go-pluck-yourself

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spin this wheel of fanfic tags. this will be the theme of your day tomorrow.

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any of my fellow skinpickers get like. weirdly fascinated with the stuff that comes out of/off of your skin? like the other day i scratched off a flake of dead skin and i just sat there for a solid minute just sitting there looking at it. like i was turning it over in my fingers and looking at it through the light like i was admiring it. and i've had a number of keratin plugs that have been solid enough that i could just hold it and i just sit there hypnotized by it like im hesitant to get rid of it.

it might be the OCD but i've also had ones that were so good that i *still* think about it today. I have clear and vivid memories of picking sessions when i was a kid because there was one particular plug that gave me such a rush of endorphins that it's become permanently embedded in my brain.

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My dermatillomania has been going on so long (since childhood basically) that I’m starting to have hand problems - tendinitis or carpal tunnel or arthritis or something. And I’m still having trouble stopping. 🙃 My hands are pretty stiff in the mornings now, especially the base of my thumbs and that pad between the thumb and pointer finger. Sometimes it can go into my wrists and forearms. And gripping things is harder overall - they feel weaker and/or will hurt. I have to completely not pick for a few days (gasp! lol) for them to start feeling almost normal again, but then I tweeze my eyebrows and my focus shifts to my skin, or I cut my nails and my focus shifts to my cuticles, and then it starts over again. The fact that I can go a few days is great but not good enough for this particular factor. Even when I don’t do those preening things, I can still absentmindedly pick at my cuticles with my fingernails throughout the day. 😣

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the problem with skin picking is that I actually really enjoy it

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So I always have a hard time figuring out whether or not to wear jackets/hoodies, and not just for the normal trans reasons, but also because I have the fun¹ combination of keratosis pilaris + dermatillomania, which means my arms permanently look like they have been ripped to shreds... and like yeah, long sleeves will keep me from fucking them up, but then I just pick at my face instead, which is arguably worse (soo much harder to get my face looking okay after I fuck it up on a really stress-heavy day, it can take months for all the scabs to go away) so like. Do I wear long sleeves and keep myself from fucking up my arms (but risk messing up my face instead) or do I wear short sleeves which is soSO much better in terms of sensory problems but leaves my arms open to harm?

¹This was sarcasm, btw. It is not fun. I fucking hate it with every fiber of my being.

Also if u wanna know more about keratosis pilaris or dermatillomania feel free to ask, I would love to explain either (and why having both at the same time feels like some kinda cruel fucked up joke from the universe).

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any other skin picking warriors got any tips for redirecting picking :( i notice i'm doing it and drop my hands but i just come back to it again in a few minutes. it's annoying >:/

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my biggest fear as a trans person with dermatillomania is that ill ruin my top surgery by picking on the scars

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Constellations, july 2021

This one is very personal. I suffer from dermatillomania and i have many scars on my arms due to me just ripping off scabs that were in the process of healing. I wanted to come to terms with that

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BFRB Resources for Struggles Like Ours

These resources vary from reliable sites and blogs to published journal articles, professional papers, books, and more. If you have any recommendations for me, feel free to Submit something.

A separate post for tips, tricks, and non-affiliate product recommendations will be linked here as soon as I've posted it.

Now then, some of you may be wondering...

What is a BFRB?

Body-focused repetitive behaviors are among the most poorly understood, underdiagnosed, and untreated group of mental health disorders.

According to the TLC Foundation for BFRBs:

"Body-focused repetitive behaviors (BFRBs) include any repetitive self-grooming behavior that involves biting, pulling, picking, or scraping one’s own hair, skin, lips, cheeks, or nails that can lead to physical damage to the body and have been met with multiple attempts to stop or decrease the behavior."

(From the TLC Foundation's webpage, "What is a BFRB?")

The PickingMe Foundation says:

"BFRB's are self-grooming behaviors in which individuals pull, pick, scrape, or bite their own hair, skin, or nails, resulting in damage to the body. Many people are more familiar with its sister disorder, Trichotillomania - Hair Pulling Disorder."

(From the PickingMe Foundation's webpage, "What is Dermatillomania?")

