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youcandoit , 07 Mar 2013

LONG POST about new Research involving NAC / Tips for Stopping

Hello All -- I hope this is helpful: This was originally in a WORD document (and was much easier to read), so I apologize that the spacing is so terrible...I didn't realize that this cite wouldn't allow ANY spacing between paragraphs. I tried to make it a little more readible by putting lines after each paragraph. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Post: I am currently pursuing a Master’s degree in counseling, and I am familiar with skin picking, nail biting, and trichotillomania. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Correcting any habit or behavioral pattern is EXTREMELY challenging and involves a personal dedication to re-training the brain. When an individual decides to pick his or her skin, the brain tricks the person into believing that picking is actually “good thing” (i.e. “If I pick this one spot, I’ll feel better”). After all, when you pick…you get to escape from outside stressors (even if only for a brief period of time). The person becomes so intensively focused on picking that he or she can enter a trance-like state  This is the brain’s way of trying to avoiding stress, but in reality it only creates more stress and frustration. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- In the moments just before picking…it may seem completely inevitable and unavoidable (i.e. “I have to do this!” “If I don’t pick now, I’m going to be anxious all day!” “I have to get this mark off my face!”). Fingertips, pins, tweezers, or other instruments are often used, in addition to finger tips, to eliminate a real or perceived “flaw” or the face or other region of the body. When all is said and done…the picking DOES lead to a state of calmness or relaxation – but the relaxation is only TEMPORARY and usually a result of exhaustion from picking for several minutes or hours. As time goes on, the initial “relief” begins to fade, and the person starts feeling guilty or ashamed of the damage that has been caused….avoidance, depression, anger, and resentment are likely to follow. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- So… in reality….the picking actually CREATES more problems than it solves. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- All of that may be true, but it is very, VERY challenging to “just stop” the behavior – even when the consequences are clear. It’s like an itch that just HAS TO be scratched. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- The good news…IT CAN GET BETTER! -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- There is some new and exciting research that may be helpful if you are struggling with face picking, trichotillomania, or nail biting. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- An over-the counter supplement known as ‘NAC’ (N-acetylcysteine) is receiving attention from experts in the field of psychology for its potential impact on skin picking and trichotillomania. The supplement affects glutamate receptors in the brain and has been shown to reduce symptoms in research subjects (over 56% of subjects in one study indicated a reduction in picking, pulling, and nail biting). -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Here’s a link for two articles on the topic…Several more can be found online: -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- NAC may take several months to be effective, but I have noticed a significant improvement in at least one individual who has been taking the supplement for 30+ days. The individual takes 1200 mgs of NAC, in conjunction with a Selective Serotonin Reuptake Inhibitor (like Zoloft or Paxil). The individual was picking their face nearly every day for the last 10 years, but recently had a period of abstinence of 4+ days (which is a MAJOR accomplishment). -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- This supplement may not work for everyone, but it is encouraging that research is finally focusing on alternative treatments for skin picking. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Below I have listed some tips that may be helpful for individuals who are coping with this disorder. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Tips that may help reduce skin picking: -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 1.)Increase your awareness- The first step in solving any problem is knowing that it exists. Once the issue is identified…it’s important to gather as much information as possible. Picture yourself as a ‘student’ of skin picking. Imagine that skin picking is an outside force or object that is trying to take over your life: ()Research skin picking patterns and arm yourself with knowledge.  When does it happen (a certain time of day?)  Where is it taking place (bathroom, office, school?)  How is it done (are instruments used? Is a specific mirror used?)  Why is this happening (are their specific triggers – feeling a bump on the skin – getting into an argument – thinking about something unpleasant) o Realize that you are MORE THAN SKIN PICKING and make an effort to defeat it. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 2.)Exercise – This is easier said than done, but exercise has been proven to increase feelings of wellbeing. It helps your body release frustration in a health way, rather than directing frustration to your face or other body parts • Establish a healthy routine- This is important in all aspects of life, but especially for skin pickers. It is important to disrupt old patterns (going right to the bathroom after work or school to pick) and replace them with more healthy approaches (visiting a friend after school, taking a walk to release tension, playing a video game to keep hands occupied). o For face pickers, in particular, it may be helpful to establish a washing routine. Everyone is different, but some people find it helpful to use an automated brush (Olay Pro-X, Clarisonic, etc.) to cleanse the face. The brush helps clean the skin without actually having to TOUCH or SCRUB excessively.  Often times, just looking in a mirror can be a HUGE trigger, so try to clean your face OUTSIDE of the bathroom (in the shower, kitchen, or somewhere a mirror is not present) or in an area where you would not normally pick your skin. • If you insist on being in the bathroom, cover the mirror or use low-intensity lights (if your home-improvement savvy, get a dimmer switch for the bathroom light).  It may also be helpful to use some type of pre-moistened facial cleansing cloth so your hygiene routine can be completed AWAY FROM THE MIRROR, OUTSIDE OF THE BATHROOM, without access to water. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 3.)Connect with a therapist- This can be scary for some people…but treatment really works. Search for a therapist in your area that is familiar with Anxiety Disorders, OCD, Skin Picking, or Trichotillomania. Therapists can provide support and expertise -- A therapist familiar with Cognitive Behavioral Therapy or Habit Reversal Training can help develop individual approaches to help you reduce or eliminate picking. IT’S OK TO ASK FOR HELP! -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 4.)Use a behavior chart- A common method in Cognitive Behavioral Therapy involves the use of a Behavior Chart. The chart can be simple (i.e. put a mark on the calendar every day that you pick / don’t pick) or complex (charting the specific time, location, and duration of picking / listing instruments used / describing thoughts before and after picking). The main purpose is to increase awareness and acknowledge potential TRIGGERS for your behavior (i.e. “I’m more likely to pick in the bathroom, after 3:00pm.” “I’m more likely to pick with tweezers” “I pick more before a big test at school”). -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 5.)Get rid of the instruments- Tweezers, nail clippers, pins, etc.  I refer to these as the ‘Tools of the Trade’ – When you’re in the ‘business’ of skin picking, you THINK these tools are making you a more effective worker. Again, ‘the skin picking monster’ is trying to take over and cloud your thinking  “If I use this pin, I can get this white head off my face” “If I use these tweezers, I can do a better job getting out these ingrown hairs.” “When I use this nail file, I can do a better job of getting out these blackheads.” Does any of this sound familiar? o Now ask yourself – In general…do the ‘tools’ make things better or worse? Sure, there was that one time that the pin ‘helped‘ you burst the huge whitehead on your nose…but how many times has the pin betrayed you? How many times did the urge to pick trick you into staying in front of the mirror for hours? Now that same pin that you though was ‘helping’ is leaving cuts that were much worse than if the pin never existed – IT’S NOT YOUR FRIEND…I PROMISE. o This is a VERY challenging step…there is a sense of comfort knowing that your tools are immediately accessible…but GIVING UP THE TOOLS leads to LESS DAMAGE. Nothing is being “fixed” or improved when instruments are digging into the skin.  If the ‘tools’ are a necessity – nail clippers, for example – consider giving the instruments to a roommate, parent, or spouse to keep safe. It may be even more beneficial if the individual who has access to the tools DOES NOT LIVE WITH YOU. For example, a college student may give the nail clippers to his or her parent or friend that lives down the street – The student still has access to the hygiene supplies, but not at ALL TIMES and ONLY FOR their intended use. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 6.)DELAY, DELAY, DELAY- Research proves that every urge, no matter how strong, reaches a peak and then subsides. Similar to a plot in a movie…a picking urge is initiated (introduction), increases (rising action / conflict), reaches a climax (this is probably where picking occurs), and then starts to decrease (Falling action / resolution) o Many people decide to pick when the anxiety increases and then attribute the decrease in tension (i.e. ‘falling action’ / ‘resolution’) to the picking behavior. The cycle continues because the person automatically connects the ‘picking’ with a reduction in anxiety. o In reality, the anxiety will eventually subside, WITHOUT PICKING (it may take longer…but research proves that the urge WILL decrease). o Again…the brain is playing a cruel trick on you. You THINK that picking is getting you to the resolution phase (which may be true for a period of time), but when you consider the LONG-TERM consequences – depression, avoidance, anger, resentment – the picking is actually CAUSING this cycle to REPEAT over and over again.  