my skin if I use it for a long period of time, it takes longer than the bandaid adhesive to have any effect on my skin. If your skin does get irritated afterwards, try using moisturizer, healing ointment or even aloe vera gel.

Use a mantra.
This is one I do a lot, and the mantra usually isn’t the same for long because after a while it loses its effect. However, I have found that these are pretty helpful. For instance, for a while I was using the mantra, “It’s not worth it” every time I would go to pick, and it would help me to break out of the picking mindset and realize what I was about to do.

Change your habits.
If you have a problem with, for example, laying in bed and picking when you just wake up, instead of laying in bed, make yourself get up. If you pick before the shower, instead of giving yourself that time beforehand, just step right in the shower. (I’ve had problems with both of these scenarios!)

Get a fidget toy.
Spinner rings, snake bracelets, silly putty, play doh, stress balls, etc. All of these things can be helpful in deterring picking. When you feel like picking, you could do something else like this instead. It keeps your hands busy.

Craft/do art.
I’ve seen people talk about how they’ve picked up crafts like cross stitch, needle point, knitting, and other such things to keep their hands busy. I personally find that if I’m drawing I’m less likely to pick during that time.

Get out of the house.
I find that if I’m out and about, or doing things with family or friends, I don’t even think about picking. The odd time that I do think about picking, it’s very unlikely that I will act on it because I’m out in public or because I’m just busy.

Wear clothes you don’t want to ruin.
This doesn’t always work, but it does work sometimes. If I’m wearing a shirt, or pair of pants that I don’t want blood stains on, I will resist picking longer.

Throw away tools.
I’m not a picker who uses tools (tweezers, nail clippers, etc.), but if you are, throw them out. Many people I’ve seen posts from and have spoken to feel liberated after getting rid of the tools.

Be aware of yourself.
This is the single most important thing for any picker, I would say. Being aware of simply when you pick can help exponentially in breaking that picking routine because then you can act against the picking urges. When you know when you typically pick, instead of just going into the same old picking trance (if you even go into those at all), you can keep yourself aware and have a better chance of resisting.

Accept that you are a picker/have a disorder.
Seems like common sense, right? I think a lot of people have trouble stopping or even reducing though if they don’t admit there is a problem. For me, one of the biggest steps in my journey has been accepting the disorder for what it is, and even accepting that it may be a lifelong thing. Some people aren’t ready for that, and may even just believe differently, but for me, accepting that this may continue for the rest of my life in some degree has brought some peace and has helped me move forward in healing.

Don’t try to stop.
Wait, what? I must be nuts. I actually find that instead of focusing on stopping, focusing on reducing picking brings me greater success. Trying to stop cold turkey just doesn’t work for me; I’m sure it does for some, but not for me. I need a gradual sort of process to reduce and maybe then eventually stop. I find too that focusing on reducing instead of stopping helps prevent greater letdowns. If you’re trying to flat out stop, and you can’t, you may feel like a failure and a sense of great disappointment. With reduction, I find that if I “fail” it’s not as big of a deal and I can just start over again.

Great tips. Especially the last one. It’s not about stopping, especially stopping cold turkey and never picking again. It’s about reducing your picking and making it manageable. That’s why I don’t recommend doing the “no pick challenges”. It’s just a recipe for failure.

mentalillnessmouse:

- Describe your environment in detail, using all your senses - for example, “The walls are white; there are five pink chairs; there is a wooden bookshelf against the wall…” Describe objects, sounds, textures, colors, smells, shapes, numbers, and the temperature. You can do this anywhere.

- Play a “categories” game with yourself. Try to think of “types of dogs,” “jazz musicians,” “states that begin with A…”

- Do an age progression. If you have regressed to a younger age, you can slowly work your way back up until you are back to your current age.

- Describe an everyday activity in great detail. For example, describe that you cook (e.g., ” First I peel the potatoes and cut them into quarters…”)

- Imagine. Use an image: Glide along on skates away from your pain; change the TV channel to get to a better show; think of a wall as a buffer between you and your pain.

- Say a safety statement. ” My name is ____________; I am safe right now. I am in the present, not in the past.”

- Read something, saying each word to yourself. Or read each letter backward so that you focus on the letters and not the meaning of the words

- Use humor. Think of something funny to jolt yourself out of your mood.

- Count to 10 or say the alphabet very slowly.

Important. 

mentalillnessmouse:

- Run cool or warm water over your hands

- Grab tightly onto your chair as hard as you can

- Touch various objects around you: a pen, keys, your clothing, the wall…

- Dig your heels into the floor- literally “grounding” them. Notice the tension centered in your heels as you do this. Remind yourself that you are connected to the ground.

- Carry a grounding object in your pocket which you can touch when ever you feel triggered.

- Jump up and down

- Notice your body: the weight of your body in the chair; wiggle your toes in your socks; the feel of your chair against your back…

- Stretch. Roll your head around; extend your fingers…

- Clench and release your fists.

- Walk slowly; notice each footstep, saying “left” or “right”

- Eat something, describing the flavors in detail to yourself

- Focus on your breathing, notice each inhale an exhale.

A few weeks ago I attended the Trichotillomania Learning Center’s conference in New Jersey, my first time ever attending this show. I must admit, I was a bit worried about attending because of the shame and secrecy I have over picking. I’ve been anonymous on this blog forever, and I I wasn’t sure things would be when I showed up in person. I figured I would be in a safe space—there were other pickers and pullers and I’ve spoken with a few people at the TLC. I also wrote a guest blog post a week before the conference. So I was excited, yet a bit cautious about being out in public.

I decided to only attend the event on Saturday even though the conference started on Friday night and ended Sunday afternoon. I just couldn’t make the trip out to New Jersey from where I lived. It took over 2 hours to get here, including the subway, a bus, a monorail and a shuttle bus to the hotel. So I got up early, left myself a lot of time and still managed to get there late after getting lose at Newark Airport looking for the shuttle bus departure zone to the hotel.

The conference is set up so that there are multiple sessions going on at the same time. I guess this is good because people can choose the session that is most interesting, but I found that there were just too many going on at the same time. Sometimes I’d want to attend more than one session during a specific time, but of course that was impossible so I just usually attended the sessions that were more focused on picking. Usually that meant just one, possibly two sessions since much of the conference is centered around trichotillomania.

Overall, there were relatively few skin picking/derma sessions, but there was always at least one session going on at any one time, so that was good. But I definitely wanted more. I’m sure the TLC is catering to their audience and attendees, but now that skin picking will be added to the DSM V, I hope that the group adds even more skin picking sessions to future events.

Anyway, the conference was held in a hotel near Newark airport, and it was relatively easy to find the conference and registration. I got to the event about 9:30 so I missed the opening welcome session that morning, and a bit of the first session on picking. It was called “An Overview on Compulsive Skin Picking” but I found out very quickly after taking a seat and settling in that the original speaker, Dr. Renae Reinardy was not there. It seemed like a sort of open session where a speaker, Dana Marie Flores, was leading a discussion.

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