Wednesday, September 26, 2012

The Fix: Skin Picking and Addiction

As you may know if you follow my Twitter or Facebook, I broke up with Tech Boy last night. We talked a lot.  It’s just been becoming more and more abundantly clear that we’re in different places in our lives and we need different things. I can honestly say this is the most amicable break up I’ve ever had.  At the end of it he said he loved me as a person, definitely wanted to stay friends, and would give me hug at work today (which is weird, but okay?).  I’m sad, but so far I’m not devastated. If anything I feel relieved. My brain is still whirring though so I’m not really feeling up to posting today.

Fortunately I have another cool article for you from The Fix. Of course by “cool” I mean informative and possibly triggering. Enjoy!

Skin Picking and Addiction
Cutting gets most of the media ink these days, but an equally prevalent form of self-injury—skin picking—is increasingly afflicting many addicts. Shannon Kelley gets to the root of the problem.

When Annie, a 35-year-old recovering addict in Brockton, Mass., who has been sober six months, talks about picking her skin, she could just as easily be talking about using.

“When I pick, it’s the same feeling,” she explains—when she’s skin picking, her thought process reminds her of when she was using. “It’s like, ‘Okay, I’m only going to pick one or two cuts, but I won’t do them all.’ And then... It’s sick, but it makes me feel good, so I do it more. Then I get those feelings of, ‘Ohhh, what did I do? Why did I do this?’ I’m so angry at myself, so I say, fuck it, why not just pick at all of the scabs, because now I look horrible anyways, so what does it matter if I do the rest of them? I end up feeling guilty and ashamed and embarrassed and I have to cover it up so nobody knows.” She sighs. “It’s the same euphoria, the same feeling of trying to hide it, the same embarrassment. And shame and regret and guilt. All the same feelings.”

Annie’s not alone. In More, Now, Again, Elizabeth Wurtzel’s 2002 memoir of addiction, she writes not just of her drug addiction but of her compulsive hair tweezing that would result in bleeding legs. Lilly, a 30-something addict in New York, has managed to kick booze, cocaine, and cigarettes, but not picking the skin on her fingers -- from the cuticles down to the knuckles. Even when she’s not doing it, it preoccupies her thoughts, and once she starts, she admits, “it’s like a never-ending train.”

Though you’d never know it from how much the disorder has been covered in the media—it hasn’t—addicts picking at their skin (a condition known clinically as dermatillomania) or pulling out their hair (trichotillomania) isn’t all that unusual. Still, knowing what to call it is tricky. Skin picking and hair pulling are often labeled “body focused repetitive behaviors” (B.F.R.B.s), but also fall under the umbrella term for “non-suicidal self-injuries” (N.S.S.I.s), which includes more severe behaviors, such as cutting. Classification is up for debate, too; some believe B.F.R.B.s belong on the O.C.D. spectrum, although many disagree. Meanwhile, dermatillomania is currently listed as an “impulse control disorder.” And, while there are similarities, skin picking is not the same as cutting.

“In general, skin picking is a more compulsive behavior associated with anxiety disorders and it’s similar to O.C.D.,” says Dr. Joseph Shrand, Instructor of Psychiatry at Harvard Medical School and Medical Director of CASTLE and the Adult Inpatient Psychiatric Unit for High Point Treatment Centers in Plymouth, Mass. “Cutting is often associated with more complex character pathology such as borderline personality disorder, while skin picking is frequently associated with trauma.”

Dr. Simone Madan, a San Francisco-based psychologist who specializes in treating people dealing with B.F.R.B.s, offers a significant stat: 25% of those who suffer from a B.F.R.B., 25% are addicts. But numbers, too, are problematic. Because of the shame around such behaviors, it’s safe to assume that they’re extremely under-reported. That said, recent literature estimates that around four percent of the population has trichotillomania, while anywhere between two and 5.4 percent of the population is affected by pathological skin picking. Skin pickers and hair pullers are more likely to suffer from body dysmorphia, depression, anxiety, and other mood disorders.
This is no coincidence, says Shrand. He’s treated several patients who are dealing with both addiction and N.S.S.I.s and says that when there’s an underlying psychological issue—such as depression or anxiety—drinking, using and even skin picking become “ways to suppress these uncomfortable feelings and overcome them with feelings of pleasure.” The problem, he says, is that “at some point, it’s not pleasure anymore. It’s simply a way to not feel the other feelings.”

While the notion of picking at skin to feel pleasure might sound odd, Dr. Shrand explains, it makes sense thanks to a trick of evolution. “It was important to be able to suppress pain if you were being chewed on by a saber-toothed tiger, so you’d release an endorphin, suppress pain and run away fast.” Endorphins, he adds, are “our bodies’ morphine”: they sit in the same receptors as opioids do and deliver the same high. Any N.S.S.I. will offer a taste. Shrand points out that, although the causation is different, this is where skin picking and cutting are similar; both, he says, “appear to have the same end point of endorphin release and relief.” On the television show House, when Dr. House is attempting to kick Darvon, he cuts himself to get a fix. In A Million Little Pieces, James Frey writes of ripping off his toenails while in rehab to get some relief. Skin picking and hair pulling offer a little dose of the same medicine—a high or escape. Madan says her patients report feeling like they’re in a “trance-like state” while engaged in the behaviors.

