I am so pleased to showcase this guest post from therapist and recovered skin picker herself, Shelley Diamond Ph.D. Dr. Diamond was also a featured writer in the book Skin Deep by Dr. Ted Grossbart which explores the impact our emotional self can have on the skin.
Skin picking and scratching are two habits that can become long-term problems. This often happens for the following combination of reasons:
• The tactile contact feels pleasurable and comforting, or occurs randomly at first, or due to itch or irritation
• It develops into an automatic habit that the hands do unconsciously
• The behavior is associated with particular cues and emotions, then linked to always occur in those situations which are usually stress-related
• The behavior is usually labeled by others as disgusting and shameful
• The person consequently feels guilty, frustrated, and angry with themselves for being unable to stop or control the behavior and obsessively thinks about it
• The habit continues secretly and compulsively
• The skin can become infected which makes it difficult to clear the skin, and the skin may clear for awhile but then the cycle starts all over again. There may be periodic flare-ups in times of stress or certain areas of the skin that have constant inflammation.
Other people typically make simplistic suggestions like “just stop touching your skin” as if it is a matter of pure willpower. They do not understand that the body-mind connection involved in this problem is quite complex. Part of the reason this particular problem is so complicated is that the habit becomes part of what’s called procedural memory. This aspect of brain activity is normally used for common actions that involve hand-eye coordination such as tying your shoes, turning a door knob, flossing your teeth, etc. The brain innocently and non-judgmently creates these behavioral batch-file routines that are assumed to make your life more efficient and productive. It is difficult to stop doing something once it has become part of procedural memory.
One of the most important first steps is to stop getting angry with yourself for being unable to control the behavior. This is not an easy or simple problem to solve, despite what others may say. This is not a matter of willpower, it does not mean you are weak, it does not mean you are a bad person and deserve to be visibly marked that way, it does not mean all kinds of terrible things you may have heard or imagined in your mind. If you believe those negative ideas and hate yourself, you are then likely to increase the picking and scratching to punish yourself, which makes you feel worse.
The emotional aspects are what differentiate this habit from other neutral actions in procedural memory. Intense emotional associations reinforce the behavior and also make it more difficult to manage. Psychotherapy with someone experienced with these type of problems is sometimes necessary to untangle all the aspects and help you gain mastery over all the separate reasons that the problem continues.
If you are suffering from skin picking and unable to stop the habit on your own, Dr. Diamond is available for help. She is a licensed psychologist in private practice in San Francisco. Her website is www.DrShelleyDiamond.com.