i quote ‘condition’ because, until recently, i’ve never thought of it as such. i’ve always just been a ‘picker’ - when i was 11 and i split my head open after an unfortunate PE incident, i vividly remember, with piercing agonising clarity, lying in the darkness the night i got my stitches out, willing myself to be able to resist the temptation to peel the new and impressive scab right off. i did not resist. a fair few towels had to be thrown out afterwards.
but it never seemed of clinical significance. i used to bite my nails, i told myself, because my piano lessons had instilled in me a hatred of feeling my nails protruding over my fingertips. whether this is true or just a would-be justifiable excuse for developing a bad habit, i’m not sure. but picking at my nails led to picking at my fingers, and that was that. i do it constantly. subconsciously. and this is where the condition itself gets complicated.
the psych bible (DSM5) lists this condition under 'excoriation disorders'. which, in turn, comes under 'obsessive-compulsive and related disorders’. and herein lies the problem. dermatillomania and its sister condition trichotillomania (and all the others that come under the broad umbrella of body-focused repetitive behaviours (BFRBs) - which i’ve listed below in a handy glossary) are not obsessive-compulsive. OCD sufferers perform behaviours as a result of intrusive thoughts i.e. over-zealous hand-washing as a result of fear of contamination. repeatedly putting lights/switches off as a result of fear of causing a fire by leaving one on etc. excoriation disorders are compulsive, but not obsessive.
i don’t pick my fingers because of a) any specific intrusive thoughts or b) any specific incident (that i know a psychotherapist would be determined to pin down). most of the time i’m not even aware i’m doing it. on thursday i was doing laundry and as i skimmed around my room throwing dirty clothes into the basket, i looked down to see that my middle, ring, and pinky fingers were keeping hold of the basket’s handle - while my forefinger quite autonomously picked away at my thumb. and that’s terrifying. to realise your body is acting apparently of its own accord is horrifying.
so i did what i should’ve done a while ago, and reached out to one of my old psych lecturers to ask for any guidance possible. i’m aware i have a horrible habit of making these pieces too long, so i’ll post a follow-up with the details of our chat in a couple of days. but for now i think it’s important to highlight the importance of being open about these things. the number of comments i got, when i first posted about this on instagram, from people saying ‘i do this too, and i thought i was the only one’ was honestly staggering. how devastating that so many people feel so utterly alone in this. so, hey, this isn’t just you. a lot of us are doing it. and, hey, it has a name. for me, at least, knowing the ins-and-outs of this makes it easier for me to manage. i’ve always maintained that understanding something properly is the key to conquering it.
and, lastly, i want to thank everyone who has offered me kind words of support, encouragement, or advice. especially those who suggested false nails as a way to combat picking. despite having always abhorred the thought of what having long nails would feel like, i applied my first ever set on friday night and, as of now - 11.24am on sunday morning - i haven’t indulged once. when, for months, you can’t go 5 minutes without subconsciously doing something that causes you such intense distress, to find myself 36+ hours free feels like nothing more than a god-given miracle. here’s to many more.
roobs’ introductory guide to body-focused repetitive behaviours
BFRBs are any chronic behaviours that involve a person consistently repeatedly unintentionally causing oneself physical damage through a chronic behaviour to relieve anxiety.
BFRBs include (but are not limited to):
dermatillomania - compulsive skin-picking
dermatophagia - skin-biting
onychopagia - nail-biting
onychotillomania - nail-picking
trichotillomania - hair-pulling
trichophagia - hair-eating
BFRBs are not the same as self-harm and, in fact, often the compulsive urge is so strong that it overrides any pain sensation.
while the majority of people will report absent-mindedly picking at their fingers and/or their nails at some point in their lives, the act becomes more closely-aligned to a ‘disorder’ when it causes significant emotional distress, it affects your day-to-day life, and provokes feelings of shame or isolation.
the OCD centre of LA has developed a preliminary diagnostic ‘ABC’ guideline:
an ‘A’ is something that Anyone would pick at - a piece of dry skin hanging off, or a could-burst-it-with-a-strong-enough-look spot.
a ‘B’ is a Bump, that only a picker would pick - a pre-spot or tiny scab, but that - when picked - will become worse and lead to more picking.
a ‘C’ is something that the individual Creates - there is nothing objectively real to pick at, but that the act of picking or squeezing or scratching will cause. this is a behaviour reserved only for those with dermatillomania/onychotillomania.
if you pick, but it doesn’t bother you - don’t think you have to start worrying. this post isn’t to convince you that you have a problem. i’m simply trying to make those who have spent years of their lives thinking that they’re alone and disgusting realise just how many other people experience this and long for the comfort of recognition. ‘i do that too!!’ is one of the friendliest, most relieving things to hear. this can be a lonely, lonely journey - i’d rather take it together.