Picking: your battle

Stub

Speaking from experience as a skin picker and hair puller – behavior has a purpose. Until you find and address the purpose, changing the behavior is going to be a challenge, to say the least. It’s so much easier to modify the habit if you know the purpose so you can find an effective substitute. Please be kind to yourself. You don’t lack the desire or willpower, it’s not “just a bad habit” – it’s a suboptimal coping tool. So the question becomes, what are you coping with?

Causes to consider:

  1. allergy
  2. Keratosis Pilaris (Chicken Skin): Pictures, Causes, and Treatment (healthline.com) (lotion with lactic acid is the standard treatment)
  3. viral lesions (chicken pox, shingles, herpes) – hydrocolloid patches work for these
  4. itching instead of pain (my shoulders tend to itch when subluxated so my hands end up scratching there a bunch)
  5. seams or tags in clothing
  6. stimming (link post pain dopamine for motivation info)
  7. self soothing – Once I started paying attention to when and where I was picking I noticed I would start with rubbing my arms or scalp during challenging interactions, find a bump, scratch it until smooth (even if bloody)

Alternatives to substitute:

  • Applying balm or patches
  • wear clothing inside out
  • scratching with a tool or gloves to not feel the things to scratch at
  • treat the underlying cause
  1. Ideally, identify the allergy and remove the allergen. That can take a while, so in the meantime try allergy medication like Lortadine (caution with regular use of Benadryl – Alzheimer’s or dementia link) or a topical anti-inflammitory
  2. lotion with lactic acid is the standard treatment, also try exfoliation
  3. hydrocolloid patches work for these, you can also try the reusable silicone ones, medication like Valtrex or supplements like lysine (find link)
  4. regular gentle (wedges or drop table to use gravity/gentle pressure, not the big crunch style) chiropractic care, bracing, strapping or taping as you’re able to support the joints
  5. wear clothing seams out, cut out tags
  6. I use a variety of hairbrushes, toothbrushes and massage tools (to link)
  7. I try to wear gloves so I can still massage myself, but don’t feel the spots so the picking doesn’t start. I also use many of the same tools as for stimming.

Understand your triggers.

There are so, so many different factors that can set off picking, from anxiety or depression, to dermatologic conditions like acne or ingrown hairs, to boredom or having idle hands.

6 Expert Tips for Coping with Skin Picking Disorder | Apartment Therapy

Boredom means your brain wants more stimulation – stimming. Idle hands is stimming or self-soothing – I dislike the use of these as to me it implies you should be doing something productive. If knitting, crochet or macrame work for you then great, and if not, there are plently of other options..

]…CBT therapy… [“Stimulus control is basically a strategy to make it harder to pick by modifying your environment,” Zakhary says. So you might wear gloves, keep your skin covered, or apply skincare masks or lotions that feel soothing to the skin. There are also hundreds of “sensory substitutes” that you can use to keep your hands occupied during times when you’re most likely to pick, like playing with silly putty or a stress ball, knitting, or painting your nails. You can find a larger list of items and activities to keep your hands occupied through the TLC Foundation for Body-Focused Repetitive Behaviors.

In the second form of treatment, habit reversal training, “Individuals are basically taught to engage in a harmless motor behavior that’s incompatible with skin picking, so clenching your fists, for example

]… [It’s also worth noting that while there are no FDA-approved medications specifically for skin picking disorder, studies have also shown that medications like SSRIs and N-acetylcysteine, an over-the-counter antioxidant supplement, can be helpful additions to CBT.

]… [While confronting the mental and emotional aspects of your picking are the keys to truly conquering the disorder, there are some short-term aids you can incorporate to lessen the likelihood of picking.

]… [If your bathroom is a particular hotspot for your picking, you might choose to temporarily cover up the mirror or remove any magnifying mirrors in your home. Zakhary also suggests using Band-Aids (of the literal kind) to cover your lesions, or put them on the fingers you use to pick to prevent yourself from doing so. “I often recommend blister Band-Aids — they’re waterproof and will stay on for a couple of days,” Zakhary says.

6 Expert Tips for Coping with Skin Picking Disorder | Apartment Therapy

I prefer the acne hydrocolloid patches. Smaller, less noticeable, helps if it’s a viral lesion (chickenpox, shingles, herpes) and can be very satisfying to remove and replace.

If the initial cause is resolved and it’s habitual, then habit modification is in order. It’s generally much easier to modify or replace the habit than it is to quit cold turkey.

Input Required

I had a friend ask for ideas, I’m generalizing here for anyone it might help.

Kiddo asks parent for proprioceptive input.

Parent either can’t or can only offer some input.

Kiddo can’t handle the refusal – they already are disregulated and needing input, so they escalate.

My suggestions came from my experience:

1 One, it’s ok to have boundaries, and the less someone respects your boundaries, the bigger the boundaries have to be.

I’ve described it like the following distance when driving – if someone in front of you or behind you is tailgaiting, you need a larger following distance. That way if the person in front crashes from tailgaiting you have time to brake. If the person behind is too close then you also need time to brake slowly so they don’t hit you like they would if you had to stop suddenly.