Now you’re stressed because of that “huge mark” on your face…which leads to more anxiety…which leads to more picking. o THE LONGER YOU CAN DELAY…THE BETTER. It will help to break the cycle. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 7.) Consider SSRI’s, if needed- I am NOT a huge advocate of medication, but I strongly believe in the effectiveness of Selective Serotonin Reuptake Inhibitors (SSRI’s). These medications do NOT have an immediate effect on your mood (it often takes several weeks to a month to see improvements), thus there is no real threat of ‘addiction’ or impairment to normal functioning. o Although may lay people refer to these medication as ‘happy pills’, in reality the medication takes several weeks or months to be effective. Basically, SSRI’s just help the brain do WHAT IT IS SUPPOSED to do, naturally.  The medication helps to block the reuptake of serotonin (made naturally in the brain), so more is available. SSRI’s are commonly used in the treatment of depression and OCD, and they may also be beneficial in the treatment of skin picking. o As always, consult your doctor before taking any mediation. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 8.)Consider trying N-acetylcysteine (NAC)- As mentioned above, studies involving NAC are citing promising results for individuals with Trichotillomania, Skin Picking, and Nail Biting. Consult a doctor before taking any medication…but educate yourself on the new and exciting research that is taking place. As I mentioned earlier, I am familiar with at least one individual who experienced improvements in skin picking behavior after taking NAC for 30+ days. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 9.)Secure an ally – Be open with yourself about picking, and reach out to a trusted friend or family member. So often, people who pick their skin try to hide from the world – Be open with yourself about this issue and maintain a realistic perspective (There are habits that are WAY worse than picking – check out the T.V. show ‘My Strange Addition’ if you are ever in doubt). -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 10.)Seek outside support. As I mentioned earlier, skin picking likes to trick your brain and it’s always helpful to get an outside perspective from a trusted source.  You may need to educate your ‘ally’ on the basics of skin picking, and explain what type of support would be most helpful for you. • Skin picking can be described as an addiction (similar to smoking or drinking) that you are “trying to quit”. • If you are familiar with groups like Alcoholics Anonymous…each member is assigned a “sponsor” to provide additional support when cravings become unbearable. Having a skin picking ‘ally’ is the same concept.  When urges arise, seek support from your ally to delay the behavior. It may help if they have responses for you like: • “The urge will pass.” • “Think about how you will feel afterwards.” • “The skin picking monster is trying to take over your brain…you know that picking leads to bad things”. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 11.) Prepare for Relapse – If you’ve been picking for several years, it will take time to change. Celebrate small victories (i.e. “I wanted to pick right away, but I waited 10 minutes) and ACCEPT RELAPSES as a necessary hurdle on the path to recovery. o We all slip up sometimes. Use the ‘slip up’ as a learning experience for the future  For example: • “I was doing good, but I just picked my face – It was right after work and I saw the tweezers sitting on the table o This is really valuable information for next time. The more you know, the stronger you will be in the future). -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 12.) Stay hopeful- If you are reading these suggestions…you’ve already initiated your journey to recovery. You’re clearly interested in decreasing this behavior and you are arming yourself with the knowledge necessary to defeat this habit. Be proud of even the smallest accomplishment (i.e. trying even one suggestion on this list, delaying picking for 5-minutes before going into the bathroom) and celebrate along the way. o None of this will be easy…but with hard work and dedication things WILL improve. o Remember:  YOU ARE MORE THAN SKIN PICKING…Just because you pick your skin doesn’t make you a BAD or UNATTRACTIVE person.  Don’t give skin picking so much power (easier said than done, I know) – This is a silly habit that, at some point in your life, made you feel better. It does NOT define you as a person…and you HAVE THE POWER to defeat it. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hope this information is helpful. Again...sorry for the spacing and any difficulty in reading looked much better in Word format. Feel free to contact me if you have any questions about the information that was presented in this post. STAY POSITIVE. YOU CAN DO IT.
9 Answers
March 07, 2013
I can also be reached by email at if you would like a copy of the Word document for easier reading. Thanks - Aaron
March 08, 2013

