'Help! I Can't Stop Picking At My Pimples!'
The next installment of Ask Ugly, my monthly beauty advice column for the Guardian, is here! Hi Ugly, I tend to get pimples, especially around my period. This is fine and normal. Whatās not fine is that I cannot stop picking at them, making my skin irritated and red. Itās important to me to let go of beauty ideals: I donāt buy into the idea that skin has to be perfectly smooth to be beautiful, and I donāt mind pimples ā but I do mind that I keep breaking my skin over and over, putting myself at risk for infections. And because itās on my face, people can see this weird pseudo-mutilation. How can I stop picking? ā Picky For the past 20 years ā since I was 16 ā Iāve compulsively picked out my eyebrow hairs one by one, trying to soothe some phantom pain in my follicles. My brain says the pain will stop once I pick the right hair, but then it turns out that there is no right hair, or maybe the right hair is simply the last hair. So I pick and pick and pick until my brow bones are nearly bald and sometimes bloody. Then I pick at the skin. And the scabs. And when the hairs grow back, I do it all over again. Which is to say, youāve either come to the exact right person or exact wrong person for advice. Iāve tried to stop, of course. Iced the area to numb the urge. Basted my brows with Vaseline (maybe if the hairs are too slippery to pullā¦?). Iāve bought self-help books and fidget toys and joined a 30-day habit-breaking group online. If wanting and willpower were enough, Iād look like Brooke Shields from the forehead up. But I donāt, because the kind of picking I do isnāt a bad habit. Itās a mental illness. The condition Iāve been diagnosed with, trichotillomania, is a body-focused repetitive behavior (BFRB), a category of compulsive self-grooming actions that result in injury. What does all this have to do with you? Maybe nothing! But there is a related skin picking condition called dermatillomania. Obviously, I canāt diagnose you over the internet. (Iām an advice columnist, not a psychiatrist.) You say you ācannot stopā picking though, so it might be helpful to visit a professional and discuss your symptoms. BRFBs also include nail biting and cheek biting compulsions, and ācan be on the spectrum of anxiety disorderā, explains Dr Amy Wechsler, a dermatologist and psychiatrist based in New York. They typically manifest āduring periods of a lot of stressā, she says. Dermatillomania affects an estimated 2-5% of the population. For context, you probably know twice as many skin pickers as natural redheads ā maybe more, since the shame surrounding self-harm often keeps pickers from reporting their symptoms. Diagnosis depends on frequency, severity and damage. Picking thatās sporadic or easily stopped is probably just āa bad habitā, Wechsler says. It enters disorder territory when the patient is ādrawing blood, leaving scars or picking at an area that other people can seeā, or if the behavior is uncontrollable and āgetting in the way of their life in any way, socially or professionally or at schoolā. Whether your picking is a temporary habit or something more serious, meditation can probably help. (I personally go longer between brow-plucking attacks when I consistently practice deep breathing.) Talk therapy or cognitive behavioral therapy with a mental health professional can help manage stress too, says Wechsler, and anxiety medication is also an option. As far as surface-level solutions, Wechsler recommends treating the underlying acne that triggers the skin picking, since most patients in your position āwill not pick if thereās nothing thereā, she says. This might be an uncomfortable concept for someone who cares, as you do, about divesting from toxic beauty standards. But beauty culture is complex. Appearance ideals are never only appearance ideals; they intersect with health and hygiene, class and power, expression and autonomy. Addressing persistent acne, in this case, isnāt about submitting to someone elseās standard of ābeautyā. Itās about reducing the harm ā to your skin and psyche ā of a condition youāre struggling to control on your own. The rest of my answer includes: hormonal acne treatment options how visible symptoms of illness can affect mental health the potential benefits of ārestorative beauty,ā according to NYC-based aesthetician Delphine Breyne my own experience with brow microblading as a ācosmetic coping mechanismā and more! Click through to the Guardian to read the full article (and if you decide to share it with friends or on social media or whatever, please share it via the Guardian link). Bonus! Here are some extra tidbits that didnāt make the final edit: I like to think of BFRBs as signs of a strong brain-skin connection. āOn seeing the effects of our deepest thoughts seeping through our skin, Carl Jung, the legendary Swiss psychoanalyst, is said to have exclaimed: āAha! A looking glass into the unconscious!āā Monty Lyman writes in The Remarkable Life of the Skin. Isnāt that lovely? GLP-1s like Ozempic and Zepbound are ābeing studied for just about everything,ā Dr. Wechsler told me, including compulsive behaviors like BFRBs. Evidence of efficacy ā empirical, anecdotal ā is debatable, and I hesitate to suggest treating an anxiety disorder with whatās been compared to āan injectable eating disorderā, but it is another potential path for compulsive pickers to discuss with their medical teams.
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