This is going to be a very long post, but I'll try to break it up into paragraphs that will make it easier to skim for what you find useful. Quick warning, I'm going to be mentioning eating disorders a few times, but without going into details. First off, I'll go into a couple of the big developments in my life that are derma-relevant. A few months ago I was finally diagnosed with bipolar II, which consists mostly of depressive episodes, but has to be treated differently than unipolar depression, since antidepressants without a mood stabilizer can cause bipolar cycling. I'm now on a mood stabilizer, which is working well, and I'm finding that without bipolar cycling I have less anxiety, leading to less need for self-soothing rituals, which for me leads to less picking. If you might have an underlying condition that's exacerbating your picking, please go see a doctor/psychologist/psychiatrist if you can and haven't already. It took me several of them over several years to be taken seriously, and I'm going to follow up with a separate post with some of the details on how I finally got through to the professionals, in case that's helpful. Another change in my life is that I've relocated, moving out of state after (mostly) living where I come from into my adult years. Being away from all the places and things that pull me back into old traumas and outdated anxieties has helped A LOT. Of course, moving isn't a solution for everyone, and it requires some money and a lot of freedom, and it's stressful... my point is really just that external circumstances play a big role in how we feel and behave and it's worth making whatever positive changes you can. They won't "fix" your derma, but if you can focus on some of your other goals you may find that you're picking less. But of course, change just triggers some people, so it's very important to take what you know about yourself into account on this one. Now, to address the question I deleted, I'm gonna lay out a bunch of the strategies that were working for me before all that: I read a post by someone in the derma community several years ago recommending the book The Four Day Win by Martha Beck, and read it. I wish I remembered who suggested this or where, so I could give credit, but this was probably 5 years back and I have no idea. It's a diet book, but many of the chapters apply to reducing any behavior that you're trying to break out of, and adapt well to skin picking. I had a hard time pushing through the book because I'm extremely anti-diet and firmly believe that advocating dieting is also advocating eating disorders. Several members of my family have struggled with eating disorders, so there were times when I wanted to throw this book across the room, but ultimately I found it helpful. You can probably get a copy from your local library if you want to read it, but I'm also going to give a capsule version here of what I found helpful/adapted from the book for my own use. The premise is that instead of setting ourselves up for failure by trying to do something difficult *indefinitely* (sticking to a diet or not picking, for example), we only commit to four days at a time, and give ourselves a reward when we complete a four day cycle. The rewards, for me, were something small and concrete, usually buying myself something inexpensive that I wanted. When the four days was up, I was allowed to pick all I wanted, but then would start another four days of not picking right after. If four days is too long to manage, you can always use shorter times. I would often do 3 days, but if 2 or even 1 whole day is more realistic for you it's more important to set a very specific time and then reward yourself at the end. You have to be consistent with the reward, not giving yourself the reward anyway if you do pick, and not sacrificing it (to save money or whatever) if you do make your goal. It's like training an animal, except we are the animal we're training. Make sure your rewards aren't anything you pretty much need, since that becomes a system of punishments for not making it, and in order to work this has to be a system of rewards for doing well. It's an entirely positive system. I would sometimes get myself a larger reward if I didn't pick (or barely picked) between 3 or 4 day no-picking periods, but didn't plan ahead for that because you really need to keep your mind on the short term when doing this. If I did pick when I wasn't supposed to, I would sometimes give myself a reduced version of the original reward if I made it to the end of the original 4 days without doing it again. For instance, if I was going to buy a new set of paint brushes, I might scale it back to choosing an individual brush. Or if I felt like it was realistic, I would start another 4 days immediately after lapsing. Being as realistic as possible is important for this one. Another thing I would do is keep a log of where on my body I was picking, when, how many individual spots I was going at, and any particularly pertinent facts like an unusual mood or triggering event. I was putting it in the calendar on my phone so the time was recorded automatically, and I had a system of abbreviations that kept it easy. An entry might read "f4, a2 (blood), s4. Very anxious", which would mean I picked at 4 spots on my face, 2 on my arms to the point of drawing blood, and 4 spots on my shoulders, and that I was experiencing an unusual degree of anxiety. I would differentiate