“These battle scars don’t look like they’re fading… don’t look like they’re ever going away” from the song Battle Scars by Guy Sebastian.
If stress had a face this would be it…
I wish I knew a healthier way to cope with my stress. This disorder is slowly killing me from the inside out. Although of course it is quite possible that this disorder could kill me from the outside in. With every wound comes the risk of infection and I’m no stranger to infections.
The cause of my stress may also be the reason I go quiet on here again. I am back to working 4-5 nights a week, full-time uni goes back on Tuesday, my little man goes back to school on Wednesday, I have a 5 week teaching practicum coming up in mid-October and on top of all of this I am still trying to sort out my furniture and a home for my cats from my break up almost 2 years ago now. I know I have taken on too much. I always do. I have an extremely addictive personality and I get addicted to work and study just like I am addicted to picking at my skin. I don’t know how to slow down. I find keeping busy helps with my Dermatillomania but at the same time the pressure it puts on my heart and my brain and my body – sometimes it feels like I will have a nervous breakdown and never come back from it.
I attended an OSPA (Obsessive Skin-Pickers Anonymous) meeting online about a week ago and this helped me come to the realisation that I am powerless over my skin-picking. It is an addiction and it does have a hold on me. Unfortunately unlike drugs and alcohol I can’t simply abstain from the substance for the very addiction is me. My fingers, my nails, my hands always constantly searching my skin for the next spot, the next pimple, the next blemish, the next scar to reopen. THE NEXT FIX! How can I distance myself from myself long enough to beat this thing once and for all?
Once I came to the realisation that this disorder has more control over me than I want it to, I contacted an addiction recovery clinic here in Perth, Western Australia. I explained Dermatillomania to them and I wondered if they would be willing to take me on as a patient. Although they had never treated anyone with my specific disorder they advised me that they had successfully treated a number of patients with compulsive disorders using a drug called Naltrexone. In their words: “Naltrexone works to block the opiate receptors in the brain, but a flow on effect of this is that it reduces surges in dopamine (surges in dopamine are what gives you the pleasure and reward from doing a certain task)”. So although the drug would stop my picking from feeling good it appears that it would also stop other things from feeling good. This wouldn’t be a problem if it weren’t for my depression. However given how low my mood can currently drop I worry about how dangerously low it could get if I no longer experienced any pleasure whatsoever.
The good news is that I haven’t given up yet. I still want to beat this and I am still exploring my options. Addiction treatment and/or having my nails surgically removed are two options I am considering as last resorts. In the meantime (now that I am finally working again) I am hoping to be able to afford the regular upkeep of acrylic nails and I may even start looking for a new psychologist or hypnotherapist to work with again. This is the longest I have gone in my life without seeing a mental health professional (from the age of 8 years old I have seen one regularly). Sadly I had to finish up a 4 year relationship with my psychologist in January of this year as she was offered a job elsewhere and it was a great opportunity for her. Up until this point I have been coping but I know I’m at the stage where I need the help again.
This post was a bit ranty and maybe a bit all over the place. It’s 3:00am here and I have a splitting headache but I just needed to write and get things off my chest so that maybe just MAYBE I can sleep tonight. I have spent the last few days and nights picking sometimes until 4am in the morning and sometimes for over 3 hours straight. I know I need to start taking better care of myself but I also know I don’t have the time right now to do that. I often think of deferring uni for 6 months and really knuckling down and working on this condition but at the same time I worry that having nothing on my plate will only contribute to more picking. At the moment it seems like a lose-lose situation whichever way I turn. So for now I will leave you and myself with the serenity prayer, sometimes referred to as the AA prayer:
~ God grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference. ~
Self-diagnosis. We are all familiar with it and we have probably all engaged in it at least once or twice. But how does self-diagnosis impact on those who have either been diagnosed with or are clearly suffering from a mental health disorder, such as Dermatillomania? This is a topic I feel compelled to write about, it is a controversial one none the less but I feel that someone has to give this topic a voice.
