Picking skin
December 16, 2010 9:14 AM   Subscribe

I can't stop picking at my skin. What can I do to try?

I started getting spots at 21 (I'm 28 now) but the picking has only began in earnest over the past couple of years. I feel like my skin is dirty and I need to get the blackheads/spots out otherwise people will notice, and my face will be really ugly. Half an hour later, I have bleeding or weeping bits on my face and red spots like I've been battered where the picking has gone.

I feel compelled to do this whenever I go to the loo or am somewhere with a mirror (such as shop changing rooms). I end up going to the toilet at work and bending my head under the light for ten minutes or so, then can't leave because my face is so red. My boyfriend gets upset about this because he feels like I'm harming myself and hurting myself with my skin. I tried getting a blackhead remover to minimise the damage but it doesn't seem to stop the compulsion outside of the home.

I tried explaining that this is a problem to my psychiatrist (NB I am in the UK and have been assigned her on the NHS, so 'get a new psychiatrist' isn't great advice. It's hard to change them. I see her because I've been diagnosed with bipolar disorder.) and she doesn't seem to understand that this isn't a habit like nose picking - she says 'you have a nice face, you need to try and stop' but it's not that simple.

I've tried cutting my nails as short as they'll go but it means I still go back to picking and the damage is worse because I end up gouging at the skin.

Is there anything I can do to reduce the congestion on the skin and remove the temptation? I try using facemasks or scrubs occasionally and it does help but I have these kind of headless spots on my chin which don't go away. It's got to the point where it is disrupting my day a bit and I've realised people are noticing the scabs.
posted by anonymous to Health & Fitness (25 answers total) 25 users marked this as a favorite
I also seem to compulsively pick at my skin (although usually not on my face). What has helped me a bit is getting into home manicures. With wet nail polish on my fingers, I'm less inclined to start picking at myself and ruining my hard work.
posted by mesha steele at 9:18 AM on December 16, 2010

This is trichotillomania sounds like, not to diagnose you over the internet and IANAT or Psych at all.

Since you said you can't get a different psych (I'd still try, since this is obviously bothering you and your current doc isn't helping) maybe try a rubber band around your wrist, which you can snap whenever you have the urge. Having the rubber band is also a reminder that you're supposed to be watching your behavior, and also other people don't really notice it so much.
posted by sweetkid at 9:21 AM on December 16, 2010 [1 favorite]

I have the same problem. The only thing that really works is keeping the nails of my two index fingers long.

I suspect it is related to some sort of anxiety disorder, but I have not talked to our family doctor about it. Maybe I should!
posted by KokuRyu at 9:22 AM on December 16, 2010

It may be the OCD-style compulsion dermatillomania. (Trichotillomania is hair-pulling/plucking.) I have this. It is a serious pain. (In fact, I was just sitting here in the zone where I tear my hands apart, and had the passing thought I wonder if there are any new AskMeFi threads on the picking thing.)

I have told my psych about it, and there are possibly medical/prescription drug methods that might help it. If you have bi-polar, I don't know enough to be able to suggest what might help. (I don't have OCD, but I have had this compulsion all my life.)

You can check out Stop Picking My Skin and Stop Self-Injurious Skin Picking. Both sites have tips, methods, and info. Both also have interactive communities. Using the term "dermatillomania" with your health care provider might help you make some headway; I always thought it was an unbreakable habit, so it was really helpful for me to be able to put it in this context.

I have some days that are better than others, but I'm not sure I'll ever be able to completely shake it. Mine is like a comfort stimulation, and I am not fussed with mirrors (though that is a very common form). Good luck!
posted by dryad at 9:34 AM on December 16, 2010 [6 favorites]

If you feel it might help you if you knew your skin was truly clean, consider getting a Clarisonic face brush. People rave about it.
posted by Dragonness at 9:43 AM on December 16, 2010

I'm very sorry your psychiatrist is glossing over this problem -- I know how upsetting it is to deal with. While I hope you're eventually able to transfer to another doctor, I'll throw out a few in-the-meantime suggestions:

1) Is 'the pill' an option for you? I will admit that I shared that very bad habit until going on birth control (Alesse/Loette, for those curious,) which thankfully cleared my skin.

