Skin-picking, hair-pulling and other body-focused, repetitive behaviours can all be anxiety-related. They’re far more common than many of us realise, but we often feel shame associated with these behaviours, so we don’t talk about them. Because we all find it so difficult to talk about, it can feel like we’re the only person in the world going through it, intensifying our shame and sense of isolation.
THEY CAN AFFECT OUR WHOLE LIFE
When we live with these behaviours, we often feel embarrassed, alone, and ashamed. We don’t want anyone to know what we’re doing. Although 1.4% of the population skin-pick, 75% of whom are women, and around 2% of the population hair-pull, we might not know of anyone else who engages in these behaviours.
Feeling like we’re the only person in the world who does these behaviours can intensify our shame, embarrassment, frustration, and the fear that someone will ‘find us out’. It can make us feel like an outcast. We can become socially isolated.
It can affect all areas of our life. We avoid relationships in case someone sees marks on our skin. Our work is affected as we struggle to concentrate; our mind occupied with trying not to do these behaviours. We might start to find leaving the house difficult for fear that the anxiety caused by going out will make our behaviours worse. It can become all-consuming.
WHAT IS SKIN-PICKING?
When we struggle with skin-picking, we find it difficult to stop picking our skin, either with our fingers, with things we’re fiddling with, or both. It can include picking existing moles, freckles and spots, or creating new cuts, bruises, burns, and bleeding, and is often repetitive. We might pick our hands, feet, fingers, arms, legs, scalp, or elsewhere.
Although it can be part of an existing diagnosis, it can also be diagnosed in its own right as dermatillomania or excoriation.
It can be incredibly sore and unfortunately can sometimes result in infection. At times, we might need antibiotics. Picking our scalp can make hair washing painful. Picking at our hands and fingers can make it painful to use our hands, which can affect all sorts from writing to washing up.
WHAT IS HAIR-PULLING?
Hair-pulling involves pulling hair from our eyebrows, eyelashes, head, or elsewhere. Sometimes we do it with our fingers, sometimes we might use things to help us. Some of us also eat the hair that we’ve removed.
As with skin-picking, it can be part of another condition, but it can also be diagnosed as a condition in its own right, in this instance as trichotillomania.
Hair-pulling can make the area where we’ve removed the hair really sore. It can cause ingrown hairs, and in some cases, alopecia. Sometimes, it can also cause infections which can have a longer-term effect on hair growth.
UNCONSCIOUS BODY-FOCUSED REPETITIVE BEHAVIOURS
To those who haven’t experienced it, the idea that we can engage in these behaviours without consciously choosing to do so might sound unusual. But for many of us, it’s our reality.
For example, if we’re incredibly anxious or tense, we might be on high-alert and not notice that we’re skin-picking because our attention is focused on spotting threats in the world around us. Sometimes the repetitive action can be soothing; we might find that we’re sitting watching TV and don’t realise that we’ve been repetitively pulling our hair out.
Doing these things unconsciously can be scary; it’s not nice to be in a position where we don’t feel in control of our actions. The good news is that whether we do these behaviours consciously or unconsciously, there are things that can help us.
CAUSES OF BODY-FOCUSED REPETITIVE BEHAVIOURS
Lots of things can contribute to the development of body-focused, repetitive behaviours.
Boredom, stress, anxiety, frustration, and tension can all act as triggers. Repetitive behaviours might help us to release some of the tension we feel, even if only for a short time. Sometimes releasing tension in this way is a conscious decision, sometimes we might not be aware that we’re doing it until it hurts.
Perfectionism can contribute towards some of these behaviours, and is particularly mentioned in discussions surrounding skin-picking. Sometimes we skin-pick to try and remove blemishes, smooth our skin, or ‘fix’ any ‘imperfections’ we see.
Sometimes, these behaviours stem from other diagnosed illnesses, conditions and disorders. Body-focused, repetitive behaviours can stem from depression, anxiety, bipolar disorder, obsessive-compulsive disorder (OCD), personality disorders, eating disorders and other mental illnesses. Autism and ADHD are also risk factors for these behaviours.
ARE THEY A FORM OF SELF-HARM?
In a very literal sense, yes, these behaviours can be classed as self-harm, or self-damaging, because we often harm ourselves by doing them (whether intentionally or not).
That being said, the motivation behind them might not be to hurt ourselves, and we might not be aware that what we’re doing can lead to harm.
It’s not a question that can be answered with a simple yes or no. Ultimately, we deserve support whether we class it as self-harm or not.
Some self-caring actions can be helpful in response to body-focused repetitive behaviours.
