It’s kind of weird.
Throughout my adolescence, I heard a lot about trichotillomania (compulsive hair-pulling). In mental institutions staff tended liked to show off their knowledge of terminology by saying it in my presence a lot when I was yanking out hair. But I don’t have trichotillomania. It was more on the order of head-banging, a response to extreme emotional distress, not an irresistible compulsion.
I know this because I experience what’s called dermotillomania, which is just an unnecessarily long word for compulsive skin-picking. I’ve experienced it my whole life, people have made me feel about two inches tall for not being able to stop it, and I still can’t stop it 31 years on (or however long it’s been since I was old enough to do it). I almost don’t want to write this post because whenever someone actually notices what’s going on, they go to a lot of trouble to tell me how bad for me it is, or exactly how much I shouldn’t be doing it, as if I hadn’t noticed already. (It’s not always clear how much of that is actual concern for my well-being, how much is being grossed out by it, and how much is being embarrassed. It really depends on the person.)
I mostly stopped hair-pulling when my life stopped being unbearably stressful. Skin-picking is a totally different story. While it seems to increase during times of stress, it also happens at other times. I honestly suspect it’s a grooming instinct gone completely out of control — picking off bugs, except now “bugs” is anything that happens to stand out against my normal skin. Scabs, freckles, moles, pimples, whatever. Sometimes I even do it to totally normal skin.
This obviously can become a serious health problem. Besides the risk of infection, it takes things absolutely forever to heal (on top of the fact that I often have slow healing to begin with). And it’s not always just pulling off the top layer, I can dig entire crevasses in different parts of my body.
Weirdly enough, there’s a level on which it’s enjoyable. A friend reports the same thing about her parrot pulling feathers out — she’s always very interested in the feathers afterward and plays with them. The skin, scabs, whatever that I pull off create the same sort of interest for me. I stare at them, I line them up, I get especially happy about ones that are unusual sizes, colors, shapes, etc. and may keep them around for awhile. I rarely get grossed out by it, I just get very interested (interested may be a better word than happy, it’s like a form of out-of-control curiosity). The parrot also does a very similar motion to the way I run my fingers over the area of skin I’m going to pick, only she does it with her beak.
Sometimes I’m able to keep the results of this hidden, sometimes I’m not. Right now most of what I’m doing is in the parts of my ears that are either invisible to people or easily covered. (And it goes against a lot of my instincts to reveal any of that. I’ve spent way too long hiding it from people who would comment or get me in trouble or whatever. Mental institution staff welcomed the excuse to put me in restraints and get me out of the way. And weirdly, while they treated the hair-pulling as compulsive, they treated the skin-picking as akin to head-banging, or as a deliberate attempt to cause harm to my body. Two totally unrelated kinds of experiences and they got them exactly backwards. In a world where they can spin this sort of thing into “a danger to self or others” (the standards for involuntary commitment in many places) it’s dangerous to admit this kind of thing in public when you’re already prone to being locked up just because of the kind of person you are.) Keeping it hidden also helps keep other people from assuming any wound on your body is caused by this, which gets really irritating really fast, as does people insisting on sitting there watching me for it and then saying “You shouldn’t do that” every time they see it. None of these things are helpful in the least bit, they just cause unnecessary suffering.
What does stopping entail? Constant concentration. Because the moment that I let my guard down, my hand will wander off somewhere and pick something without my even being aware of it half the time. It also can make the problem come back even worse. I’m still recovering from ripping toenails out yet again after an attempt to stop. When you’re doing to yourself things that are normally described as a form of torture, you know something’s very wrong.
But “very wrong” doesn’t translate into an ability to stop this. I’ve tried just about everything possible and the moment I let up my concentration I’m back to doing it again. This isn’t the thing where “just put something else on your skin and pull it off instead” works easily. It requires so much concentration that ability to do other things can suffer in ways where it can be better for a person just to go back to doing it. It takes every bit of willpower I have (combined with increased picking in other places) not to do really serious damage by doing things like picking surgical wounds, and I only manage that by picking still other things, not by stopping altogether. And no, there’s no medication that has ever helped, even a little, and I’ve been on a lot of different medications (not explicitly for this, but if they worked they’d work regardless of why I took them).
By the way, I know there are people who consider this (and all sorts of other things) an “illness”, but I don’t. While it can always be useful for something normally considered a moral issue to be considered a medical issue instead, I don’t find it useful in my life to treat an overactive instinct as if it’s a cold or the ever-present diabetes comparison. Clearly it’s something wrong, but the only way medicalizing it would ever help me would be if it helped me pay for some way to stop doing it. And that still wouldn’t mean I wanted to medicalize it in the rest of my life. I don’t find it remotely useful to treat picking my skin more as “getting sick”, it’s just not a useful analogy for me (and in some situations I’ve found it worse than useless).
So why am I writing about this? Because it’s a large part of my life and one that very few people seem to understand to any great degree (and then their lack of understanding only makes things worse when they try to “help” me). And it’d be nice to not experience their fumbling attempts at “help”. Plus, as usual, I write a lot of things because other people’s writing has been useful to me in self-understanding and I’ve often wanted to give that back to other people when I can.