2) Another idea that might be helpful is to schedule routine visits with an aesthetician for skin care once or twice a month. Reassuring yourself with the knowledge that someone else is going to be taking care of the spots, or even the anxious expectation of being chided for the self-destructive behavior by a professional, may be enough to get you to kick the habit.
posted by biggity at 9:52 AM on December 16, 2010

When I used to have the impulse to pick at my skin, those Bioré blackhead strips helped me a little bit. The, uh, reward of a high yield on those strips kept me from picking at the individual ones. The strips are expensive enough that I never got carried away with using them. That helped because pickfests would always start with the thought that I'd just get this one zit and then 5 minutes later I've gone at my whole face. Also reminding myself that picking leads to scarring helped a little bit.
posted by mandymanwasregistered at 9:53 AM on December 16, 2010 [1 favorite]

This is trichotillomania sounds like, not to diagnose you over the internet and IANAT or Psych at all.

Actually, this does not sound anything like trichotillomania, which by definition refers specifically to compulsive hair pulling. Which is especially why you should not let people diagnose you over the internet.

That said, as someone who has trichotillomania and understands the compulsive aspect of these sorts of problems, I will let you know that hypnotherapy has helped me. Not everyone is a good candidate for hypnotherapy, but it might be something worth exploring.
posted by hermitosis at 10:21 AM on December 16, 2010

My friend puts peel-off gel masks on her face when she gets the urge to pick. The wet gel makes it difficult for her to do anything damaging to her skin in that moment, and it gives her something to focus on while it dries and fidget with when it is ready to peel off. I don't know if you also pick at your fingers -- putting some plain white office glue on a fingertip and letting it dry until you can peel it off gives the same kind of instant prevention/brief respite/delayed gratification as the gel mask.

Is your urge stimulated visually? Is it the mirror that triggers you? She recommends a hand mirror (no magnification, no lighting) at home instead of whatever you've got. It will make it harder for you to pick if you have to hold your mirror at the same time. She has a gauze curtain in front of her bathroom mirror for the same reason.

I am not a picker, but I am a fidgeter, so I keep a couple of preeny-pinchy-petty things on my desk to twiddle with. My favourites are a wad of play putty and a little tassel on a loop. If you find yourself absently touching your face at your desk or while watching TV, and you are triggered to pick by feel, you might be able to distract yourself with something similar.
posted by Sallyfur at 10:34 AM on December 16, 2010

I had a friend with this problem. She made a lot of progress with a therapist (psychologist, not psychiatrist) who specializes specifically in anxiety/picking/hair-pulling disorders. Here's the website of a specialist who practices remotely. It's expensive, but with this kind of therapy you're not going to be going forever, maybe more like 6-12 visits.
posted by yarly at 10:47 AM on December 16, 2010

If the blackhead remover helps when you use it at home (which I think is what you were saying), can you try carrying it around all the time? I suppose that is only practical if you carry a purse or bag of some kind. If not, maybe you could keep a second one at work?

Similarly, I found that carrying around a good nail file pretty much entirely thwarts my nail biting compulsion.

The eyebrow pulling, which may or may not be trichotillomania, is something that I am still trying to work on.
posted by couch fort dinner party at 11:11 AM on December 16, 2010

i used to do this. sometimes i still get caught at a mirror if i linger too long. i avoid long sessions by avoiding mirrors for longer than just a moment. if i look for longer than a few seconds i know i'm in dangerous territory.

it also helps to think about the terrible scarring that will probably result, all the germs i'm subjecting my poor helpless face to.

take care!
posted by quiteliterally at 11:43 AM on December 16, 2010

Some meds for mental issues cause the picking. I was switched from one anxiety to buspar because the first caused me to pick at myself - mostly my hands and arms. Check on that first.

I continued to pick at my fingers, though, and they added luvox and cbt therapy for obsessive behaviors related to ocd, and that helps.

Cut your nails, give yourself a time limit in the bathroom, wear white cotton gloves when you can, and see a dematologist.

Good luck.
posted by FunkyHelix at 12:10 PM on December 16, 2010

I have a similar issue flare up sometimes, but it's my hands and feet that get the brunt of the abuse. Right now, the skin around my thumbnails is torn up pretty badly, but I'm not biting my nails to the quick or peeling strips of skin off of my feet, so I feel pretty under control.

I will say that anti-anxiety medication, which I was prescribed for actual anxiety, has made a difference. When I was able to take Xanax (which I can't right now because I am pregnant), the really damaging picking was also much more under control, because an anxiety attack, for me, would also exacerbate the behavior. You might talk to your physician, if your therapist isn't helpful or able to prescribe medication, about any options along these lines.

Since my medication options are limited at this time, I try to keep it under control with regular manicures and pedicures. The skin being smooth and well-tended minimizes spots where I can get a hold, for want of a better description, to start picking. In your case, since you pick at your face, perhaps a regular series of facials would help? If your skin is being very well-cared-for by a professional, on a regular basis, maybe the sense that your skin is dirty or flawed will be reduced.

