With the heightened anxiety of late, people are manifesting all sorts of coping skills, some of which are self-destructive. A couple I’ve seen more than once are trichotillomania, which is also known as hair-pulling disorder, and excoriation, which involves picking at one’s skin, blemishes or scabs. Together, I’ll refer to these as pulling and picking (P&P) disorders.
Why do people do these things to themselves?
P&P disorders are, ultimately, anxiety disorders. The P&P are designed to self-soothe when a person is feeling overwhelmed in one way or another. The person may not actually feel overwhelmed at the time or at all, for that matter, but the subconscious brain is registering the stress and the nervous system is overstimulated. Fortunately, there are many things that can be done about P&P disorders, so I’ll discuss several of those here.
If you have a P&P disorder, the single-most important thing you can do is to see your P&P as a behavior over which you can exercise control. Put simply, P&P are like any other compulsive or addictive behaviors in that you are the only one who can ultimately stop the behavior. And that’s what it comes down to: You just have to stop doing it. I can give you all the techniques, tactics and strategies in the world; but you still have to make the decision to simply stop engaging in the behavior. Don’t misunderstand; I’m not saying it’s easy, but the solution is simple in the end.
How do I stop P&P?
Once you recognize that you are dealing with anxiety and decide to take control over your behavior, the next steps are increasing your awareness of what leads to the behavior and what the consequences are. One helpful method for doing this is behavior chaining. This involves looking at the ABCs: antecedent, behavior and consequence.
Antecedent
An antecedent is simply something that comes before something else. So, you have to figure out what it is that leads to your P&P in order to combat that precursor. Potential antecedents can be a stressful day, worrisome thoughts, an upcoming event, medical issues or anything else that causes anxiety.
If you know that you had a stressful day or otherwise have anxiety, you can decide to engage alternative behaviors, which we will discuss in a bit. If you don’t have this insight and foresight, you may have to do some reverse engineering to figure this out. That is, once you notice that you are engaging in P&P or someone else points it out, grab a piece of paper or a journal and write about what’s going in your life at that moment. If you aren’t aware at the time that you are P&P or no one is around to point it out to you, you’ll have to do your reverse engineering once you realize that you have a bald spot, made yourself bleed, etc.
Next, it’s important to learn what the signs are, if possible, that you are about to engage in P&P. Like some migraines that begin with an aura, you may be able to discern what the signs or symptoms are of building tension that indicate you are about to engage in a maladaptive coping skill. Then, when those signs appear, you can choose to engage alternative behaviors.
Behavior
Once you figure out what the triggers of your behavior are, you can target them to prevent the behavior. You can do this by engaging the alternative behaviors I referenced earlier: redirection and distraction. For example, once you’re triggered, you can work to redirect your attention using deep breathing or imagery or by doing a relaxation exercise such as tensing and releasing muscle groups, one at a time, from head to toe.
Many people engage in P&P when they’re reading or watching TV. Because they’re so engaged in what they’re doing, they may not even realize they are P&P. If that’s you, you can wear gloves during those activities or redirect your behavior by finding something else to do with your hands, such as playing with clay, knitting, holding hands or manipulating a fidget spinner or toy. To combat hair-pulling, you can also try wearing a hat or scarf on your head. For skin-picking, you can put bandaids over blemishes, sores or scabs to deter picking and prevent worsening. For people who really need something to pick at, you can get tapered candles from the dollar store, burn them for an hour or two, let them cool and then pick off the wax that has run down the sides. If you have a tendency to bite your nails or chew your cuticles, you could try dipping your fingertips in acetone. The bitter taste will work as a deterrent, and acetone stays on your hands even after you wash them.
You can also distract yourself by drinking a glass of water, doing ten pushups or sit-ups, cleaning something and so on. You should preemptively make a long list of healthy or productive distractions so you don’t have to think about what to do while you are in the middle of trying to fight the urge to engage P&P. Like any other compulsive or addictive behavior you are trying to quit, if you can use redirection or distraction to fight the urge or craving for 90 seconds, it will pass. Some days will be lived in 90-second increments, but you can overcome!
Consequence
You can build motivation for quitting by exploring the consequences of behaviors or looking forward to events. For example, if you are a nail biter or cuticle chewer, be aware that open sores on your hands are an easy target for germs and bacteria, which means you are more susceptible to infection. Or, maybe you have an upcoming event for which you don’t want to have bald patches or sores on your arms. You can post reminders of the upcoming event all around your spaces to help keep you on track.
Be sure to find ways to encourage yourself in the process of quitting. You can stick motivating post it notes around your space or use a dry erase marker to write encouragement on mirrors and windows. Use your favorite motivational quotes or search the web to find some. You can also choose a friend or family member to use as an accountability partner. They can check in with you each day and give you daily encouragement in the form of scripture or motivational quotes to keep you on track. You may also find encouragement from local support groups or online discussion forums.
If these things don’t work for you, you might want to consult a professional who works with anxiety. Your therapist can give you skills and strategies for combating P&P like those above, as well as help you work through the underlying anxiety that drives these self-soothing behaviors. Therapy can help to decrease your overall anxiety, which is a buildup of perceived (read: self-inflicted) pressure. You can press the release valve by focusing on what you can control, what you can do something about and release. There are also various amino acids and prescription medications that may help. Talk to a naturopath, physician or psychiatric provider for more information on those options.
If you or someone you know is struggling with this or another psychological issue, help is available. Talk to your insurer about available options under your plan. For more information on teletherapy sessions with me, visit the FAQs section at www.doctorbellingrodt.com.
DISCLAIMER: Material on this site is for informational purposes only. The content of this site is not intended to be a substitute for evaluation or treatment by a licensed professional. Information contained on this site should not be used to diagnose or treat a mental health issue without consulting a qualified provider. The use of this website does not convey any doctor-patient relationship. All material is the intellectual property of Jennifer Bellingrodt, Psy.D. The material is copyrighted and may only be reproduced with the express written permission of Dr. Bellingrodt.