What this looks like is stopping your kiddo farther away and asking them to slow down and ask first. If they are too disregulated to respect the boundaries, then you know to take action to protect yourself and help them get regulated. For example my personal bubble with the kiddo is my head and my back, if he wants to go behind me he has to ask, and if he wants to touch my face he has to ask, and if he wants to give me a hug, he doesn’t have to ask unless he’s trying to come up behind me.

2 Two, if they are asking for input you can’t give, try to give them or help them get the input they need. I’ll offer “squeezies” – a big bear hug, “squishies” – squishing the kiddo between me and a counter/wall/etc. or “jumpies” – holding hands and the kiddo jumps while pushing down on my hands, similar to holding a gym bar or pushing down on a counter or table and jumping.

In this case kiddo wanted what we call “shoulder bup” – sitting on shoulders. The two alternatives I thought of was doing a piggy back and then leaning against the wall to take some of the weight off or doing the shoulder bup with leaning back so that most of the kiddo’s weight ends up on the back of the seat if available.

If those aren’t options, a headstand or handstand might help or the other types of input mentioned. Another one we like is “Timber!” where they call that and you are a tree that then falls down on them – usually sitting side by side and leaning into them.

The Human Animal

Wait, you think humans aren’t animals? We certainly aren’t minerals or plants…..

If we weren’t an especially fancy type of animal, then animal studies and models would be worthless.

This research showed how all temperament types responded to the stimuli the same way, but different temperaments move through the responses at different times. He commented “that the most basic inherited difference … was how soon they reached this shutdown point and that the quick-to-shut-down have a fundamentally different type of nervous system.”[27]

He is known in some fields primarily for his work in classical conditioning.

Ivan Pavlov – Wikipedia

So, ND/HSPs have a fundamentally different type of nervous system (including the brain) is what I would take away from this.

Also, if you have an issue with “Pavlovian Training” and consider it being treated like a dog…. you are choosing for yourself an interpretation that is only going to make your life harder and more painful.

Another name for it is classical conditioning, which is a behavioral procedure in which a potent stimulus is paired with a previously neutral stimulus.

It is used for things like ADHD treatment and in life hacks like Atomic Habits by James Clear who describes it like this: “All habits proceed through four stages in the same order: cue, craving, response, and reward.”

“It is easier to prevent bad habits than to break them.” ~ Benjamin Franklin

“When dealing with people, remember you are not dealing with creatures of logic, but creatures of emotion.” ~ Dale Carnegie, author of How to Win Friends and Influence People

“We are what we repeatedly do. Excellence, then, is not an act, but a habit.” ~ Will Durant

“Change is not popular; we are creatures of habit as human beings. ‘I want it to be the way it was.’ But if you continue the way it was there will be no ‘is.'” ~ Robin Williams

“Man is largely a creature of habit, and many of his activities are more or less automatic reflexes from the stimuli of his environment.” ~ G. Stanley Hall

“We are all creatures of habit. We can do most things without even thinking about them; our bodies take charge and do them for us.” ~ Earl Nightingale

“It is hard to let old beliefs go. They are familiar. We are comfortable with them and have spent years building systems and developing habits that depend on them. Like a man who has worn eyeglasses so long that he forgets he has them on, we forget that the world looks to us the way it does because we have become used to seeing it that way through a particular set of lenses. Today, however, we need new lenses. And we need to throw the old ones away.” ~ Kenichi Ohmae

“I’m a creature of habit and I like to stay in my own little comfort zone, but you have to reach out of that sometimes. And when you do that, you grow.” ~ LaToya Jackson

TOP 25 CREATURES OF HABIT QUOTES | A-Z Quotes (azquotes.com)

The shaping of character mimics the smallest detail of habit; humans are creatures that learn from observation. Each little thing you do, and each thing you allow yourself to become desensitized to matters. They create you – whether you know it consciously or not. — Grace Sara

Quote by Grace Sara: “The shaping of character mimics the smallest de…” (goodreads.com)

Rehearse for life

I can’t find the article, but when the kiddo was biting more, I remember reading that you can’t tell a child not to bite when they are flooded (Gottman term for the amygdala being in charge), and just telling them not to bite when they are calm doesn’t work – they can’t remember in the heat of the moment. You have to role play appropriate responses.

Like training for martial arts so that when you are in fight/flight/freeze your automatic reflexes take over.

We have a policy that once calm and we’ve figured out what the problem was, we have to roleplay a healthier/more adaptive method at least 3 times so that those neural pathways are reinforced more than the maladaptive ones that were defaulted to. And for really big things like hitting or biting we do at least 5 – and include variations. Basically the “What Would Danny Do?” (there is a Darla one out now too) books, but instead acting them out and using our situations. We also tell (and keep meaning to write up) “choose your own adventure” versions – the first is what actually happened and why, and then we come up with two or three more other options and results.

This can also help with theory of mind and empathy. It is the reason that pretend play is so important and if it doesn’t come naturally, it should get modeled. The Hot Wheels City videos on YouTube actually helped us with that. The kiddo didn’t like watching real life people but that one only shows the hands using toys to do pretend play.