If we skin-pick, then looking after any wounds can stop them from becoming infected. This means cleaning and dressing any wounds. Try to avoid using cotton wool as this can leave strands of the wool in the wound. Historically, antiseptics have been recommended both to clean wounds and to use in cream-form to promote healing. However, this is no longer recommended by the NHS.
It’s also important that we keep an eye on wounds to check that they don’t become infected. If we’re concerned about infection, then a good way to monitor it is to draw around the red area with a pen and check to see whether the redness has spread beyond that line as the day goes on. If our wounds are infected or we’re concerned about them for any other reason, then our local chemist or GP surgery should be able to help us.
For hair-pulling, we might find that there are specific shampoos or other hair treatment which are good for soothing our scalp and helping our hair to grow back. Different products will work for different people so the best thing to do would be to speak to our chemist, GP, or even our hairdresser.
Keeping our nails short and filed can make it harder to do these repetitive behaviours unconsciously.
Sometimes, caring for our skin and hair can help us to stop repetitive behaviours. Regularly moisturising our hands and skin can stop dry skin (which can be a picking temptation) but can also give us a soothing, caring association with our skin. Caring for our hair by regularly cutting split ends, treating ourselves to hair-masks, washing and conditioning it relatively often, brushing it when we remember, and even dying it a funky colour if that’s our thing, can all give us positive associations with our hair.
When we’re low, stressed, and anxious, these preventative actions might be impossible. They can also be difficult if we have sensory sensitivities. But there are things we can do to make these actions feel more doable.
For example, we could pop moisturiser in easily-accessible places and pop some on whenever we see a tube. If we like face masks, then we could have a permanent supply. Chucking a hair mask on and leaving it until we go to bed can be less effort than conditioning it, and leaves our hair feeling super-soft. Swapping towels for an old t-shirt when drying our hair can prevent split-ends. Ditching the hairdryer and other heat-styling items can help our hair health (and save us time and energy).
If one of our sensory sensitivities is smell then we could buy scent-free or similar-scented products. If the feeling of shampoo, conditioner or moisturiser makes us cringe, then we could try solid bars instead.
Preventative self-care doesn’t have to involve buying the whole chemist. We don’t have to spend a fortune or use ten different products with ten different textures and smells. It can take some trial and error to figure out what we like, but with so many products available, we should be able to find something that works for us.
REPLACING BODY-FOCUSED REPETITIVE BEHAVIOURS
Deciding to suddenly stop what we’re doing altogether might be possible for some people, but for many of us, that won’t work. We need to replace our repetitive behaviour or we’ll go straight back to our old ways when stress stacks up.
If we use our hands, then some people find that wearing gloves can be useful. This isn’t always possible but may be an option for some, especially when at home or during winter.
For those of us who use particular items when engaging in repetitive behaviours, keeping these items out of sight can reduce temptation. It might not be possible to remove them from our home entirely, depending on what it is we use.
If we’re a fiddler, then finding a fiddle to replace our behaviour can be a good option. There are lots of different fiddly things we could try – twist and lock blocks, stretchy men, magnets, stress balls, tangles, fidget cubes, fidget spinners, spinner rings… the list goes on. Different fiddles work for different people. Each involves a different action and feeling, so sometimes we’ll have to try a few before we find our favourite.
For creatives, picking up a repetitive evening craft like crochet, knitting or sewing can keep our hands and mind busy. This one’s especially good if we usually engage in repetitive behaviours when chilling on the sofa.
If mirrors are a skin-picking trigger for us, then covering them up or removing them can to reduce that temptation. We might still choose to look in a mirror sometimes, but covering them means we only look after making an active decision to do so. This means that we can avoid ‘glimpses’ that we might find triggering. It might also be helpful to remove hand mirrors from tempting places, such as our sofa or bag.
THE UNDERLYING STUFF
Replacing behaviours can be great, but unfortunately, it’s unlikely to deal with the underlying cause of our body-focused repetitive behaviours.
Figuring out what it is that underlies our need to pick or pull can allow us to work through these things, and reduce our repetitive behaviours. Sometimes we can do this figuring out with a close friend or family member. There are self-help resources online which we can access should we want to. Sometimes, we might choose to access professional help via our GP. If we live in England then we could self-refer to our local mental health team.
The idea of ‘letting go’ of these behaviours can feel paralyzingly terrifying, and shame can glue us to the spot. But we don’t have anything to be ashamed of. We deserve help and support. We’re allowed to feel safe and to care for ourselves. Our wellbeing matters, and we’re absolutely not alone in this.
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