The Recovery Village describes BFRBs as:

"Body-focused repetitive behaviors (BFRBs) are a group of mental health conditions that cause people to bite, pick, pull or scrape their skin, hair or nails compulsively. While some people with BFRBs have awareness and insight into their behaviors, others do them automatically. BFRBs are often linked with disorders like anxiety or substance abuse. Treatment is essential for people with BFRBs, but many often hide evidence of these harmful actions and have trouble asking for help."

(From The Recovery Village's webpage, "Body-Focused Repetitive Behaviors")

According to Angela Hartlin's skin-picking support website:

Body- Focused Repetitive Behaviours (BFRB’s) “is an umbrella term for any chronic behavior that causes a person to consistently cause physical damage to oneself unintentionally through a compulsive act in order to relieve anxiety.” The key difference between BFRB and other compulsive behaviours that cause harm to the body is that BFRBs are characterised by direct body-to-body contact. The website goes on to list other BFRBs such as: hair-pulling disorder (trichotillomania), hair eating disorder (trichophagia), skin biting disorder (dermatophagia), nail biting disorder (onychophagia), and nose picking disorder (rhinotillexomania).

Getting BFRBs officially classified as disorders has been a long, slow process that only hurts those of us who struggle with them daily, as treatments and available resources relating to BFRBs can be very difficult to find. That's the reason why I'm composing this. I'll keep updating this post to the best of my abilities, both for myself and for anyone else it might help.

The good news is that while progress may be slow, there is still progress. Dermatillomania was finally added to the DSM-V-TR under the same OCD-Related Disorders umbrella as Trichotillomania, which has been a big step in the right direction. The more awareness brought to BFRBs, the sooner more can be recognized for what they are so the people suffering from them can receive proper medical and psychiatric help where necessary.

Are BFRBs a type of self-harm?

No.

While the two are not mutually exclusive, the general consensus seems to be that where self-harm is voluntary, BFRBs are grooming behaviors that have gone awry to the point that they are categorized as "OCD-Related Behaviors" in the DSM-V-TR due to their compulsory nature. These behaviors may or may not be driven or worsened by anxiety.

In the case of BFRBs, even though these behaviors cause varying degrees of bodily harm, they're ultimately driven by impulses and urges that cannot easily be controlled. Quite often the triggering event is discovering a physical imperfection in any way for any reason and attempting to "fix" it, despite the behavior being counterintuitive to the goal. The resulting behavior can occur actively or passively, with severe active episodes usually likened to being held hostage in your own body.

There is no desire to harm and very little ability to stop, and then all of it is followed by distressing feelings such as shame, guilt, or embarrassment. We try so hard to "break the habit" that we ultimately beat ourselves up mentally for "failing" yet again. Even though many of us might know we can't control it, it's too easy to blame ourselves for something we feel is somehow our fault.

[Please be advised the purple paragraphs below are personal examples with a few details that may be triggering for some.]

For example, the only way I can come out of bad episodes is when my bodily literally cannot continue. This may look like my back giving out from leaning on the counter in the bathroom, or my legs going completely numb from sitting for too long, or (much more commonly) my fingers or nailbeds hurt too much for me to keep using them, regardless of how much I may or may not have bled.

This is always followed up by what I call the "walk of shame" phase as I clean up every injury, apply Neosporin or other balms/salves, and bandage what I can. I've burst into tears before when I had to use Neosporin like it was lotion in order to cover everything, because I had too many wounds on my arms to be able to safely apply bandages/plasters.

No part of that process, from the trigger response to the cleanup, is something I want to do. If I had a say in it, I'd never pick or bite ever again, and my skin would finally be able to heal.

Self-harm, on the other hand, is a term reserved for bodily harm that is deliberately inflicted on oneself, usually as a way of dealing with difficult emotions, memories, situations, or experiences. Instead of acting on an uncontrollable compulsion, this type of harm stems from a different set of triggers, many of which relate to trauma or other disorders. This makes the behavior more of an unhealthy coping mechanism for people in pain who are desperate for release from those feelings.

Note: If you are unsure if your behaviors are a result of a BFRB or self-harm, Crisis Text Line is a good resource:

"Self-harm is serious. And, while the intention behind self-harm usually is not death, it can still be dangerous—both physically and emotionally. Talking to someone who can help you find alternatives is incredibly important. Of course, you can start by texting us. Also, consider telling someone you know who can help you connect with a professional."

