Help with compulsive behaviors and anxiety?
February 11, 2019 3:57 PM   Subscribe

I'm a 37-year-old female with a history of depression and anxiety. The latter has worsened recently and I seem to be developing some compulsive behaviors. Has anyone experienced or treated these types of issues, who could help me understand why I'm doing these things to myself and how to stop?

My latest symptoms: when I'm stressed or anxious I compulsively pick at the skin around my fingernails or chew on the inside of my lips or cheeks until I'm bleeding, to the point that I've developed visible scar tissue. Or I will unconsciously rub my eyebrows or hairline; I have given myself bald spots and inflamed skin/ingrown hairs by doing this. I also subconsciously fiddle with jewelry or clothing, or whatever is in front of me. I'm not usually aware that I'm doing these things while they're happening but they seem to be worsening; other people are starting to notice and I feel like I'm losing control.

For additional context, my life and career are in a state of transition and I think these circumstances are contributing new symptoms to the milder anxiety I've experienced previously. I'm not in an especially happy place right now and I tend to overthink and worry to the point of paralysis and sometimes-debilitating fear of failure. I live alone and do not have a close family or social network that I can rely on. I've tried talk therapy a handful of times and it hasn't helped me.
posted by AnnaBegins942 to Health & Fitness (20 answers total) 26 users marked this as a favorite
Ugh. I am also a picker and having these finger fidget rings hidden in my pocket are wonderful for releasing that nervous energy. When I’m talking to someone I can just twist away.

Finally, just sitting with my anxiety. Saying, I'm feeling nervous about X and then just feeling nervous, the emotion, in my chest, allows me to let it go. It’s the fighting of the feeling that makes it worse and sublimates it into something compulsive. Facing it directly takes it down.

You can read about trichotillomania which is compulsive hair pulling for other symptom and support ideas.
posted by St. Peepsburg at 4:13 PM on February 11, 2019 [4 favorites]

Just throwing this out there, but personally when I was on Adderall I had a seemingly-insurmountable
compulsion to pick my skin and pull at my beard. You don't say if you're on any medications, but if you are consider talking to your doctor about adjusting them. If you aren't, consider talking to your doctor about starting some. Be sure to mention that you're having compulsive behaviors, as some medications often help with that while others often make it worse.

Also, redirection is huge. I've always been a bit of a fidgeter, Adderall notwithstanding. It helps to have something acceptable to fidget with. Playing with your jewelry is a lot better than picking your skin, for instance. If you can find something nice to fidget with that you can keep in a pocket, that's even more discreet. I think it's important both to work on reducing the compulsion and also on redirecting it to something more acceptable.
posted by Anticipation Of A New Lover's Arrival, The at 4:16 PM on February 11, 2019

If it helps to know what this is called (it helped me), it's body-focused repetitive disorder. It's a self-soothing mechanism and the act of doing it does actually temporarily make you feel better, which is why it usually upticks when one is under stress or anxiety.

I found this article, and especially the comments, really helpful when I was having an intensely stressful period of time last year and feeling a lot of shame about my picking; maybe it will help you too. What seems to help me best is whenever I notice myself picking, to: play with fidget toys and paperclips I keep at hand; apply and rub in special luxe cuticle oil that I keep on my desk/in my purse/on my nightstand; physically get up and do something else, like organize the recycling or do the dishes.

I also find that if I can stay on top of other anxiety-reducing work like regular exercise, eating healthy, and meditating, it's better, but I know that's hard to do when you're already in a not-great place. Since you mention talk therapy I'll say that you might find relief from tapping or other body-based therapy like trauma yoga; in my experience if the issue is with the body, only a body solution will help it.
posted by stellaluna at 4:42 PM on February 11, 2019 [16 favorites]

I have anxiety and at a few points during very stressful times, it's manifested as trichitillomania, aka pulling out hairs. I had a bald patch on my scalp that I lied to hairdressers about - said a kid I was babysitting snatched it out.

You're SO not alone. Stuff like this is very common, and animals do it too, like when stressed birds pluck their feathers out. It helps me somewhat to know that this is a basic biological stress response, rather than "just some weird thing I'm doing for god knows what reason."

In the short term, try substituting similar but less harmful activities. I might comb my hair instead of plucking it; you could maybe chew gum or bite down on hard candy instead of chewing on your lip, or any number of things.

