This won’t go away just because you want it to.


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.

About Mel Baggs

Hufflepuff. Came from the redwoods, which tell me who I am and where I belong in the world. I relate to objects as if they are alive, but as things with identities and properties all of their own, not as something human-like. Culturally I'm from a California Okie background. Crochet or otherwise create constantly, write poetry and paint when I can. Proud member of the developmental disability self-advocacy movement. I care a lot more about being a human being than I care about what categories I fit into.

18 responses »

  1. “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. ”

    I’ve had people reacting this way when I talk about eating paper (MY paper), which I don’t do much. “Pica pica pica.” Maybe we should start making up medical terms for things other people do and place the verb after the noun to make it sound more medicalized. What’s weird is that people seem to see eating paper as one of the worst things I could do and I get scared when someone might find out about it, but it’s actually not harmful to eat certain types of paper. And the harmful types taste bad anyway. I flat out LIKE eating paper too, I want to write something really condescending as satire about how nuerotypical people will never understand the joys of eating paper.

    I’ve probably messed up my teeth a bit by chewing/eating plastics and that might actually be harmful since there are lots of chemicals and things but I actually feel like that’s a bit less objectionable to people.

    I wish you could talk to people about the skin picking stuff without them trying to take away your freedom/ability to make choices or turning you into a “threat to self or others,” a term I dislike as much as you. Because it obviously is a problem and making you hide it only serves to make more comfortable people who want to pretend it doesn’t exist.

    • I’ve had people reacting this way when I talk about eating paper (MY paper), which I don’t do much. “Pica pica pica.” Maybe we should start making up medical terms for things other people do and place the verb after the noun to make it sound more medicalized. What’s weird is that people seem to see eating paper as one of the worst things I could do and I get scared when someone might find out about it, but it’s actually not harmful to eat certain types of paper.

      Seriously? I ate paper all of the time up through early adolescence (I’d tear Kleenex into strips and eat them), as well as all kinds of other odd things, and never got more than a mild “That’s weird” from people. However I’ve never been diagnosed with anything (I am, as far as I know, totally neurotypical) and was pegged as gifted and artistic at an early age, so that probably makes an immense difference in how these things are handled.

  2. Telling someone to stop doing something that is automatic doesn’t work.

    I normaly poke my nails and cuticles until wounds are formed, many times they bleed, I don’t think to do that, I don’t even notice, when I’m distracted it just happens, head-banging and self-injury are different for me, more in time of stress and I learned to avoid.
    I keep hearing people telling me to stop poking my nails, that does not help me stop.
    It’s strange that most movements that are automatic for many I need to think about it and this I don’t even notice doing.

    Thank you for writing.

  3. I have one good result from medicalisation – I was taught about dermatitis artefacta (I think this is the more common UK term?) in my medical school, and was able to tell a friend where the strange marks on their arms and hands came from (they were so disconnected from the automatic action that they were completely unaware that they were skin picking at all). But the flip side is that while the dermatologists who taught me were very positive about it, most of the stuff I read in textbooks is convinced that it’s attention-seeking or an ‘unconscious need for care’ or whatever. This just doesn’t gel with my experience of drawing their attention to it mid-scratch and them being totally surprised that they were doing it. A misfiring grooming instinct seems to fit much better with what actually happens.

    Thanks for writing about this. There must be more people like my friend who don’t know what’s going on with their skin, or don’t understand their skin picking.

  4. Marge: Wow. Yeah, “attention-seeking”, because that must be why I hide it so thoroughly that generally only my closest friends know I do it anymore. (And even them I don’t tell a lot to. The main person I tell is the person with the parrot who plucks because she wants to know more about what she might be going through.) I really don’t understand why so many professionals seem to leap to that sort of explanation before anything remotely sensible.

  5. I used to have major trich in high school. This was a period where I was very stressed and confused, and I likely did it in an attempt to calm myself. To, I can look through books I read at that time and find the twisted hairs I was using as bookmarks.Sometimes I still pick it, but that isn’t as severe and is usually under my control.

    I skin picked then too, toying with the area around a peritoneal catheter I needed for dialysis; this gave me a near-fatal infection at one point. When I received a kidney transplant and the catheter was gone for good, the picking stopped.

    I’m not saying that I should simply have been let off the hook for doing these things, but at least your post sums up a lot of the thoughts I had about my SIBs during that time. My sister currently skin/hair picks (without a catheter) and chews plastic like Pancho. I will keep what you wrote in mind when I see her doing these behaviors again.

