Crossdressing, acne picking, and scalp wound picking

I pick acne lesions and an old scalp wound compulsively when I get tired or anxious. I take Vyvanse, a prodrug that releases amphetamine from the GI tract, to treat some attention deficit problems or frontal lobe and midbrain damage due to a midbrain bleed that was complicated by acute hydrocephalus that required an emergency ventriculo-peritoneal shunt in November 1996. I know that amphetamines can make acne worse and increase OCD symptoms, but I cannot function or stay alert enough to work without taking this medication. From 2002 to February 27, 2008, I used to crossdress compulsively. St. John's Wort, Vyvanse, imagining that my mother is embracing me, fasting and prayer, and thinking deeply about what I loved and what I feared about crossdressing and not crossdressing freed me from the crossdressing compulsion but not from the acne and scalp wound picking. In fact, the skin picking problem got worse when I stopped crossdressing. I am 59 years old. I used to be a general surgeon and Chief of Surgery in a small rural county hospital. I closed my surgical practice due to stress and fatigue related to sleep apnea, my use of Ritalin to treat a condition I turned out not to have--narcolepsy--I actually had simple obstructive sleep apnea that was later treated simply with uvuloplasty and CPAP--and to the strain of helping or tutoring my children. My children all have to one degree or another an inherited inductive learning disorder that runs in my wife's family. My wife and I have tutored each of them intensively for a period of about 15 years to maximize their chances of excelling in some areas in which they were exceptionally strong. This effort turned out to be immensely successful. Our four children are a source of tremendous joy to both my wife and me and appear to be completely "out of the woods" with their learning disorder. In November 1996, I suffered a midbrain bleed unrelated to high blood pressure that occurred when I fell asleep away from my CPAP machine. The bleed caused acute hydrocephalus that required an emergency ventriculo-peritoneal shunt. After this bleed, although I could have died or lost my ability to move my eyes or my extremities properly, I suffered only from increased sleepiness and some difficulties controlling anger that were successfully treated with Vyvanse and Lamactil, an antiseizure medication that controls abnormal temporal lobe activity. I enjoyed an almost idyllic childhood. I was the second of five boys. There was no abuse, no drug or alcohol abuse, and remarkably little conflict among us. Although I was close to both my parents, I had a somewhat closer relationship with my mother who worked as a Health and Physical Education teacher. Shortly after the death of my mother in 2002 and during a time when my wife was becoming the principal breadwinner in our family, was blossoming in her own work as a piano teacher, and beginning to go through menopause, I found that the appearance of my face, my difficulties getting and keeping a living-wage job, and about a 50 lb-weight increase were beginning to diminish her desires to have intimate contact with me. At that time I developed full blown OCD characterized by two connected compulsions: facial acne and scalp wound picking and compulsive crossdressing. Oddly I observed that crossdressing helped decrease the number and severity of my inflammatory cystic acne lesions and decreased my perceived need to pick the acne lesions and the old surgical scalp wound in which a suture material called Vicryl could intermittently be found. At present I am physically but not legally separated from my wife. We still see each other and are not planning to divorce, but we have considered divorce from time to time. I was strongly invited to leave my home and live with my brother and his wife in November 2007 because I could not stop crossdressing at the time, had difficulty keeping work, and looked terrible from my facial picking. I am currently working as a waiter in a senior citizens independent and assisted care facility. I have been under the care of a psychiatrist for OCD and anxiety since 2006. In addition to 200 mg a day of St. John's Wort, I take fluvoxamine 25 mg, a seratonin reuptake inhibitor and Buspar 7.5 mg a dopamine-elevating medication each day. My psychiatrist also suggested squeezing vaguely breast-shaped stuffed animals when I got the urge to pick my facial acne and my old scalp wound. It helped! Holding the animals to my chest helped even more, however--a practice feels disturbingly similar to crossdressing. The doctor also had me try Xanax 2.5 mg once or twice a day to diminish my picking urges. It doesn't help very much, but does help decrease anxiety and my tendency to get upset with myself for lateness, forgetfulness, and lack of organization or focus. For my skin I am using Altabax, a new topical antibiotic, 10% Benzoyl Peroxide, an OTC Apricot Facial Scrub, and a Head and Shoulders product containing Green Tea Tree Oil on my scalp and face. I also take one week to one month courses of amoxicillin or doxycycline. The lesions are improving slowly, but new highly inflamed cystic acne lesions continue to appear on my face about once a week. Lancing them as opposed to using my fingernails or a small pair of forceps or tweezers to open them up and drain the lesions does little to change the acne lesion's size or course of inflammation, pain, drainage, and eventual healing. My face, however, is quite scarred. Covering the actively inflamed red lesions or open wounds with coverup generally delays healing, but is occasionally necessary for important social occasions. I am also contemplating getting blue and red light treatments that kill the bacteria that cause facial acne. I have taken full course of Accutaine, which initially helped me a great deal, but I could not tolerate long term treatment with even one tab per week. While I was crossdressing, I contemplated using Spironolactone or Aldactone, to control the acne, which I knew might also result in gynecomastia. I no longer wish to take a medication that would have gynecomastia as a side effect. I do not wish to resume crossdressing. I would lose my wife completely if I did and distance myself significantly from my wonderful children and a church that I love deeply. I eat a healthy diet and ride a bicycle to work on a daily basis. I have not lost much weight, however, which may in part be due to some of the medications I am taking, i.e. St. John's Wort, fluvoximine, and Buspar. I can't always squeeze stuffed animals, and I don't want to use a benzodiazepam anti-anxiety medication if I can avoid it. Dependency is common, and withdrawal can be life-threatening. Does anyone have any suggestions? Has anyone out there experienced this odd connection between crossdressing and facial acne picking and scalp picking? Help!! I am sure that my health, job, appearance, and marital difficulties are all playing a role in this disorder. My wife says that she will let me live with her if I can find and keep a decent job, get control of my picking, and lose about 5 or 6 inches around my waist--my waist circumference is now about 44 inches. I had it down to about 40 inches and my weight was about 220 last year. I started Abilify. I gained 4 inches and about 30 lbs in one month before I stopped the Abilify. I haven't been able to get it down again despite the Vyvanse and riding a bicycle to work. I need to look better if I hope to find and keep a good job. At age 59, over 30 years out of medical school, and 12 years out of practice, I cannot return to the practice of medicine unless I retrain. I tried for two years to get a position in a residency training program, but was unsuccessful. I can practice medicine under supervision in a research setting or engage in administrative or teaching work. I have enjoyed teaching anatomy and physiology and chemistry for health professionals but was plagued with attention and focus problems and OCD symptoms that are now largely under control except for the facial acne and scalp wound picking that ironically gets worse when my Vyvanse levels are low in the morning and in the evening. If anyone has any job leads or suggestions, I would appreciate learning about them. Yours truly, XTVcAcne