Longer term, there are many treatments for anxiety, including medication and various forms of therapy (not just talk therapy). I had good results with a psychiatrist who both prescribed medication and did talk therapy.
posted by showbiz_liz at 4:44 PM on February 11, 2019 [6 favorites]

I've done similar things my whole life, and for me it's just a way to self-soothe when I'm in a situation that's stressful and beyond my control.
Like another poster suggested, rings help if your self soothing is otherwise destructive. Gum and candy can help keep your mouth busy. Painting your nails will deter you from biting them. A lip piercing made me stop biting my lip. Tying back my hair made me not shred my hair, etc.
Redirecting it to something more socially "acceptable" can help if others noticing it really bothers you, but personally I don't give much of a crap because at least I'm not popping benzos that came with horrid side effects anymore.
There is nothing at all wrong with self soothing behavior, in fact they teach you to do it in therapy, but looking into dbt techniques can give you a lot of new ideas for how to do it if you're finding your current ways bothersome.
posted by OnefortheLast at 4:50 PM on February 11, 2019 [3 favorites]

I get fidgety like this when I have a lot of coffee, and I've started chewing gum when this is happening. There's probably some downside to that but it's kept me from biting things that shouldn't be bit.
posted by twoplussix at 5:08 PM on February 11, 2019

Not trying to be that person that recommends it for everything but I am F and tend to also have anxiety and similar compulsions. CBD oil has helped with the anxiety and the resulting compulsions/symptoms immensely. Also cutting down on caffeine and exercising if you can.
posted by Young Kullervo at 5:15 PM on February 11, 2019

My biggest and best trick for this has been to start painting my nails. I do so crappily, with thin coats, and then deliberately scrape the polish off with my fingernails as a replacement for my picking. It's the same feel of cleaning/fussing/smoothing/grooming without any actual harm to my body. Then the routine of actually cleaning and reapplying polish helps bracket a day or gives me a wind down.

These days I only do thisoccasionally, but a few years ago it was daily, until I saw a psychiatrist and got a prescription for zoloft. While I was taking that, I found it infinitely simpler to cope and maintain a feeling of control, so much so that I was able to stop doing a lot of the built up behaviors I had engaged in - just lots of little compulsive stuff. I figured out the source of a bunch of my sensory issues and have learned direct coping methods for them.

I no longer take zoloft because of a few different reasons but this is a personal journey I'm in the middle of and I'll probably try a variety of different medications over time. Now that I'm more in touch with why I do the picking and fidgeting that I do, I can catch it a whole lot earlier and productively focus it in ways I couldn't before. But I'll still paint my nails only to scratch the polish off when I'm doing new things or know I'm going into a high pressure (for me) situation. Nobody thinks ill of a thirty something "creative" woman with raggedy polish, and it takes thirty seconds with some polish remover to make it disappear.

You're not alone. Things like this are extremely common. If talk therapy was useless for you there are many other forms of help out there. I like the suggestion of therapy yoga above, but you could also try low impact exercise of almost any type, maybe beginners tai chi, swimming, or just going on daily walks, but a class environment might be a great motivator and structured social thing for you right now. Something that gets you in touch with your body more than anything that's meant to make you sweat. There's also volunteering which can be a source of incredible positive feelings and social engagement while distracting you from your anxieties and compulsions, depending on where you are and your interests and beliefs. A lot of times doing more can help unclutter things so I stop doing the useless/actively harmful stuff and start doing what I want to instead. Your mileage may vary.
posted by Mizu at 5:26 PM on February 11, 2019 [8 favorites]

I'm a sociologist and I whenever people tell me they are in transition and they are anxious, I encourage them to read about liminal space. If you think of a rite of passage, liminal space is when you have left the old identity/state/status, but not yet gained the new one. It is a difficult place and it is not a place, I believe, we are intended to be for very long.

Today, for example, I gave the go-ahead to our realtor to start trying to sell our house. We are moving to a great new place and I've had no anxiety about what we are doing up until today, but I still felt really anxious after she left. I was able to identify it as liminal space and know that it's not a harmful place, but it can be disconcerting, and the feeling passed after a few hours.

I believe it passed because I labeled it and just let it go through me without panicking. But that's not always possible, and when it's not possible, anti-depressants can be a great way to help you through the transition. It's important to remember that anti-depressants can take a while to help, so the sooner the better. A GP can prescribe them in most cases, you don't need a psychiatrist.

I would also question your "therapy doesn't work for me" statement. Sometimes therapy doesn't work because we don't want it to, or we haven't found the right person, or we haven't given it enough time. The symptoms you are describing are fairly serious and you could probably use some help addressing them.

Therapy doesn't need to be long-term. Anti-depressants don't need to be long term. But either way, I would look into liminal space.
posted by orsonet at 6:08 PM on February 11, 2019 [14 favorites]

Like Young Kullervo I also don't want to be that person re CBD, but without claiming it as a panacea, taking it has had a noticeable effect on my overall anxiety and has also dramatically reduced how much I engage in my tic, which is digging under my index finger nail with my other thumb. It was getting to the point where my finger was starting to hurt because I was doing it enough to start separating my nail from the nailbed, and of course with things like that the habit becomes subconscious to the point where you do it without even noticing, so good luck trying to fight it by watching yourself.
posted by invitapriore at 6:34 PM on February 11, 2019

CBT therapy helps me with compulsions a lot more than standard talk therapy does. You could try a workbook like this one if you can’t find a therapist near you - the author works with patients with OCD and/or trichotillomania.
posted by bananacabana at 7:34 PM on February 11, 2019 [1 favorite]

My psychiatrist recommended NAC supplements for this. I was very sceptical but they do seem to work if you take some every day. It doesnt get rid of body focused compulsions but it does turn the volume way down on them. Took a couple weeks to really notice results.