  6. I wonder if the rhythmicity of skin picking is self-soothing as is the fact you are creating a closed circuit in touching your skin and is it possibly being reassuring in some way. I think back to the rhythm of your head swinging in infancy or the repetitive sucking on your passifier. It was such a necessary part of your coping that we had spares in case one was lost.

  7. Ehhh marge is this why I sometimes wake up with cuts and things on myself? I always thought that was weird but it was never enough to be worrying and it hasn’t happened in a while.

    And yeah it’s strange how people can completely ignore how hard you are trying to hide something and call it attention seeking.

  8. The way you describe your skin picking sounds in some ways like how hair pulling actually is for us. We’ve made some progress over the years in cutting down on it, but there are times when it just requires… like you described, that constant, constant vigilance every second, or else we’ll just find our hands going to our scalp and picking through our hair and pulling it out. And there just seems to be no way to continually maintain that vigilance every second of every day, and then if we end up doing it again after a relatively long period of going without it, we’ll get angry at ourselves for “relapsing” and then because of that, pull out even more hair, even though that makes no sense by any kind of conventional logic.

    And… in our earliest memories of doing it, we remember it clearly as being an enjoyable activity for us, not something like hitting our head we did out of stress. It was like a kind of stim. I might go so far as to say that it just flat-out is one, under a lot of circumstances– not only the physical texture of the hairs, but also the pain. That part, actually, did not really come into focus for us until we read an essay on BDSM talking about the difference between “good pain” and “bad pain,” for many people who practice it, and the description of “good pain” kind of flipped a switch in our brain and we went “oh, yeah, holy crap, it’s a lot like that.” Because we had never really been exposed to the concept that pain could be good in any case, and we’d spent several years dealing with various kinds of chronic pain in various ways, none of which were “good pain” at all and which we very much wanted to get rid of. (Then again, like I think you mentioned in another blog post somewhere, the things that get called “pain” are a whole bunch of different types of sensations, and we haven’t got as many as you do, but have still had the experience of our brain dealing with and processing them in totally different ways. Like going to look for an Advil for a headache when our legs have been burning all day fron the fabric in our pants, but that somehow not registering to our brain as “being in pain,” and the concept “our body is in pain” only happening when we start experiencing a type that isn’t usual for us.)

    So, yeah, I don’t know if it’s like this for you, but the pain associated with it is often a good feeling for us. And one of the other earliest things we remember about it was being fascinated with the hair that we pulled out and how it could vary in color, texture, etc, and a lot of other little things, and having a box that we’d saved a bunch of our hair in, and making up various onomatopoeic words for different types of hair. And it not seeming to be gross at all, just fascinating, sometimes too fascinating to the point where we had to force ourselves to try to do something else.

    …we’ve, um, also had some experience with people regarding it as a deliberate form of self-harm, even if not the exact same experiences as the ones you describe, and… well, I don’t feel comfortable talking about it much here, but there was a point at which we felt absolutely horrible not because we couldn’t stop doing it, but because we had been told that if we kept doing it, it meant that we “believed our body deserved to be punished” and that meant we hadn’t “healed,” in a recovery-movement type of way. And we had this thing going on for awhile where we would be able to kind of “save up” the impulse to do it and then let it out in private, because we got told we were hurting people we cared about by making them “watch us hurt ourselves.” And that, in its own way, felt worse than the guilt about not being able to stop it ever did, or having people yell at us that it was disgusting, or having people spread rumours around our school that what we were actually doing was picking lice out of our hair and eating them. We’ve actually had more success minimizing it by… approaching it as something to be managed rather than totally eliminated, or guilt-tripping or psychoanalyzing the hell out of ourselves by deciding there must be some deep buried psychological reason for why we “want to hurt ourselves” and that we must stop it now now now.

  9. I have mild dermatillomania. It’s only on my scalp and is exacerbated by stress (it was also exacerbated massively by a particular medication, which I don’t take anymore.) Wearing a hat helps. So do gloves, but they get in the way if I need to write, type, turn pages or do ANYTHING with my hands.

    I do get fascinated by the scabs and bits of skin, too – although I don’t keep them.

    I always *know* when I’m picking, but it’s a really strong impulse and not doing when I want to means I can’t fully concentrate on anything else.

