Matt Traube, MFT

Healthy Mind, Healthy Skin

Skin Picking and Hair Pulling

Learning how to manage skin picking and hair pulling.

Posted Oct 19, 2016

Most of the people in my practice who suffer from skin picking or hair pulling initially have a deep sense of shame and guilt about their habit. They often wonder what’s wrong with them. Why do they have this issue when others seem to have no problem with their skin or hair? They often feel as though their problems are trivialized, and that no one understands how significantly their condition impacts their quality of life.

In our society, if someone has a common medical condition that impairs their social, occupational, or psychological well-being, most people will agree that they should get help. But while many of my clients report social, occupational, or psychological issues as a result of their uncontrollable urges to pick or pull, they often receive responses like, “Why can’t you just stop?” Instead of feeling supported or understood, they feel they have to hide their behavior or be judged and ridiculed. They try their best to cover up the scars or bald spots and keep their issue secret. Although hundreds of thousands of people suffer from picking and pulling, the behavior is often not very well understood.  

One reason skin picking and hair pulling can be difficult to stop is that the motivations behind it are wide-ranging. It’s commonly believed that skin picking and hair pulling are a result of stress and anxiety alone. But while this is true in some cases, it can also occur while you are simply bored. Many report picking or pulling when they feel under- or over-stimulated. Sitting in car, watching the TV, or sitting in front of the computer, the urge can feel automatic as your hand slowly moves towards the areas you generally pick or pull. It often happens without your awareness. Most people describe it as a trance-like state.   

For some, a common visual trigger such as a mirror may intensify the urge. They did not have the urge to pick or pull until they saw themselves in a mirror and suddenly realized that an area of their skin or hair feels like it needs to be picked or pulled. For others, the urge is triggered by a tactile compulsion. After touching their skin or hair, they feel an irregularity which produces an intense impulse to pick or pull. For skin pickers, it can create a vicious cycle that’s difficult to escape. Picking often causes scabs, and of course scabs are often identified as skin irregularities that must be removed. But when a scab is removed, a new scab is formed and the process continues to repeat itself.     

Another group of people see a skin or hair imperfection as a sign of personal tarnishing. They believe something is wrong with them, and without removing the imperfection, they can never be at their best. I might hear someone say, “I will never find a good partner or be successful in school or at work while my skin is bad.” 

Some use picking and pulling as a protective mechanism. It’s an intelligent strategy, whether it’s done consciously or unconsciously. For example, if you are someone who is hesitant to socialize or date, you can justify not addressing these issues by telling yourself, “How can I show up for a date or go out in public with scratches on my skin or missing hair on my head?” You focus on your skin or hair instead of the actual problem.

Many people think that picking and pulling must cause a lot of physical pain, which should deter you from doing it. That couldn’t be further from the truth for people who suffer from compulsive picking or pulling. For many, scratching their skin until it bleeds or pulling their hair out until they feel a “pop” can be euphoric. Generally, after picking or pulling, people feel shame and guilt, but during the act, it’s addictively relieving. It can reduce intense feelings of stress and anxiety.    

Ultimately, skin picking and hair pulling are used to control discomfort and relieve emotional pain, physical pain, or a blend of the two. The key is to figure out what the motivation behind the behavior is. I always use a combination of behavioral approaches, which address the physical act of picking or pulling, and then look at what might be at the heart of the issue. For instance, if someone is experiencing intense social anxiety, they may be picking or pulling to cope with the intense feelings of stress. Learning how to manage the areas in life that trigger the behavior can make a significant difference.

Finally, receiving support can be life changing. You are not alone, and human connection can be a powerful tool. If you are reading this, you have the ability to link up with an online group or work with a therapist via Telehealth. Many people have experienced similar symptoms and have learned how to manage the behavior. 

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