As a Dermatillomania awareness advocate I come across and converse with many derma sufferers on a daily basis. Mostly what I see is upsetting – people caught in the grips of an illness that is literally tearing their lives and skin apart, then there is the occasional hopeful story – those who say they used to suffer from the illness but now have it beat (I always wish there was photographic proof for these stories though as I am a bit of a sceptic); and finally there are times when what I see confuses and deeply upsets me. By this I mean those who say they are suffering from Dermatillomania and yet I can’t see any scars or marks on them. Then I find myself wishing that my derma could be that mild [edit: as physically mild as theirs] so I too could experience what it’s like to wear tank tops, shorts, go without makeup, or even wear a bikini! In fact I don’t even own said swimwear. The last time I went swimming was 11 years ago when I was 14 years old. I lived in a very hot and humid coastal town, so avoiding the water was near impossible, it just came with a sideline of questions and bullying.
Now as a Dermatillomania sufferer I am well aware of the tips and tricks one can take advantage of to hide the damage we do to our bodies, including Photoshop, taking photographs from certain angles, experimenting with different kinds of lighting, wearing certain types of clothing and picking only in certain areas. I am also well aware that Dermatillomania is a condition similar to physical illness, in that the sufferer can go through periods of remission, a word most commonly associated with cancer but it refers to the period of time during a serious illness when the patient’s health improves. I experienced remission when I was 17 years old to the point I almost considered myself recovered, although I did still pick every day even if it was only at a handful of hidden spots. Then I went through similar incidences of remission again when I was 22 and 24 although I relapsed in both instances within a matter of months. My skin-picking also decreases during winter when I have less opportunity to pick at my skin due to the fact it is always comfortably covered by jeans, jumpers, scarves, etc. And because I am not standing out as the only person wearing pants and long sleeves (as I do in the warmer months of spring and summer) I find that I fit in to the wider community a lot more which lessens my stress, depression and anxiety which in turn decreases how often I pick. So keeping all of this in mind I understand that I may be making judgements on people who are in remission; however if this is the case then it is helpful to state that you are in remission when discussing Dermatillomania with other sufferers so they don’t feel upset or confused by how flawless your skin looks in comparison to theirs. This is something that I learnt when I was in remission interacting with other sufferers and I found myself having to explain that I really did know how it felt to have severe Dermatillomania.
When I was 19-21 years old, my Dermatillomania reached its most severe point and thankfully it hasn’t been back there since. I was that disabled by my condition that I NEVER left my house without assistance and only then it was to force myself to do the grocery shopping in order for me to feed my son. I could not even walk to my letterbox, I could not put my bins out on the verge, I could not even open my front door to put rubbish in the bin, I would not open my front door to anyone and I would not even hang the washing out in my own backyard for fear of being spotted by a neighbour. My curtains and blinds were always drawn shut – I lived in complete darkness for more months than I can count! My only regular interaction with others was with mental health professionals, social workers and family support workers. I was that disabled by Dermatillomania I needed encouragement to walk outside of my own house because I felt as though my legs were going to collapse underneath me from the anxiety of it all; and if someone did manage to convince me to leave my house I would walk with my head faced firmly down, eyes fixated on the pavement, struggling to breathe, on the brink of tears and completely lost for words. During this time of my life I would engage in 7 hour long picking sessions most nights, where I would gouge at my skin with tweezers to the point I felt physically ill. I hardly ever slept, I was constantly infected and I was inundated by suicidal thoughts. I started planning my own death and writing goodbye letters. The next day I ended up as an outpatient at my nearest mental health hospital. This is severe Dermatillomania.
In the DSM-5 it states that: “Excoriation (skin-picking) disorder is characterized by recurrent skin picking resulting in skin lesions. Individuals with excoriation disorder must have made repeated attempts to decrease or stop the skin picking, which must cause clinically significant distress or impairment in social, occupational or other important areas of functioning. The symptoms must not be better explained by symptoms of another mental disorder”.
