In the first half of this post (The Evolution of My Self-Mutilation: Part I), I described how I began cutting at the age of 13. I was always very careful with my routine, never daring to nick an artery or something that could cause a trip to the hospital, as that would reveal my secret. I was a cutter throughout my teens and into my 20's, but then I took a break for several years and didn't cut. I turned to tattoos and body piercings as a substitute. I told myself I was better, that I'd outgrown such behavior. That was a lie. I started cutting again on my 30th birthday. But this post isn't about cutting, it's about self-injury, which comes in many forms. I didn't need a razor blade to harm myself. In fact, the self-injury actually began many years before I picked up a knife and made my first cuts. This post is about my main form of self-mutilation.
I've suffered in silence since the age of 9 from a disorder whose name I never knew until two months ago. This particular disorder is actually visible to others, in a tangible, physical way, or at least its symptoms are; it's much harder to hide than say Bipolar Disorder. It's something I've misunderstood and been ashamed of and hidden from family and friends, and my doctors as well, all these years, for almost my entire life. Dermatillomania is an impulse control disorder characterized by the repeated urge to pick at one's own skin, often ending in bloody wounds and causing tissue damage severe enough to leave scars. The urge to pick-or scratch, bite, tweeze, or squeeze- is similar to an obsessive compulsive disorder, but for some people the condition is more akin to substance abuse; I haven't yet figured out which one of those two groups I am in. The activity causes great anticipation in me before I engage in the behavior (as with substance abuse), and while I'm doing it I feel a tremendous sense of anxiety relief (as with OCD). Plus, 79% of patients, including myself, report feeling a pleasurable sensation while picking.
My first memories of picking at my skin were in 4th grade, and it was on my face of all places. There was no way to hide it. I can remember staring into the mirror and seeing all these flaws on my face, all sorts of imperfections. Well, we, the K's, cannot tolerate imperfections, especially when we can alter the appearance of the flaw and hopefully remove it altogether. (This thinking stems from my Body Dysmorphic Disorder) So I began to squeeze any little bump I thought I saw on my face. Then I mashed some pores on my nose that seemed dirty. This led to my scratching at a mole on the side of my cheek. And so on and so forth...worse and worse every day. One day I was feeling sick at school and the teacher sent me to the nurse, and she looked at my face and decided I had chicken pox and so I got to go home that day. I was too embarrassed to tell her that I'd created those angry red spots myself. To this day,I find the subject completely humiliating and I hesitate to write about these things here, but when I started this blog, I said I was going to be honest, and so here we go.
How did my parents not notice? Well, they did notice, but I pretended that it was just acne. Puberty came early for me and so it wasn't hard for them to believe the lie. As the years went on, I honed my skills and began using implements, not just my fingernails, to pick. Tweezers were, and still are, my "weapon of choice", but at different times I have used scissors, nail files, needles, safety pins, and nail clippers, plus weird little things here and there, such as a paper clip or a thumb tack. Anything I can use to remove the perceived imperfection, which apparently only I could see. That's the thing which kills me, the fact that no one else can see all those blackheads on my face, or all those pimples, enlarged pores, scars, or ingrown hairs. That was what I saw when I looked in the mirror. I saw something flawed, something ugly. I started wearing my hair in my face, but then in junior high I discovered that I could have just as much fun-yes, FUN-picking at the skin on my arms as I could my face, and no one would be able to see it. That was a real turning point for me, when I moved from my face down to my body. It was easy to wear long-sleeves and keep my skin covered, and since I quit picking at my face, my skin cleared up and I actually had a very nice complexion. It's ironic, that everybody in 4th grade thought I had acne and teased me, but once I was in high school and everybody else had acne, I had smooth skin. (We never teased anyone with acne-one of the K's wants me to tell you that.) I'm not sure if my skin-picking was a precursor for my cutting. I just know that my cutting and my skin-picking coincided beginning in 7th grade and lasting until I was in my 20's. I'd cut and cut, then take great pleasure in picking at the scabs from the cutting. I loved seeing how many times I could make the same wound bleed. We'd go through phases of terrible picking, and then we'd stop for awhile, and let our skin heal. Often we'd just move to a different part of our body to pick while the first area healed; the cutting was random and could occur anywhere on us. Try to imagine how horrible this looked-my body covered in rows of razor blade cuts on my thighs and upper arms, and then surrounding the cuts were open wounds, all shapes and sizes, all over my body from the chest down. The only part of my body that didn't get cut or picked at was my hands, but even they were subject to abuse-I bit my fingernails down to the quick, I tore at my cuticles, and I chewed the skin all around my nails, resulting in horribly ugly hands which I mostly kept in my pockets. It wasn't until my mid-20's that I was able to control chewing on my hands, and my nails finally grew out and I kept them manicured and no one would ever guess that I'd been a nail-biter for so long. That was the same time I gave up my cutting and skin-picking for several years, and I actually had nice skin with no bloody wounds or scabs. I was modeling then, so it was important to keep my compulsions in check, but God it was hard to do. I was only able to maintain this smooth, clear skin for those few years in my mid-20's; I was cutting and picking again by the time I turned 30. And this time, I had a new favorite area to pick at-my lips. Yes, I'd bite and tug at and peel the skin from my lips until they were raw and bloody. To this day, I cannot keep my fingers away from my bottom lip. It's a compulsion which my husband tries to help me control; if he sees me chewing on my lips he'll tell me to stop. He also polices me when I shave my legs or pluck my eyebrows, as he knows how these activities can easily trigger me and lead to my either cutting or picking.