  10. I totally get that. I have the same issue with hair. Thankfully after I shaved my head a couple of times, I got used to not pulling any of the hair on my head, but… all the other hair on my body still gets targeted. I’m pretty sure it’s a sensory issue. I hate stuff touching my skin–including my own hair. I do the whole minor-self-injury thing, too, and got hospitalized twice because of the “danger to self or others” issue. I hate that phrase. Utterly hate it. It’s like they can bring it out and then do anything they please, like it’s a magic spell or something.

    The way I figure it, minor injury isn’t a problem–you just have to keep things clean, so the danger of infection is minimized.

  11. That’s interesting. I have no doubt that the impulse is very similar to feather-picking in parrots, falling into the class of stereotypic behaviors.

    The suggestion ‘put something else on your skin and pick that off’ seems pretty stupid, since putting something on, peeling it off, putting it back on, repeat, is just not the same pattern of behavior. I imagine it might actually work if you spattered specks of adhesive all over one arm or something, but that would probably be, under most circumstances, not an improvement.

    A friend of mine who had this problem was able to transfer the behavior to a big piece of flaky sandstone that I used as a coffee-table, when in the presence of my coffee-table. This sort of thing may help the parrot who plucks. Not a coffee-table, but a toy that has soft pieces that can be pulled off one by one.

  12. we have the same issue with picking at our left eyebrow……..eventually the skin gets hard and then forms a nub…… just feels really, really good. And yes, trying to stop reuquires lots of concentration,……….sometimes our parents get irritated/distracted by it and tell us to stop……….not wanting to be yelled at some more we comply but………makes it harder to process what they’re saying………..

    thanks for sharing. and hope everything is okay after Irene

  13. Thanks a bunch for this post- it really is a great resource for others who have similar habits and want to know that they are not alone.

    A friend of mine has an issue with his eyelids where they are almost open wounds for months at a time, and because he squints quite often, they rarely have a chance to dry and heal and he just keeps rubbing and rubbing and rubbing on them.

    I’m glad to have read a post that didn’t offer a laundry list of solutions that aren’t personal at all and instead just celebrate the fact that it is what it is.

    Also- thanks for the cat video ;)

    If you ever want to chat or need additional resources, stop by our facebook page & say hello! We believe in supporting all kinds of awareness and progress in the autism community. :)

  14. I did a lot of skin picking in high school. I used to peel the skin off the palms of my hands fairly constantly, and I’d sometimes use needles to do it. I stopped doing that and biting my fingernails down to the bloody quick shortly after I left high school and never did it again. High school was pretty stressful for me, which contributed, but it wasn’t something I recall ever consciously deciding to do it or stop, I just did it, and I don’t recall many people noticing, and at some point I noticed I didn’t do it anymore. I had several relatively mild SIBs in childhood and teen years that are mostly gone now.

  15. Sorry for the late comment, but I haven’t been keeping up too well lately.

    I’ve had a milder version of that kind of thing going, which mostly comes out day to day in not being able to leave my cuticles and other skin around my nails alone, and picking at scabs and keratosis pilaris bumps and sometimes eczema. (Leading to some scabs to pick, yeah.) It gets harder to manage when I’m under stress. To the point that if I start having worse trouble leaving things alone now, I look for stressors that I might not have consciously registered yet. And, yeah, to me it’s very different from either purposeful SI (which I have also done) or the headbanging kind of reaction. It kept getting treated as purposeful SI, and I was also threatened with hospitalization over it more than once. Which did not decrease the stress causing that exascerbation, no.

    someone^Amorpha wrote: And we had this thing going on for awhile where we would be able to kind of “save up” the impulse to do it and then let it out in private, because we got told we were hurting people we cared about by making them “watch us hurt ourselves.” And that, in its own way, felt worse than the guilt about not being able to stop it ever did, or having people yell at us that it was disgusting, or…

    Oh yeah. I used to get guilted like this a lot, not limited to the picking at things, but definitely with that. For extra fun, substitute “mutilate” for “hurt” there. Definitely identify with managing it rather than doing the destructive kind of neverending self-psychoanalyzing. Which, to me at least, is about as appropriate as trying to come up with the deep hidden psychological reasons you’re having Tourette-type tics. (Not that this was not pushed as necessary too, mind you.) The compulsions feel similar enough to me that I have wondered if it might be related.

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