Good luck with this; I do feel for you. For the most part, I'm able to conceal the damage so at least I don't have to justify or explain what's going on; I can't imagine having to deal with other people's reactions all the time.
posted by Lulu's Pink Converse at 12:21 PM on December 16, 2010

I saw an episode of the A&E show "Obsessed" about a woman with dermatillomania you might find interesting or informative. It's episode 2 of season 1.
posted by Safiya at 12:46 PM on December 16, 2010 [2 favorites]

Curiously, I found my urges in this direction were completely suppressed while on my ADHD medication.
posted by blue_wardrobe at 1:03 PM on December 16, 2010

My mom is a compulsive picker (compounded with some other anxiety issues, and potentially an actual skin issue) and it definitely sounds like a form of dermatilomania. Also it sounds like you have some related self-image anxiety issues that are exacerbating the situation.

I'm sorry your psychiatrist isn't listening to you. It sounds like he doesn't have a lot of history with anxiety disorders. Skin picking becomes a vicious cycle. You can't just tell someone "stop picking." That's like telling someone who has Generalized Anxiety Disorder to "calm down." How fucking insensitive!

I would definitely suggest looking for a counselor/therapist with experience in this area. Also maybe if you try to really assert yourself with your psychiatrist, he could prescribe an SSRI or other anxiety drug.

Also since it seems that you do have a legitimate skin concern, could you see a dermatologist? They could help you get into a routine that works for your skin. Also the Clairsonic mentioned above is pretty awesome although not cheap. It does feel like a mini-facial though!
posted by radioamy at 1:38 PM on December 16, 2010

Hello. I'm the OP.

Not so simple to 'see a dermatologist' here. You need to be referred through a GP. I've spoken to both my GP and my psychiatrist about this and both have said 'Just remember that picking will make things worse'. Yes. I know that. (I#'ve tried explaining to my psychiatrist about another compulsive behaviour I have =- spending money and acquiring things - and she says 'just write out a budget and remember you work hard for your money and don't need to spend all your mnoney = make a list when you go to the supermarket of your meats and fruits'. If it were that easy...) I have been prescriped Citalopram some time ago and still take it.
posted by mippy at 2:28 PM on December 16, 2010

Your doctors suck - and I say this as a UK person who has seen a fair number of NHS psychiatrists. It is possible to change doctors on the NHS; a friend of mine managed to change psychiatrists. The best thing to do would be to contact mental health charities in your area, or even national ones to get advice about the best way to go about it. If you're not comfortable with this, you could ask on the forums at the MDF, recommended by a friend with Bipolar as a good place to ask about things!

Are you only on Citalopram for your Bipolar? If so, that's quite worrying as antidepressants are only supposed to be prescribed in Bipolar along with mood stabilisers, and would make me question your psych in general (and make changing doctors a more pressing issue).

If you want a referral to a dermatologist, you can get one, but it will take effort. Big holes in your skin is a serious problem, that should be seriously addressed; go into your GP with this thought firmly in your head, preferably with a friend who is firm and forthright, and tell them exactly how much of a misery this is making your life, that you can't stop it, and give every signal of not being prepared to leave the room until you get that referral. This last part is the key - overrunning appointments can really screw up a GP's day, so if you make it clear that the only way you're going to get out of there nicely on time is by a referral you should get one (no guarantees). Dermatologists are as variable as any other doctors, but the ones that taught us were very positive about treating skin picking disorders.

Lots of good advice on self-help upthread that I can't really add to.
posted by Coobeastie at 3:46 PM on December 16, 2010

Yes, stabilisers have been prescribed too.

she has been useful for other things - I went to ask her about possible side effects and after a couple of diagnostic tests she said I seemed to be anaemic and should arrange a blood test ASAP - and I wonder whether it is the role of the NHS psych to look into things like this. She always asks me about self harm etc, so maybe I'm not explaining well enough how much this is becoming a problem.

I have changed GP a while ago thanks to moving house, and whenever I've gone to see her she's prescribed things for problems that weren't there (head lice treatment for scalp dermatitis - even when I explained to her that I had a history of dermatitis on the scalp so it was the most likely cause of itching - is one example) and I don't know how kindly GPs take someone going in and saying 'I think I have X, please give me treatment Y'.
posted by mippy at 4:54 PM on December 16, 2010

SSRI antidepressants can sometimes really help for OCD-like behaviors, which this sounds like it is one of. If you genuinely have bipolar, doctors may be unwilling to prescribe for fear of setting off a manic episode, particularly the higher doses that may be needed to reduce compulsivity. Clearly, however, you have already been prescribed an SSRI, so you may want to ask (do not do this on your own) about increasing the dose or switching to a different medication. It is not always true that SSRI's cannot be used safely in bipolar— this is a controversial issue. A dermatologist will not be able to help if you are causing the problem by compulsive behavior that you can't control. IANAD, etc.
posted by Maias at 4:54 PM on December 16, 2010

Never lean close to the mirror. It's only close-up that you'll be able to see the 'imperfections'.