I have these episodes in which I lose time and stop thinking about anything other than the imperfections on my skin. I can go into the bathroom, and won't emerge for hours, literally. Some days, I have shorter picking sessions scattered throughout the day and night, but a lot of times I go into my bathroom, lock the door, and get lost in the mirror. I have lost entire days like this (when I lived alone of course) and I always feel the same way when it's over=baffled. I usually don't remember what I was doing, and I can't believe I was in the bathroom for such a long period of time. I will look down at my body and be shocked to find bleeding, open wounds scattered all over my arms, shoulders, legs, chest, and sometimes even my breasts. God this is embarrassing. But I want you to understand that this compulsion is something that certain people deal with. This is a real disorder.
Approximately 2% of the population has this disorder. It's considered a similar condition to and is often comorbid with Trichotillomania, where persons pull out their hair, and is as difficult to treat. Thank God I don't pull out my hair. Treatment for Dermatillomania include Cognitive Behavioral Therapy and prescriptions for SSRI's. I do take medication which helps me, but I've never sought therapy for my disorder because I'm just too ashamed and embarrassed to admit to my psych doctor that I have this problem. She knows I self-harm, she just doesn't know to what extent. Dermatillomania causes intense feelings of guilt, shame, and embarrassment, and this increases the likelihood of self-injury. Suicide attempts occur in approximately 12% of patients with this condition.
And I have to interject this now--The Kellie is really very angry that we are divulging this information to anyone, let alone The Public. The Kellie has a diva's reputation to uphold. The Kellie is NOT a compulsive picker. She has soft, smooth porcelain skin which she works hard to maintain. She can't look at us when we're covered in sores and scabs; she is disgusted by us. I'm fairly certain that anyone would find us disgusting. I mean, this is a really gross habit. No, not habit, compulsion. I am powerless to stop this behavior. In fact, I usually don't even realize I'm doing the picking. I lose time, a lot of it, and I become absorbed in the activity, and it's as though someone else is driving the car, so to speak, and I don't have true awareness of this...not really. I see the aftermath. I see the bleeding, gaping holes in my flesh, the peeling skin, the nasty scabs, and of course the scars.
Recently, as in two weeks ago, I had to go see a medical doctor because the self-harm had gotten so out of hand that my wounded legs would NOT heal, and I feared I was getting infected. I was totally humiliated to show him the dozen or so large (3 inch x 2 inch) sores on my calves. They were all bloody and scabby and it was obvious I'd been picking at them as early as that very morning. He was very understanding and did not embarrass me. He gave me a steroid cream and said it should clear up my skin in 3 weeks. So far, I've got the same large wounds, only now they're all dry and cracked and peeling. It is my belief that the scars from these particular self-inflicted wounds will be the worst ones I've ever acquired, and will probably result in me never again being able to wear shorts or dresses. Sigh. (Last Summer I wore short dresses and told everyone the sores on my legs were just mosquito bites, but that excuse won't cut it this year)
I don't want to make myself ugly, really I don't. But this is my fate. I've gotten much better about the cutting, and only do it in times of extreme stress, but the picking is harder to control. I can stick my hand in my sleeve and pick at my arm right in front of someone and they'd never know. And I do. Thankfully it's Winter now, so it doesn't seem odd that I'm all covered up. But I worry about Spring and Summer...I have a whole new group of friends now that I've gotten married, and I do NOT want any of them to find out about this. My big fear is being invited to a pool party. I can stop picking long enough to heal for special events (I wore a sleeveless wedding dress) but I can't stop altogether and it's impossible to predict when some skin might be visible. I worry constantly about my secret being exposed. Sometimes, I'm still asked to model, and whether or not I take the job has to do with which areas of my body will be seen. I had to turn down 2 jobs in the past few months because my arms were too scabby. I don't know if this condition will ever be under control. I fear that I'll have to deal with this for the rest of my life. Man, that's a hell of a lot of scars.
This was very difficult to read, and I applaud your courage. My mother suffers from trichotillomania, and it's painful to watch her destroy herself. Her hairline is often red and scarred.
ReplyDelete