Attempting to Heal: Day 1

I'm a self-harmer, but I go through phases where I stop and let my wounds heal.  These periods have, in the past, lasted from a few days to a few years.  I'm ashamed to say I haven't had clear, uninjured skin in a year now. So I've decided to take action, before it's summer and I want to wear something that reveals skin.  I am just starting on a healing program for my Dermatillomania (or CSP- Compulsive Skin Picking). (See blog post Evolution of my Self-Mutilation: Part II to learn more about this condition) My calves are currently covered in angry, deep, red wounds. Bloody and scabby and rather large-about 3 inches long and 2 inches wide.  It all started as a small, pink rash. But I started scratching.  Soon I had scratched all the skin off, and before long I had bloody holes in my legs, all over. I mean a dozen or so wounds, maybe more.  I'm not sure how long it's taken me to get to this point; I remember that my legs looked bad back in February. I got brave at my last therapy session and showed my doctor my legs. I decided at the last minute to do that; some part of me, inside, decided it was time to break my silence.  So I showed Dr. H my shins.  She said, "Oh my goodness!" and then suggested a few products for me to try.  I got a prescription for a steroid cream, and I'm using Neosporin antibacterial cream and hydrocortisone.  I put the Neosporin on first, then the steroid, then I cover the whole leg with hydrocortisone to prevent itching. Some of the more serious wounds need bandaging.  I'm also using these 3 creams on my arms, as they're affected by my CSP as well.  So today is Day #1...sortof.  I've been using the medicines I got for several days now, but today is the first day I haven't picked or scratched or ripped off a scab.  Of course, the day isn't over yet.  But I'm really determined to get my skin cleared up and smooth and healed and scab-free by the time sleeveless weather gets here.  I don't know what I'll do if I'm unable to wear shorts or a dress this Summer.  This healing plan MUST work.  Now I've done it before, many times, but as I said earlier, the latest bout of skin picking has been constant and severe for the past year.  It's directly related to stress; when things get serious or difficult, I have to turn to something I can control. So I self-inflict wounds to my body.  Yes, I'm a cutter, but even more so now am I a picker.  It takes a lot of stress and negativity to get me to actually cut now with a razor.  But the skin-picking, well that's something I just cannot control.  I lose time whenever I go into the bathroom, and I'll often emerge hours later, covered in bleeding sores.  Everytime I enter a bathroom, there's a risk I will self-harm.  If I have no access to any implements,  that is, razor blades or scissors or tweezers, then I'll use whatever I can find. An earring post.  A nail from out of the wall.  A bobby pin. Safety pins are a favorite; when I was younger I took great pleasure in sticking safety pins through parts of my body-ears, lips, hands.  Sometimes I'd get a needle, thread it, and sew words into my arms.  There's just no telling what I'm liable to do to my skin.  My Body Dysmorphic Disorder makes it impossible for me to see myself in the mirror the way other people see me, so while I've always been told that I'm very attractive, I just can't see it. I'm obsessed with my skin, particularly on my face, but all over really.  I can find any flaw, no matter how tiny, and within a few moments, I can have it large and red and angry and bleeding.  But for some reason, in my mind, when I pick at something imperfect on my skin, then I'm helping make it go away.  Logically, I know that by picking it I'm making it look worse.  But I just can't think that way. I just think "Must remove flaws" and I'll do whatever it takes to dig out a perceived blemish. 

Dermatillomania is a condition which causes tremendous shame, and it's difficult to write about the subject.  However, I really, really am going to try and make an honest attempt at getting my life back on track and healing all my body wounds.  Plus. I've been asked to model again and I can't possibly do it unless I get my face cleared up at the very least.  So I'm doing it.  I'm going to layer the three creams onto my scabby sores throughout the day and night, every chance I think about it.  Dr. H told me that if I keep the area moist, I'll be less likely to pick. So I'm going to try it.  Giving me even more incentive to quit mutilating my skin is my desire to shave my legs.  I'm unable to shave or wax while I have these large open wounds on my legs.  It's just too risky. So I have to admit that my legs are awfully hairy at the moment, at least where the wounds are located.  I can't wait to clear up all these sores, for all my scabs to fall off (on their own, not by me pulling them off), and for new skin to start coming in and renewing my complexion.  Yes, there will be scars, some of these will be my worst ones ever...but many of the scars will fade (I have a scar-fading program I follow too) and by the time I'm invited to a pool party, I should be mostly "normal", or at least I can appear that way through the use of waterproof body makeup on the most prominent scars.  Other scars should fade to something pink and/or shiny by July.  Yes, my body is covered in scars. All over my body. In unexpected places.  But I can't help that-I've been a compulsive skin picker since 4th grade.  Dermatillomania is an impulse-control disorder which is also akin to substance abuse. It's been a lifelong struggle for me.  Hopefully, today is the beginning of a new upswing in my daily life.  I'm hoping to replace my habits of picking with habits of treating the wounds and bandaging them.  I'm determined to wear a short dress this Summer. Day 1 has been a success. Let's see how Day 2 goes...

The Evolution of My Self-Mutilation, Part II

(This is going to be a very difficult post to write; I've never confessed these things to anyone. I'm completely humiliated and ashamed and embarrassed to death to admit these things out loud, but I feel it's important to speak out. Perhaps I can help someone else.)

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.

Don't Look At Me!