between my arms and shoulders because my shoulders are a particular problem area for me, but I also pick at my scalp sometimes, so I would indicate my scalp with an "h" for head, since "s" was shoulders. If I picked at an area enough that I couldn't say a specific number of spots, I would just say "bad", like "a2, sbad, l3" would mean I picked 2 spots on my arms and 3 on my legs and really took it out on my shoulders. Of course, you would adapt your log to what is most pertinent or useful for you. The log served a few purposes. For one, just having more awareness can be really helpful, also I would actually sometimes hold off on picking just because if I did it, I would have to acknowledge it in writing. I would sometimes stop myself in time to put down a number instead of "bad". It also makes it easier to see when you've been doing pretty well lately, and feel good about it. Prepping to pick helped too, instead of denying that I was going to do it until the very last minute and then going at it impulsively. I would get home at night or in the afternoon and wash my hands with antibacterial soap first thing, then rinse my face and put on a face mask that I could keep on for a couple hours. Its best if you can do that without being in front of a mirror, which could mean using your kitchen sink or covering your bathroom mirror. If you can't do that, try not to even glance at the mirror if you can manage. I got pretty good at keeping my eyes down completely while going through this routine. When I eventually had to rinse off the mask, if I did get sucked into picking at least my hands and face were clean and the skin on my face was in pretty good shape so the damage was minimized and the spots I picked at wouldn't flare up and get infected from getting all the dirt you pick up outside in them (gross, I know). Honey works pretty well in place of commercial face masks, cause it's a physical barrier and great for your skin, but you have to be more committed to avoiding mirrors, since you can still see your skin through honey. Besides face masks/honey, there were other physical barriers that helped. Pretty much everyone comments on this, but it bears repeating. I would wear shirts at home that were tight in the sleeves so getting at my shoulders wasn't convenient, which honestly is something I need to get back in the habit of doing. As you can probably tell from all the past-tense, I'm doing well lately, but my arms and shoulders are what I go for most when I do pick. If there were only a couple visible spots on my face, I would cover them with band-aids, and I would sometimes wear gloves at home. I've also made lists for myself of anything that's helpful, meaning both practical tips and alternatives to picking (even if they sound dumb or obvious), and information that it's helpful for me to remind myself of. I have an old list in front of me right now, and some of the suggestions on it are super simple, but were actually helpful for whatever reason. Some of them actually strike me as kind of self-shaming now, but inspired me at the time. Whatever works, I guess. Here are some of the items from the list (the not-shamey ones): Wait it out. Later is better than now. Drink some water. Have a snack. Take a nap. Put on long sleeves. Consciously remember not to do it. Turn out the lights. Watch a movie. Read a book. Listen to music. This is an outgrown coping mechanism. This is an internalization of being "picked on." I don't want to let people who have treated me unfairly manifest themselves in me. DON'T do "just one" (it's never just one). Relapse is a normal part of recovery, and it doesn't determine the future. Adherence is the goal, but near-adherence is almost as good. If I can't do 100%, I can try for 90%, or 75%. It's still worth maintaining, even if it's not perfect. No comment made by any idiot is my problem. Relax and breathe. Remember to eat, sleep, and play music. I really don't need to touch my face at all except for daily skincare. Even MH "just stopped". I'll explain that last item. It's a reference to Marya Hornbacher's memoir, Wasted. Marya had a severe eating disorder for years, to the point that it almost killed her (you may know this part, it's been a popular title for a while...) Like I said, my family history is peppered with eating disorders, so I've put in my due diligence reading up on them. She reaches the point of almost dying, and then -like some kind of miracle- she "just stops" the behavior that would otherwise have taken her life. The reason I included that as a kind of affirmation isn't because I think my picking will "just stop", but rather because it's such an extreme example of how people sometimes turn a corner in their struggles and start to get better, no matter how bleak their future looked during their darkest times. Anyway, making lists like this are helpful if you can include whatever helps YOU to remember, not what helps someone else, or only things you don't think are obvious. If it's obvious and it helps you, put it on the list. If it's not clear why exactly it's relevant but it helps you, put it on the list. Then keep your list someplace handy, like on your wall or taped to your desk, or in the back of your journal. I hope some of this helps y'all, sorry it's 5 miles long, but I wanted to include everything I could think of. Love you all. Best.
yousharknotpass
blakekathryn
stormborns
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