Apart from the name Excoriation Disorder, I feel that the DSM-5 has it fairly spot on so far. To be diagnosed with the condition one must have skin lesions present on their body, there must have been some desire to want to stop, it must cause clinically significant distress and/or it must cause impairment in social or occupational functioning. It also must not be better explained by symptoms of another mental disorder and I think this is the most important signifier. In some instances there seems to be a fine line between Dermatillomania and Body Dysmorphic Disorder. I say this because if one has flawless skin but believes they have imperfections on their body that are not observable or appear slight to others, then this more accurately fits BDD. With Dermatillomania there is no doubt to oneself or others that the condition very much exists physically! This is backed up in the DSM-5 under the Body Dysmorphic Disorder Diagnostic Criteria which states that a BDD sufferer has a “preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others. At some point during the course of the disorder, the individual has performed repetitive behaviours (e.g., mirror checking, excessive grooming, skin picking) in response to the appearance concerns”. The DSM-5 then goes on to state under the Excoriation Disorder section that although “skin picking may occur in individuals with body dysmorphic disorder who pick their skin solely because of appearance concerns; in such cases, excoriation disorder should not be diagnosed”.
This brings me to my next point however and that is that the DSM-5 should include an assessment criterion which diagnoses Dermatillomania on a sliding scale as it does with depression. When my derma was at its worst I was also diagnosed with severe depression however I can go through stages now where my depression is quite mild. Then there are days when I am just sad. Sadness and depression are two different things as are skin picking and Dermatillomania. One has to be severe enough to negatively impact the sufferer’s mental health and/or their ability to function in social situations in order to be classed as a disorder. Hopefully with more research and more awareness into this disorder a sliding scale for derma might come into existence, one where it can be assessed as mild, moderate or severe. I feel this is important because some people only focus on one area (and it may be an area that one can hide) whereas other sufferers can’t help but pick at numerous areas and in places that can only be hidden when the sufferer takes great extents to do so (e.g. by wearing long sleeves and pants in summer). Also some derma sufferers are still able to maintain friendships, relationships and hold down employment whereas others are unable to function in any social situation. In order for no one person to feel isolated about living with a condition such as Dermatillomania, it is important that there are different ways to describe the severity of the disorder, ones that are backed up by thorough medical and psychological research.
In a world where Dermatillomania is only just starting to be recognised in the medical and psychological field, I understand that many sufferers self-diagnose because they feel that there is no other option for them. I self-diagnosed 5 years ago when I first found information online about this disorder but I then brought that information to my doctor and the psychologist I was seeing at the time in order to receive a proper documented diagnosis – albeit they have spelt Dermatillomania wrong on my file! Whilst self-diagnosis can be helpful, it is only a stepping stone in a greater journey towards clinical diagnosis, treatment and then hopefully recovery. The reason being is that when self-diagnosing ourselves with disorders or illnesses, whether they be physical or mental, we can sometimes get it wrong or be quick to label a habit something more serious than it actually is. To put this in perspective: I often pluck my eyebrows, sometimes I over pluck them in my desire to shape them perfectly, I will also pull stray hairs from my chin or upper lip, and if my hair is done up in a style and I notice some are out of place I will pull them too. I occasionally pull hair but I do not have Trichotillomania or Trich. My hair pulling is nothing out of the ordinary and does not cause me any distress or social embarrassment. Everyone picks at their skin. This is normal. Many people even take pleasure in popping pimples or satisfying an itch. This is also normal. What is not normal is when you do not know how to stop and when you keep going to a point that it causes you significant distress and/or impacts on your ability to function socially. So please keep this in mind when self-diagnosing, as a wrong diagnosis can have a detrimental effect on both yourself and those suffering from the mental health disorder in question. I don’t want Dermatillomania to be misunderstood more than it already is or to be made out less serious than it actually is – this disorder has the potential to put a sufferer in a life threatening situation and this is why I am so passionate about spreading awareness, however controversial it may be.
