Dr. Ted Grossbart's blog

HYPNOSIS FOR SKIN PICKING--Part 1

Question: I've heard that hypnosis can be quite useful for controlling picking. I don't know much about it but would like to learn more. Can you suggest some information on the real science so I can go beyond the cliches like swinging watches and people clucking like chickens?

Answer: Even many otherwise well-trained mental health practitioners know very little about the research and practice of hypnosis. There is an excellent review article from SCIENTIFIC AMERICAN which I give to new patients. This is a great place to start.

You can read it at: http://grossbart.com/sciam-1.pdf

WHEN TO GET PROFESSIONAL HELP FOR PICKING

QUESTION: I have recently discovered that Dermatillomania exists through recent conversations with my friends. After some research, I realize that I have several of the symptoms, such as acne picking, scratching at the skin around my nails, lip biting, continuously picking at scabs, and a few other of the characteristics. My question is this: at what point does it become a serious condition? I understand that is serious at all times, but at what point should a professional be sought out for help? Until I heard about this, I thought that everyone picked at their face and nails, so I am unsure at what point it becomes severe.

ANSWER: This is a frequent question, a fair question to ask, but one that is very hard to answer. Some people come to see me with very moderate levels of picking. Others have delayed until they have needed hospitalization or a partner has practically hit them over the head with a 2X4.

My hunch is that anyone who is asking the question or surfing forums and websites is bothered enough to be a good candidate for professional help. One thing that can get in the way of getting help is shame or feeling that it is your fault. Don't be surprised if these feelings come up, but don't let them get in the way.

Ted A. Grossbart, Ph.D., Harvard Medical School, Boston, MA

EAR PICKING

QUESTION: Can a person be a skin picking inside of the ears? For some time now, every now again I pick and scratch my ears, inside the crevases until the point they bleed.

ANSWER: Picking is picking regardless of where. It can happen at any area.

Sometimes the choice of area is a good clue, other times not. A woman who was frightened of relationships picked her breasts and pubic area for instance. Other times it can just be where the person had a mosquito bite, or acne. One person whose father did really sadistic and destructive ear cleaning. kept picking their ears themselves.

Treatment is similar regardless of area: barriers and substitutes, feeling things in your heart so you don't have to feel it in your skin, and hypnosis and self-hypnosis.

Ted A. Grossbart, Ph.D., Harvard Medical School, Boston, MA

WHERE TO GET PICKING HELP

QUESTION: I'm a sixteen year old who has been picking at my acne ever since I can remember. I pop any pimple or black head I feel or see until it bleeds, and then usually end up picking off the scab that forms on it. I pick at the skin on my lips with my teeth or fingers when it gets chapped, too, as well as picking bumps on my back occasionally. I'm really too nervous to talk to my parents about it because a lot is going on because my mom has just had surgery. I can't tell if what I do is dermatillomania or whether I'm just a whiney teenager with mild acne. Could you please tell me if I need to seek help, and if so where to go? Thank you so much!

ANSWER: I think it is important to get help. You can start with sites like this one, trich.org, and grossbart.com to get support and information. Then you need to approach your parents and let them know that this is really bothering you and put your heads together on how to get help. This site and trich.org have list of local therapists who know the problem.

If there is no one local treatment is available by phone or Skype.

Ted A. Grossbart, Ph.D., Harvard Medical School, Boston, MA

PICKING: OCD, DEPRESSION, OR NEITHER

QUESTION: I have picked and chewed at the skin around my nails for many, many years. I have tried simple things like wearing gloves, neosporin, liquid bandaids... My fingers will heal slightly if I really concentrate on stopping but then I always start doing it again, no matter what. I have always just thought of this as a habit but after seeing the site I am wondering if it could be more. I have never been a nail biter,or have never picked skin anywhere else but my fingers, and have never had any other OCD tendencies. I haven't felt like I have depression or low confidence. Could this be related to "picking" or another underlying cause?

ANSWER: The idea that nail biting and picking are typically related to OCD or depression is open to more and more contradictory research. At least statistically they more typically go with anxiety issues.

Any of these problems can come from a variety of causes so you have to look at your own individual experience You can do this on your own or with the help of a therapist experienced with these problems.

Ted A. Grossbart, Ph.D., Harvard Medical School, Boston, MA

CHEEK CHEWING

QUESTION: i chrew on the inside of my cheek all the time, even if i dont realize it. is this habit harmful to my health? and what causes the intense chewing ? also when i chew at it i dont feel any pain at all.

