daughter is skin picking

[worriedmom]

I need advice about my daughter. She started picking her ears saying that the itched so bad etc. Now she picks at her face and fingers until they bleed. I have asked her why and she can't give my answer. If one of the sores is bleeding, she will make up a story and say that she doesn't know what happened, she probably bumped it etc. Also, I have caught her squeezing the sores until the blood comes out. I don't want her on medication at such a young age. Any advice?

[coolhandluke]

Worried:

I was so convinced you were MY mom! I have checked this board at my house and I wondered if my mom stumbled upon it and let her imagination get out of hand or something...but you were another girl's mom. She is lucky to have a mother who is so concerned about her behavior, and I admire your determination to get help for her.

YOUR DAUGHTER: First of all, how old is she? From what you described, I figured she was around nine or ten, maybe even thirteen or fourteen, but definitely in or on the brink of puberty. Although many of us pickers start picking as early as four and five years old, puberty seems to start the cycle of picking---maybe it's the increased oil and pimples that result, but I'm guessing it's because of an increased awareness of and concern about appearance.

Second of all, and this is VERY important: DO NOT "NAG" YOUR DAUGHTER ABOUT PICKING. It is easy to come off as nagging, even when you aren't. And while your story definitely shows that you are seriously concerned and not in the least trying to be irritating, your daughter may see it differently. Because right now, she is probably beginning to feel embarrassed by and possibly even alarmed at her picking, and trying to do it when Mom isn't around only increases the EXCRUCIATING sense of isolation---as a picker, I know how much of a freak it can make you feel. You are her greatest ally in this fight, and so there is no room for he possibly misunderstanding that.

You might sit her down sometime when she's calm, not busy (which, of course, includes making plans for hanging with her friends---I have a 15-year-old sister who has a busier social life than J. Lo), and IS NOT PICKING. This way she doesn't feel attacked or spied on--girls of what seems to be your daughter's age range are on the paranoid side; I know I was. Make it clear that you really want to help her stop picking, because ONCE SHE GETS INTO THE PICKING "HABIT," IT IS *SO* HARD TO STOP---not because you are afraid she'll end up with horrible scars and a fractured self-image (which are very possible realities of picking), but because you want her to have healthy ways of monitoring her moods/stress levels, as well as her having a life that doesn't revolve around her looks, which revolve around picking, all of which influence how she views her worth as a person. Emphasize the difficult of stopping once it becomes a regular habit, rather than the impact it will have on her appearance. That is a very important distinction.

Lastly, take her shopping for some earrings, or offer to get her ears pierced if they aren't---but as a reward for not picking a certain amount of time. Also, take her to pick out some sort of hand-fidget toy, like a Rubix cube, or anything that she thinks will help her not pick and yet not make her "look like a freak." You could even begin a sticker chart, or some kind of age-appropriate version to keep track of the number of days she doesn't pick. I, at age 22, have drawn myself a special calendar where I give myself one of my favorite stickers for each non-pick day. Stickers are one of those rewards that no one ever gets tired of receiving...that is something I'm totally convinced of.

Help her find things to do that put her hands to work in a soothing, concentrated rhythm---such things might include coloring in a coloring book, brushing her hair, brushing the dog's/cat's hair, knitting, sewing, painting (art or walls or attic shelves, it doesn't matter), carpentry, folding laundry (but only if she likes it---if she hates that chore, have her do it at times when she doesn't have the picking urge), braiding hair, painting finger/toenails. There are so many other calm, rhythmic things to do that get the hands to focus and relax the brain.

Not only am I a psych major 1.5 semesters away from a BA in psychology, I'm also a 9-year picker, and have only a year ago begun experimenting with ways to quit. A note on medication: picking is a behavior that is classified as being indicative of Obsessive-Compulsive Disorder, but because it is not a ritualized behavior like handwashing each time you touch a doorknob, or walking up steps beginning and ending with your right foot, it does not respond as well to common anti-depressant (SSRI, or Selective Serotonin Reuptake Inhibitor) drugs such as Zoloft, Paxil, Celexa, Lexepro, and others. There is research that shows otherwise, but we pickers, most of whom take some form of the above medications, have not found specific picking relief from these. They are WONDERFUL for depression, anxiety and other problems, but not specifically for picking. The only drug that has been consistently shown to help picking is Seroquel and Zyprexa, both of which are dopamine antagonists (they reduce the amount of dopamine in certain areas of the brain). Still, all of the drugs I've mentioned are extremely safe and work wonders when prescribed correctly. But only a child psychologist can determine if your daughter needs a medication, and only a physician specializing in prescription of psychotropic medications can determine if they are right for her.

I hope this helps you, and good luck with your daughter. Keep us posted on her progress!
Love,
Cool Hand Luke (real name: Margaret)

[coolhandluke]

Sorry, Mom ( ), one more thing:

If you want more information on the problem, do an internet search for "acne excoriae", "neurotic excoriation," "dermotillomania," or "compulsive skin picking." For information on medications, look up "atypical neuroleptics and [insert one of the above skin-picking labels, or replace with "trichotillomania," which is compulsive hair-pulling, but is identical to skin-picking in every other way, cause, and treatment characteristics]." Since I'm doing research on this very topic, a lot of the articles I've found have shown excellent results with the dopamine antagonists (atypical neuroleptics), either by themselves or in tandem with anti-depressant drugs--both kinds of studies exist.

More importantly, people on our board have actually taken Seroquel for picking, and have had good results with it; not only does this drug make better neurological sense, its effectiveness is shown in both scientific research AND among real people who take it.

But again, that's very, very far down a road that hopefully, your daughter won't have to take. I suppose I'm just wanting to give you the absolute most correct information, because I'm bothered by the studies that somehow indicate that anti-depressants work. That is ENORMOUSLY misleading, as many skin-picking sufferers haven't had any relief from picking with those drugs, no matter how long they take them.

Okay, I'm finished yammering like an arrogant professor. I'll shut up now!
Good luck,
Margaret (cool hand luke)