I decided that I am going to shout myself a ticket to Ballet Revolucion this week and so it prompted a spur of the moment try-on-every-single-dress-I-own moment at almost 1am in the morning. I originally started trying on these dresses (of course they ALL still have their tags attached) with a pair of knitted stockings and a cardigan. Then out of curiosity I wondered what they would look like without the arms and legs covered up. And you know what… it actually gave me a confidence boost! Yes my legs are scarred, scabby and covered in bandaids at the moment. But so what! I am sick and tired of hiding! I am SO OVER being this shy insecure girl when all I really want to do is go out and have FUN without a care in the world! I am done covering up! I am done making excuses! I have had enough! This Summer I WILL wear whatever the hell I like whenever the hell I feel like it. And I will go to the beach. And I will hit up the nightclubs. And if someone has a problem with the way I look… then that is THEIR problem… NOT MINE!!
I came across this quote on Facebook tonight:
“Never be ashamed of yourself. Because you are born into one skin. You can scar it, stretch it, burn it, mark it, tan it, peel it. But you are always in it, so you might as well learn to love it.”
It’s funny how such a little thing can trigger an epiphany. I only have one skin and I have been choosing to wreck it. I don’t know why. I may never understand why. But this is all I have. This is all I am ever going to have. So I bloody well better start taking care of it. I am almost 25 years old… I should be having the time of my life. I should be comfortable in my own skin. I should love who I am. And so starting now I AM going to have the time of my life, I AM going to choose to be comfortable in my choice to be comfortable and I AM going to love who I am!
“These battle scars don’t look like they’re fading… don’t look like they’re ever going away” from the song Battle Scars by Guy Sebastian.
So when my sores start to vanish I start to notice my scars a lot more. This photo doesn’t really do the scars justice but you can still make them out – they are the purple spots on my arm/hand. The colder it gets or the colder I feel the more pronounced these scars become. And I have them ALL over my body. Legs, arms, face, back, stomach… bottom… you name a body part and I can guarantee you it is covered in scars. It gets me down. I know I shouldn’t let it get me down but it does. Even if I stop the picking I still won’t be able to enjoy my skin because I have essentially wrecked it. However I have heard somewhere (not sure where) that skin renews itself every 7 years. So I’m going to hold onto the hope that I won’t always be scarred… or at least they won’t always be so noticeable. In the meantime I am using this:
It is Palmer’s Cocoa Butter Formula (with Vitamin E) Skin Therapy Oil. It has replaced Bio-Oil as my new favourite scar treatment. I found Bio-Oil quite greasy, you couldn’t put it on open sores and I didn’t overly enjoy the smell. This stuff, on the other hand, smells FANTASTIC (rosehip fragrance), is light & non-greasy, it doesn’t mention anything on its packaging about it not being suitable for use on open sores AND it’s gentle enough to be used on the face! WINNING! And as an added bonus not only is this stuff available for sale in the US and UK but also Australia and a few other countries! I’ll keep you updated on how well it goes on improving the appearance of my scars; in the meantime they have a website you can check out: http://www.palmers.com/
It’s Winter here in Perth, Western Australia but you wouldn’t know it! The sun is still shining and there’s hardly a chill in the air so yesterday I decided to catch a bit of the sun’s rays while they’re still hanging around.
I decided to take pictures so you could see the different types of scarring I have on my body. There’s the white lumpy scars on my belly. The dark purply brown scars on my legs. And then of course as soon as my skin is exposed a bit of picking is bound to happen. In that photo, not only can you see the freshly picked spots but also the white and brown scars. If I tan, the brown scars fade but the white ones stand out and if I remain pale the white scars aren’t noticeable but the brown ones are. So I can’t win either way really!
Woke up… Started picking. Completely forgot that today was the day I was meant to start trying to stop. Got angry with myself. Went to the mirror, grabbed my tweezers and picked every spot I could find on my face. In this picture you can even see the indented scars by the side of my eye. They look like pock marks from acne but they are just from me picking continuously at the same sore over and over again until I’ve created a “crater”.
Exam stress… be like making me pick!
My new motto to try and get me to stop picking when I’m in the moment. I thought I’d share it on the off chance it may help someone else!