Please sign up for the Yahoo groups Pickaderms. It's an online community with resources and support for people struggling with Compulsive Skin Picking (CSP).
posted by oceanmorning at 8:21 PM on December 16, 2010

Substitute a different habit; carry a washcloth and acne soap, and wash your face and hands well. It will help a bit, and reduce the inflammation and other problems from picking. I find that my nervous habits are way worse when I'm tired or stressed, so a moment or 2 of deep, cleansing breaths and self-calming is a good thing.
posted by theora55 at 10:33 PM on December 16, 2010

She always asks me about self harm etc, so maybe I'm not explaining well enough how much this is becoming a problem.

Just a quick addition here -- this kind of compulsion can be construed as a self-harm act, so if she's not making the connection, maybe ask her if she thinks it's related? Everyone presents a little differently; I know that for me, this compulsion has occasionally taken on this cast, though not often.

Don't be afraid to advocate for yourself. Though I'm in the US and thus not at all familiar with your health care scenario, the fact remains that YOU are the person who lives in your body. It's true that doctors are authority figures of a kind, but you're entitled to having someone listen carefully & with respect when you're talking about your own experiences. It sucks having to advocate for yourself in a mental health situation where you might lack the spoons to do so, but you seem to clearly feel that your care providers are missing something. It's okay to tell them that. This is about your well-being, not about their feelings.
posted by dryad at 9:51 AM on December 17, 2010 [1 favorite]

I'm not a doctor, psychiatrist, or dermatologist, but I have been trying to stop picking at my skin for the past ten years. Before that, I pulled out my hair (truth be told, I still do a little).
It's great that you're trying to stop; as much as you think it will help your skin and will make you feel cleaner and better, it never ever does. All it does is damage your skin, make you feel worse about yourself, and take up a ton of time.
I haven't managed to stop picking yet, but it's something I work on daily and I have seen some progress. What really helped me was reducing anxiety. The calmer/happier I am, the less likely I am to pick. I also try to keep HALT in mind: if I'm hungry, angry/anxious, lonely, or tired, I know need to stay away from mirrors and I need to keep my hands occupied otherwise I'll rip up my face. I'm pretty sure I got that from http://www.stoppickingonme.com/. It's a good site to read through: it helped me feel that I wasn't alone in struggling with skin picking. Personally, I don't like the AA approach, but you may find it helpful.
As far as the health of your skin goes, I really love acne.org for the regimens and product reviews. You may have to try different things over a period of time before you get noticeable and consistent results (and the skin picking will absolutely get in the way of improvement).
I'm so sorry that your psychiatrist isn't knowledgeable or supportive- skin picking is a serious problem! Compulsive spending is also a problem; I've heard skin picking, trichotillomania, and compulsive spending referred to as OCD-spectrum disorders. A good therapist can be very helpful. (You don't necessarily need to have your skin picking "cured," you may need to do something about the underlying causes. That's how it is with me.)
What you can try to do is avoid anything that causes you to pick. I've heard a lot of recommendations to write it down every time you pick along with where it happened and why/what the circumstances were. If you're not sure yet what triggers the picking, this might be helpful. Personally, I was too ashamed of myself to actually write this all down. :) If it's the harsh lights in public bathrooms that trigger your picking, you may just need to not look at yourself. I can't stand the way my skin looks in public bathrooms under those lights, so what I do is avoid looking at myself when I'm near the mirror. When I'm done washing my hands, I stand as far back as possible (so I can't see my pores or anything) and take a look. This keeps me from obsessing about how my skin looks, but doesn't let me close enough to the mirror to start finding the imperfections!
Do you use concealer? Yeah, makeup isn't always great for your skin, but I would have such a hard time going out into public without it. I mostly use concealer to fill in and hide my blackheads and large pores so I don't obsess, but if you find that makeup enables your picking, stop using it as much as possible.
Do whatever you need to do and whatever you can to help yourself: wear gloves (nice lacy ones, maybe?) all the time, put notes on all your mirrors or just cover them up, go to the bathroom in the dark. Find out what triggers your picking and try to get rid of it or avoid it.
I wish you the best of luck! It's no fun to be a skin picker. Just remember to enjoy your successes and to not beat yourself up too much over your failures!
posted by Baethan at 9:21 PM on December 17, 2010 [1 favorite]

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