General BFRB Resources:

Sites:

The TLC Foundation - "The TLC Foundation for Body-Focused Repetitive Behaviors helps end isolation and shame for people experiencing hair pulling, skin picking, nail biting, cheek biting, and associated behaviors." They feature a robust website full of information on all BFRBs, including "Medications for BFRBs" and "Evidence-based Therapeutic Treatment for BFRBs."

The Recovery Village - "The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals." (BFRB-specific information can be found here.)

SkinPick.Com - While this site is centered around skin picking/excoriation disorder/dermatillomania, they have excellent resources for other BFRBs as well, including their Glossary page, "Complete List of BFRBs," and the blog section for "Related Disorders." I have also listed their site in the Dermatillomania section below.

Articles:

Online Journal: International Journal of Environmental Research and Public Health, Special Issue: "Body-Focused Repetitive Behaviours (BFRBs). Risk Factors, Prevention, Treatment"

The Recovery Village’s article, "7 Myths About Body-Focused Repetitive Behaviors"

The Recovery Village’s article, "8 Little Known Facts About Body-Focused Repetitive Behaviors"

Outreach:

"Health Education & Community Programs" (the TLC Foundation)

Communities & Support:

PickingMe Foundation's Online Support Group.

TLC Foundation's Support Group Directory for peer-led support groups.

SkinPick's online Forum.

Self-Help:

Nathan Peterson's ComB Model for BFRB Treatment, Part 1 and Part 2 on YouTube. Peterson is a licensed OCD specialist who helps people with OCD, anxiety, and BFRBs in person, through his OCD & Anxiety YouTube channel, and through his site, OCD-Anxiety.Com. (His BFRB specific course can be found on his site here.)

SkinPick's free self-guided program to stop skin-picking.

PickingMe Foundation's Derma Resource Packets "...are our campaign to spread Dermatillomania awareness to skin care providers (Dermatologists, Estheticians, Nail Salons, Clinicians), mental health professionals, and anyone who wants more info! We provide them with tools and the opportunity to point Skin Picking Disorder sufferers in the right direction."

PickingMe Foundation's Management Tips page, a "growing list of tips and management strategies!"

Mobile Apps:

SkinPick App – "A free tool to monitor your skin picking behaviors."

Specific BFRB Resources:

Onychophagia:

Not every instance of nail-biting is considered onychophagia. Most nail-biting behavior dissipates over time. It’s when it doesn’t that the behavior requires a closer look. Chronic nail-biting is categorized as an obsessive-compulsive related disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR).

SkinPick's blog post, "Onychophagia: More Than a Nervous Habit"

"Art of Prevention: The importance of tackling the nail biting habit," authored by Mohsen Baghchechi BS, Janice L. Pelletier MD, FAAP, Sharon E. Jacob MD, FAAD, FAAP. Published in the International Journal of Women's Dermatology, Volume 7, Issue 3, June 2021, Pages 309-313.

"Update on Diagnosis and Management of Onychophagia and Onychotillomania," authored by Debra K. Lee and Shari R. Lipner. Published in the International Journal of Environmental Research and Public Health, 2022, 19, no. 6: 3392.

Dermatophagia:

Formerly referred to as "wolf-biting," dermatophagia has yet to be recognized as a diagnosable disorder.

SkinPick's blog post, "Do you eat your own skin after picking? There's a name for that."

SkinPick's blog post, "Dermatophagia - What is it?"

Dermatillomania:

Dermatillomania means “Skin Pulling Madness,” and has only been diagnosable since 2013. It is currently classified as an “Obsessive-Compulsive and related disorder” in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), where it is listed as Excoriation Disorder. However, it is known by many names, such as: Skin Picking Disorder, Compulsive Skin Picking, Acne Excoriée, Pathological Excoriation, Neurotic Excoriation, Pathological Skin Picking, and Psychogenic Excoriation. The many names for this disorder cause interference with its understanding and awareness.

Dermatillomania is often confused with other conditions. Common misdiagnoses result because the picking behavior is a result of a medical condition, confused with OCD, Body Dysmorphic Disorder (BDD) and in some cases, Non-suicidal Self-Injury (NSSI).

PickingMe Foundation - "Picking Me Foundation NFP is the only donor-supported non-profit dedicated to advocating for Dermatillomania (Skin Picking Disorder) sufferers, supporters, and educational communities alike, encouraging individuals to choose themselves over the mental illness that chose them by #PickingMe over Skin-Picking."