...and I'm going to go take some right now because I've been slacking and my picking has crept up again.
posted by ananci at 7:58 PM on February 11, 2019 [2 favorites]

Other terms to research are dermatillomania, skin-picking disorder, and excoriation disorder. Whatever you call it, I've had it since I was a kid. Some anxiety meds help, some don't. Some therapists have helped, some haven't.

One of the biggest things that's helped me is something my therapist before the one I have now made. She suggested some kind of creative pursuit with a tangible output, something I could point to and say, "I made that thing." And it's helped a TON. I have a lot of these artistic pursuits now, but the one that helps most with the skin picking and hair pulling is doing English paper pieced hexagons, towards the end of making quilts. I can do a few at a time, or I can do a boatload at a time. None of it requires a machine, so I can toss a stack of hexagons-to-be in a ziploc bag and haul it with me across the countryside visiting various and sundry doctors.
posted by The Almighty Mommy Goddess at 8:13 PM on February 11, 2019

You are definitely not alone. I am a fellow cuticle picker. I'm not thrilled about it and when it gets bad I slather affected finger in shea butter or anything hydrophobic and moisturizing and put on a glove and sleep that way - it really helps heal things. Of course, my situation also includes some mysterious dermatological conditions hat exacerbate the issue, so that might be overkill for you.

I don't know if it's helpful but .. try not to pathologize yourself too too much, I really do think a lot of humans (a majority?) have a habit or two like this.

good luck with everything, transitions are hard and exhausting, especially on your own .. I've been there. If a random non judgy internet stranger's ear could be helpful, feel free to memail me.
posted by elgee at 10:50 PM on February 11, 2019 [2 favorites]

Ditto NAC (N-acetyl cysteine) supplements, made a huge difference for me when I started taking it about 3/4 years back; have kept taking a daily dose since and the compulsion has mostly gone. When it does come now it actually tends to be when I'm very relaxed / idle, rather than when I'm stressed or nervous.

I've found Jarrow brand NAC sustain 600mg (combines fast and slow release layers in a single tablet), one a day in the morning on an empty stomach, to work noticeably better than generic tablets or capsules.
posted by protorp at 1:08 AM on February 12, 2019 [6 favorites]

Thirding NAC. It's cheap, easy to find, etc-- but it's also a heavy-hitting game-changing miracle for many people.
posted by thegreatfleecircus at 3:07 AM on February 12, 2019

Response by poster: Thank you, all...I am a little overwhelmed and touched by all these responses! It does help to know I'm not alone and I appreciate everyone sharing your personal experiences with me. Your suggestions are wonderful and I'm planning to try a few of them today.

@orsonet, if you have any resources about liminal space I would love some recommendations.
posted by AnnaBegins942 at 5:16 AM on February 12, 2019 [2 favorites]

Reading this, I was like, "Wow, this could be me." A zoloft prescription and beginning therapy (the former covered by work benefits, the latter unfortunately not and quite expensive) is beginning to help a lot. I've started to recognize compulsive behaviours related to anxiety (re-checking over and over that I've locked the door, for e.g.) and can better resist the temptation to do them with the zoloft.
posted by Kurichina at 6:49 AM on February 12, 2019

There's some great resources in this thread, but here's one more: the Calm Hands community on Reddit. Sometimes it just helps to see so many other people struggling with what you thought was only you. Sometimes they have really good suggestions.

I have found that wearing Kiss press-on nails physically makes me unable to do much damage to my skin -- they are thick and dull and I can't pick, and they make it difficult to get to the sides of my nails where I bite the skin. That, and having fidgets literally everywhere (purse, desk, bedside table, car). Otherwise, nothing has really helped me, but I am glad to feel less alone.
posted by fiercecupcake at 7:32 AM on February 12, 2019 [1 favorite]

Seconding press on/full gel nails. You can't get any purchase on your skin with them. Gloves in quiet periods/tv/couch/bed/driving helps.
Doing chores/hands occupied with dirty items helps.
Less playing on the phone helps me not idly let me hands drift to picking at skin.
When I was on escitalopram alone for anxiety reduction, the picking was almost completely stopped. When Adderall was added to the mix, the dose was too high and drove a lot of picking/repetitive action... dosage was cut in half and the complusion settled a bit. If you have meds in your day, you may need a bit of adjustment.
This website was helpful for me: OCD LA... they have a good weekly newsletter.
(P.S. I admire you for being brave and asking this question. .. I sometimes have wanted to post this same question, but felt too ashamed. Thank you.)
posted by NorthernAutumn at 12:19 AM on February 16, 2019 [1 favorite]

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