ANSWER: This is one of the many variations of picking, biting, and chewing habits. The variety of causes and treatment approaches are pretty much the same for all of them.

It is hard to say at what level it becomes a health risk, Ask your local doctor.

You may not feel pain as you are in an inadvertent hypnotic trance state. Some people have had major surgery with no anesthetic in these states!

Ted A. Grossbart, Ph.D., Harvard Medical School, Boston, MA

CAN PRESCRIPTION DRUGS WORSEN PICKING

QUESTION: Can anti-anxiety drugs increase scab picking? My husband thinks I have gotten worse since I started taking Klonopin (1mg 2x/day).

ANSWER: It is certainly possible. The prescription drugs that most frequently trigger picking are the ones prescribed for ADHD. Sometimes a drug which one person feels is making it better is the same one that makes it worse.

You have to experiment to know about your own situation.

Ted A. Grossbart, Ph.D., Harvard Medical School, Boston, MA

LIQUID SKIN: GREAT RESOURCE FOR SKIN PICKERS

QUESTION: hello, so i've read some of the posts on here but i dont think i can classify myelf as a obbsessive skin picker, except for this one bad habit...so a couple years ago i dont know how it started but my middle finger on my left hand has one side of the cuticle bed next to my nail that is constantly hard like sandpaper, then it dries out and flakes off and at that point i start picking at it and i will pick and pull until all the hard skin is off leaving it red and raw flesh and bleeding and then i will repeat the process. i am a bad nail chewer and this is how i think it came to be. i am looking at a way to fix this problem, i just cant handle when its sandpaper feeling and hard...anyway to soften the skin? thanks

ANSWER: First off I'd say anyone who picks to the point it is a problem is a skin picker and all the general advice would apply to you. I don't know what would soften the skin but I have another approach for you.

One great resource to try is Liquid Skin or NU Skin. It is a clear liquid that comes in a small bottle from any drug store. Paint two or three coats over the area when it is dry. It stings a bit but forms a smooth clear shell the breaks the picking cycle for many.

Another way to use it is to put some on another neutral area and pick it off instead.

It is not the answer for everyone, but has been very helpful for many. Of course using it as part of a comprehensive treatment program is best.

Ted A. Grossbart, Ph.D., Harvard Medical School, Boston, MA

PICKING AND EMBARRASSMENT

QUESTION: I have been picking my skin for a few years now and it sometimes gets to the point where it becomes painful and then bleeds. What are some of the options for resisting the temptation to touch the areas that are most affected? I feel very uncomfortable and embarrassed at my condition and would be very greatful of any advice :)

ANSWER: First be aware that a sense of shame and embarrassment is nearly universal with picking. It is usually a key part of the problem. It often keeps people from talking to parents, doctors, or therapists who could provide badly needed help. You need to fight your way out of the closet. Online resources like this site are often a first step.

As to treatment people who contact me are often looking for the technique or handy hint that will work for them. It is like the old 'good news--bad news' jokes. There is very rarely a single approach that does the job. But the good news is that an integrated treatment program can provide 10 things that each work 10% and that can do the job nicely.

There are hundreds of resources to choose from, including ideas from CBT, psychodynamic psychotherapy, hypnosis, etc.

For a quick hint to try: put Band-Aids on a couple of the key fingers you pick with. It won't prevent picking, but will give you an extra moment to decide to stop.

Ted A. Grossbart, Ph.D., Harvard Medical School, Boston, MA

SKIN PICKING LOCATION

QUESTION: I seem to always have scratches over one leg, that I pick at, it has been for years, I have kept making excuses and even seen doctors, can u skin pick on just one part of your leg?

ANSWER: Everyone has their own pattern. For some people it is just a leg, or an arm or a lip, others cover a wide area. I have never seen anyone who covers 100% of their body,

Sometimes there are good clues in the Why There? question. One woman who had relationship fears picked her breasts and told herself that she could never go out with a guy looking like that. For others it started with a mosquito bite that might have been anywhere. Underlying acne or eczema got the picking started for some others.

From a treatment point of view it is much the same. Generally if the picking has been going on longer, or covers a wider area it will take more effort to beat it.

Ted A. Grossbart, Ph.D., Harvard Medical School, Boston, MA

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