Angela Hartlin's Skin Picking Support website. Hartlin is the author of, "FOREVER MARKED: A Dermatillomania Diary" and the creator of the documentary, "Scars of Shame," which you can watch for free here with the password, "Scars1" (Thanks, Angela!)

SkinPick.Com - "SkinPick is the #1 platform to treat excoriation disorder (dermatillomania). Get one-on-one support from a therapist specializing in treating compulsive skin-picking through evidence-based techniques."

SkinPick's "Do I Have Dermatillomania?" Test

SkinPick's blog post. "Skin Picking and Body-Focussed Repetitive Behaviours (BFRB)"

Stuff That Works’ page, “Excoriation (Skin-Picking) Disorder”

Trichotillomania:

Probably the most famous BFRB, Trich has the most resources available thanks to being the first diagnosable BFRB. The resources below are more general as a result:

TrichStop - "TrichStop is the world’s leading platform for Trichotillomania treatment. Get one-on-one support from a therapist specializing in treating compulsive hair pulling through evidence-based techniques." From the same support team behind SkinPick.Com.

TrichStop's "Do I Have Trichotillomania?" Test

TrichStop's blog post, "Trich and Comorbid Disorders: What We Are Learning"

The TLC Foundation's Trichotillomania page.

"Trichotillomania," authored by Aubree D. Pereyra; Abdolreza Saadabadi. Published in StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. (Ongoing)

More to come.

There are more BFRBs than this out there, but I don't have the resources gathered for them yet. Hopefully the General resources help! I'll update this as I have time. In the meantime, I wish you all luck on your BFRB journeys.

-> Anxious? Try This:

[go-pluck-yourself]

how the hell do i stop picking at my skin and picking at the scabs and then pulling out my hair when i don’t have the money for getting stim toys rn and nothing feels the same or good in replacing the behavior and i keep doing it when i’m anxious or as a stim / impulse… ughhh

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Super awesome thing about derma is how it’ll take you way longer to get ready bc every time you look in the mirror you can’t stop yourself from popping one or more of your acne spots and then you have to hold a bit of paper towel to it for like 5-10 minutes to stop the bleeding, and if you didn’t get them all at once, once you’re done dealing with one round, you go back to the mirror to try getting ready again, and the cycle repeats 🥲

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a really frustrating part of body focused repetitive behavior (skin picking/nail biting/hair pulling) for me is like. I KNOW it's ocd, but most of the time it doesn't FEEL like ocd.

for me it's almost the opposite of "pure" or "obsessive" ocd, where I have a compulsion but no clear obsession attached to it. how can I manage a compulsion that I can't identify the cause of? literally the only correlation I've noticed is gender dysphoria and that's not a specific thought I can target with therapy.

I'm just a little exhausted bc ocd treatments should work but at least the few I've tried. just don't.

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"Trichotillomania isn’t just pulling hair—it’s a complex response to stress, emotion, or even boredom. Healing starts with compassion and small steps toward understanding the patterns behind the urge." ______ The Trichotillomania Workbook !

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I don't think I'll ever not be annoyed-amused at the Catch 22 that is OCD-BFRB and "being tired"

Cause being tired is one of the number one controlling factors to how well I can resist compulsions and impulses to engage in compulsions, the more tired I am, the more likely I am to do them

So what often happens is I am more tired than usual so I go "Hey Ill go to bed early" so I start getting ready for bed

The ISSUE is that while getting ready for bed, I go to the bathroom to brush my teeth and what not. The bathroom ALSO has a mirror, toe nail clippers, shavers, and scissors - all of which are moderate triggers to BFRB compulsions

I am tired so I am much more prone to doing them. I start doing one and continue doing it for an hour plus

It is no longer early

If I stop then I can sleep as planned

If I can't I will likely stay up

In the end, the next day, I am tired and so...

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Me: I’m gonna try going to sleep a lil earlier tonight, I’m feeling pretty sleepy anyway

The nefarious 2 hour skin-picking session:

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dermoed too close to the sun and now im having intrusive thoughts abt infection thats why some professionals call ocd a spectrum

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every dermatologist ever: dont pick your skin, it will make it worse

me after picking my skin thus causing it to get worse: :0 how did this happen