In reply to by Flowerinafield

Hi Flowerinafiled, I hope the information was helpful -- And just to speak to the 'disorder' comment....the reason I say 'habit' in the post is to stay away from the negative connotation associated with 'disorder' -- It sounds so permanent. Certainly, Skin Picking is a 'disorder' --as we all know-- and thankfully the new Diagnostic Statistical Manual for Mental Illness will be adding skin picking as an officially recognized illness. This is GOOD NEWS for those of us who are in the field and struggling with the effects of picking. Hopefully it will lead to more research, more funding, and more support -- which is so desperately needed. Hope all is well. Stay strong!
March 08, 2013

In reply to by Flowerinafield

Flowerinafield, I read your post on harm reduction and think that it’s an interesting concept. To be honest, I was not familiar with the approach (for picking or for addiction treatment). In terms of “harm reduction” for skin picking…I think it makes sense to REDUCE RISK as much as possible – If instruments are used (tweezers, pins, etc.) it’s best if they are cleaned and sanitized to avoid infection (sort of like the clean needle program you were talking about). If this method is showing promise for you…then by all means keep trying it ------------------------------ I noticed in your post, though, that eventually you wound up picking the bigger scabs, as well. In my experience…once the picking door is “opened” – It’s hard to close it (i.e. just picking the small scab might lead to: 1) The small scab becoming a bigger scab…or 2) Wandering hands that feel even bigger scabs or other areas that you are trying to “lay off” or let heal). By opening the “picking door” with the small scab ---- the odds of big scabs getting involved is more likely __________________________________________________________________________________ With face picking, for example, is SO easy to be drawn to the mirror to “just pick that one pimple / scab / etc.” You might approach the picking session with that mind-set…but once you get started it is very, very challenging to stop ------------------------------------------------------------------------------------------------------------------------------------------------------- I think the concept of harm reduction is really interesting…and if you are in a place where you “just have to pick”, then by all means, it makes sense to reduce the harm as much as possible – cleaning your hands, instruments, etc. ---- trying to limit picking to one spot --------- but again…be weary that picking that “one small scab” might be your brain’s way of tricking you into “opening the door” and picking the other scabs, as well. -------------------------------------------------------------------------------------------------------------- Just my opinion on it...but you’re insights are really valuable --- Keep “studying” the picking patterns and try to fight / outsmart that urge that tells you “it’s impossible not to pick” or “I’m just going to pick a little bit”. --------------------------------------------------------------------------------------------------------------------------Wishing you good (and pick-free) weekend!
March 08, 2013
Thank you for this info, I am 53 years old and have all these symptoms. I cannot remember a day where I have not picked at something on my body. I do know when it got worse it was after I quit smoking back in 1998, but I was on wellbutrin to help me quit and it worked. But my doctor took me off the med and that's when I realized I needed to be on an antidepressant. Went on Effexor for several years and did not really pick just once in while. Had to go off due to no insurance so My doctor put me on generic Prozac and generic adderall for ADHD still on both of those, 20mg of prozac and 10mg of adderrall twice a day. I have been thinking that the adderrall may be making me more OCD about my skin, not sure maybe someone else can answer this for me? If so I would love to hear any suggestions. THANKS LKING
May 26, 2013
I have a daughter who is mildly retarded and is on Effexor 37,5, just came off Abilify. She is picking at the top of her head. Can she take NAC with the Effexor. Grateful for any feedback/thoughts
May 27, 2013

In reply to by sanduchi13,97-4252 I'm no medical professional or anything like that. From what i understand about these, I can see no reason for negative reactions. I'd check with a pharmacist to be safe. CSP - 3 little letters in my giant bowl of alphabet soup!

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