This makes sense, according to Shrand. “You get this sense of relief and a high,” he says. “With picking, you don’t feel actual pain at the time. There’s this buildup of emotional pain, this anxiety, and the brain has learned, ‘Well, if I pick at myself, I will release an endorphin’—which is the brain basically going, ‘Ah, this is great, I feel so much better, I’m so relieved: thank you!’ And you really don’t feel the pain until maybe 20 or 30 minutes later.”

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I think a lot of the Borderline pathology also has to do with trauma, which is why these kinds of behaviors, impulses, and compulsions are such a problem for many of us.

19 comments:

  1. I always thought this was something I just did. Now I have to be burdened with the knowledge that I have yet another disorder? Knowledge is not always power. It's sometimes debilitating.
    Sorry to hear about your breakup. At least you were both mature enough to realize it and have a clean, amicable breakup.

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    1. Yeah, I just always thought it was part of my anxiety and nervous habits. Apparently it's a form of self-injury. My poor fingers have been a mess for the last couple months. And I thought I was doing so well ::sigh::

      Yeah, it'll be okay I hope.

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  2. I pick at my skin, rip off nails, bite fingers, shake legs, pull hair out on my fingers, rip cuticles and hang nails. All depends on the severity of the situation

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  3. so you're single now then Haven? How you doing? ;) *winkwink*

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    1. Oh Ukan, haha, as long as the Missus doesn't mind ;)

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    2. As long as she can join in, I don't here there being a problem ;)

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    3. Sounds like we got ourselves a party, haha.

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  4. I bite my finger nails. When I was younger, it was bad. I'm talking, Lebron James bad but I have been able to cut down some over the years.

    Sorry to hear about the tech boy but it sounded like it was not meant to be. I utter Ukan's sentiments but I doubt you are into chubby married Jedi's fathering five year old girls, so......Moving on.

    I pray that this finds you as well as possible, Sith.

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    1. Ukan is a special acquaintance of mine haha.

      I go through phases with my skin picking. It's definitely a stress reliever and isn't so bad at other times. I hope things continue to improve for you.

      Well the force is still with me so I think I'll be okay.

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  5. Sorry to hear about your breakup. Sounds like it's probably for the best, but sometimes that can be just as hard! I have been through a break up earlier this year and have had a somewhat delayed response to mine, only recently losing the plot, but mine is more complicated due to having a child together. Anyway Thankyou for your post, I am a skin picker too and once I start it's hard to stop, it's definitely a compulsion and enjoyable for me, love having something heal enough that I can pick it again!! Sounds pretty gross doesn't it, but usually it's not that visible where I do it anyway. Hmm anyway kinda makes sense seeing as I'm a fairly nervous and anxious person, and also have depression. Recenty started pristiq too so hoping that is going to help somewhat, although having some fair side effects so far, like no appetite (kinda good) and sexual issues (not so good!!!). Anyway hope you can stay positive:)

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    1. Yeah, it still hasn't hit me, if it's going to hit me at all. We'll see I guess. Break ups just suck in general. If I'm not worried about me, I'm worried about him, even if I don't want to be with him. idk. I'm so glad I don't have any kids to worry about. That must be so hard.

      ::laughs: It does sound pretty gross, which is why I think it gets shamed, but hey! I'm not afraid of getting gross.

      It always amazes me how many disorders intermingle the way they do. Stay strong!

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  6. To say sorry about the break up would be completely fake I feel... I don't even know you, and I hardly ever feel sympathetic towards people I know, but you have intrigued me. Your site is inviting, captivating/entertaining, and educational. So, I do feel this desire that you find ease quickly in the midst of your change. Stay tuff, girl! You are the shit!

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    1. ::smiles:: Hi there Tom. You'll probably see me a lot over at SW now that I'm shunning my social life. I like your honesty though. And do be honest myself, I don't feel sorry, so I don't expect anyone else too. It sucks being so sad, but in a way I'm very used to it, so I'm not afraid of it.

      Always tough ;)

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  7. Hello,
    I would like to access that article if you could give me some idea of how to?

    Thanx

    Graffiti

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    1. Hey Tony. I included the link at the top of the blog, but here it is for you: http://www.thefix.com/content/pick-me-baby-one-more-time?page=1

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  8. Well I'm sorry you're sad but things will perk up and glad it ended well for you both!

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  9. I can't believe this is something others do. Haha. It drives my partner mad! I pick the skin around my nails almost constantly all day - I don't even think about it anymore. I pick them until they bleed and I squeeze it hard when it's sore. Its a really addictive comforting feeling for me. I do it moreso during periods of stress/going out in the world etc and my hands/fingers look a bit sore and scraggy then.

    I find this really amusing. We're all doing it. hehe.

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  10. I squeeze blackheads on my face every day for 45 minutes. When i have dead skin i pick that off. It's mostly my nose. I absolutely hate what i look like without makeup and am terrified of getting a staph infection on my face. This has been going on 11 years.

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Leave me a comment! It makes me feel good and less paranoid about talking to myself =)

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