I knew I would slip-up going into a self-imposed second quarantine due to my struggles in being a mother, needing at least one hip surgery, and living through a pandemic. A fact I accept in my dermatillomania recovery is I can’t be perfect with a disabled body and chronic pain, especially while going through everything else 2020 has tacked on. My skin picking urges increase with stress, pain, sleep deprivation, and exhaustion. As a new mom, all of the aforementioned applies to my current situation along with the struggle to cope during these tough times.
From far away, you may think the spot that triggered me today was one of a few other darkened marks, but it’s a smaller, deeply-embedded pimple under my eye that makes me want to get rid of its fullness immediately. Specifically, by popping it. WARNING: In reading further, you may be triggered as someone who skin picks, uncomfortable if you cannot understand the condition, or fascinated if you’re interested in understanding psychology and mental health. As someone who has been in recovery from skin picking after receiving therapy from Karen Pickett following our appearance on The Doctors in 2015, I want to break down the thought process that went into managing this one specific urge.
My bathroom only has one bulb out of three as a precautionary measure in dimming the area so I don’t sucked in by noticing my imperfections. I try to stay away from my mirror when in the bathroom if I’m overtired, in worse pain than usual, or feel like tuning out problems by focusing on my skin instead of the chaos around me. Compulsive skin picking has served as an emotionally-regulating behavior since I was at least ten years old. Before my therapy, I picked primarily as an emotionally-numbing way to process uncomfortable thoughts, feelings, or events that triggered me enough to begin scanning (automatically or deliberately) to find a bump with my eyes or through touch.
I found this pimple after wiping my eyes, shortly after doing my third feeding this morning. Due to how full it felt, I immediately became panicked and thought “I must get rid of it“. I made a mistake by walking into the bathroom to investigate it. Mistake number two is that I leaned into the mirror. However, I was surprised that it didn’t look as intrusive as it felt. Since it isn’t wasn’t red, swollen or didn’t have a whitehead, it was easier to walk away from because it didn’t tap into my more severe insecurities of how I feel my skin should look.
Although it’s not a cognitive distortion related to this urge, no, skin doesn’t have to look a certain way. Skin can be textured, discolored, jagged, flaky, and all of these imperfections belong on our bodies. Some occurrences come and go while others are scars for life. My initial panicked reaction to finding the pimple is a blatant cognitive distortion; there was no urgency for a “must” in popping the pimple other than to feel like I rid my skin of something that doesn’t belong- thus, pacifying my primal fear response of recognizing a threat.
In learning about Acceptance-Commitment Therapy (ACT) as it relates to excoriation disorder, I had to experience how intense an urge was in order get through it, including recognizing physical reactions to finding or resisting an urge. With my teeth clenched, when I held back on this urge I also felt a hollowness in my chest. The panicked perceived need to touch the spot and trying to come up with a legitimate reasons to prevent myself from picking it interrupts my life, taking away from other issues I could be spending my mental energy on. In going through an urge, my fists ball up and I stimulate my fingertips with my nails (fidget toys would be a better alternative if I picked at my tips). I feel a deep sadness- a mental defeat- with spiked anxiety, but the intensity dies down… until the next time I think about it or accidentally touch it, triggering the panic all over again. To feel like I’m being productive toward my recovery but not hyper-focusing on my skin, I use Polysporin cream or a zit sticker on a spot depending on if I have opened a spot or if it’s visibly triggering.
Unlike what many of us have learned, that feeling unhappy, down, cranky, or anything unpleasant is “bad” and needs to be remedied- we are allowed to feel awful. It’s how we move through situations, feelings, and urges. It’s part of the human condition to feel emotional agony in distressing circumstances. In time the urges do decrease along with their intensity, but they can always re-emerge when life throws new challenges your way. You don’t need to ride out the same unbearably strong urge every time it comes up, which is why I used to believe “why bother?” challenging those thoughts years ago.
Not all thoughts we tell ourselves are true. We get caught in picking cycles for years because we don’t- then can’t after repetitive reinforcement- challenge the untrue thoughts that give us permission to pick our skin. I was unable to walk away from any urge before therapy because I didn’t have the mindfulness to trace my triggering steps, and if I tried to refrain from picking deliberately at the mirror an overwhelming feeling of anxiety always won. I recognize my faults in moving forward with the steps to make it to the bathroom, then looking into the mirror. I caught my cognitive distortion and challenged it before it became a “permission-giving statement” to correct later.
Excoriation disorder is much more complex in managing than the infantilizing phrase “just stop picking” implies. Maintaining recovery requires self-care, keeping in touch with my body, slowing my mind/ decreasing my anxiety, and balance. Stay tuned for the step-by-step process of my 12 weeks of therapy in EMBRACING DERMATILLOMANIA: Through Pain & Recovery, co-authored with Karen Pickett.