K was diagnosed with Body Dysmorphic Disorder about 10 years ago, but she's had it much longer than that, I'd guess since she was a pre-teen.  Body Dysmorphic Disorder is a mental illness characterized by distorted body image and obsessions about perceived physical shortcomings.  A person with BDD is extremely concerned with their appearance, and this manifests as a preoccupation with a perceived defect of their physical features.  Simply put, K's obsessed with how she looks, because of her (self-declared) flaws.  This causes psychological distress that impairs occupational and/or social functioning.  The person complains of a defect in either one or several features of their body, or vaguely complains about their general appearance. (K complains both generally AND specifically.)   The disorder is generally diagnosed in persons who are overly critical of their mirror image, physique or self-image, even though there may be no noticeable disfigurement or defect.  In other words,  K sees an ugly (read=imperfect) reflection upon looking in a mirror, even though no one else sees anything wrong with her appearance.

BDD is often misunderstood as a vanity-driven obsession, whereas it is quite the opposite; people with BDD do not believe themselves to be better looking than others, but instead feel that their recognized "defect" is unforgivably ugly or not good enough. People with BDD may compulsively look at themselves, or do the opposite-cover up and/or avoid mirrors. They typically think about their appearance for at least one hour a day  (usually more) and, in severe cases, may drop all social contact and responsibilities as they become a recluse.  K positively must look at herself in any mirror she comes across, and spends hours making herself "presentable" before she will leave her house.  We haven't dropped social contact altogether, but do go through periods in which I'll avoid people for days or weeks at a time.

Common symptoms of BDD include:

• Obsessive thoughts about a sensed defect(s)
• Delusional thoughts and beliefs related to sensed appearance defect(s)
• Chronic low self-esteem
• Seeing slightly varying image of self upon each instance of observing a mirror or reflective surface
• Major depressive disorder symptoms
• Suicidal ideation 
• Strong feelings of shame
• Social withdrawal, isolation or social phobia
• Perfectionism 
• Alcohol & drug abuse
• Feeling self-conscious in social situations; thinking that others notice/mock their perceived defect(s)
• Repetitive behavior (such as constantly applying makeup or checking reflection in mirror)
• Compulsive/repetitive body modification (such as multiple plastic surgeries)

I exhibit all of these symptoms.  I must point out that K has never had plastic surgery however.  Instead, my body modification rituals include tattoos, multiple body piercings, cutting, and branding.  One therapist told me that my tattoos and piercings were another form of self-injury, and that my methods had evolved from cutting with razor blades to piercing with needles.  I guess I could believe either explanation.  I am trying to permanently alter my appearance to distract from our flaws (BDD), but K very much enjoys the pain and gets pierced to help her deal with reality or emotional distress (SH).

A person with BDD may exhibit obsessive and compulsive behaviors related to perceived appearance defect(s). (K does all of these things.) Some of these include:

• Compulsive mirror checking OR avoidance of mirrors-- I can't walk past a window or a reflective surface without looking at myself;  I'm not vain, I'm checking my flaws.  On the opposite end of the spectrum, there is a K who hates to see herself in a mirror and tries to avoid it (she also doesn't like to get her picture taken)
• Attempts to camouflage perceived defect (such as wearing lots of makeup, hats, or baggy clothing)--A couple of the K's wear little to no makeup, but most of us use a good deal of concealer and liquid foundation, and a bright red lipstick to draw the eye away from our flaws. (The Kellie loves to be dramatic and wears heavy eye makeup as well.)  All of the K's wear hats (K collects hats) and most of us wear baggy clothing to hide our body.  However, The Kellie will wear fitted clothing, and she loves to wear corsets. Note that corsets also alter the appearance of the body.
• Use of distraction techniques (such as wearing extravagant clothing or excessive jewelry)--Each of the K's has a different style, but almost all of them stand out in a crowd and are over the top with accessories-hats and scarves and tons of jewelry.
• Excessive grooming behaviors (hair-combing, eyebrow plucking, skin picking)-- Throughout the day, most everyday, K smooths or touches her hair, plucks her eyebrows and also picks at her skin. I'm not sure if this counts, but she also paints and repaints her nails and toenails.
• Seeking reassurance from loved ones-- I seek constant reassurance from my husband, friends, and family about how I look.  "Do I look OK?" comes out of K's mouth dozens of times a day.
• Comparing appearance to that of others--Not only do I compare myself to every female over the age of 16, but I almost always feel that every other girl I see is more attractive than I am.
• Compulsive skin touching (to feel the perceived defect)--I catch myself constantly touching the areas of our face and body which I feel are unacceptable; I don't know why...maybe to see if the flaw is still there or has grown larger?
• Self harm--My first memory of self-harm is from 4th grade, and it's gotten worse over the years.  I intend to do a blog post soon about my experiences with self-injury.
• Obsession with plastic surgery--As I said earlier,  I've never had plastic surgery,  but I do constantly think about which procedures I'd  have done if I could afford it. (breasts reduced and lifted, tummy tuck, forehead lift, butt lift, facelift, all-over liposuction...) In extreme cases, patients have attempted to perform plastic surgery on themselves, including liposuction and various implants with disastrous results.  I have to admit that I have done some minor work with a scalpel, but certainly nothing drastic. 

The three most common areas of which those suffering from BDD are critical are the hair, the skin, and the nose.  For K, the obsession focuses on her skin, especially that of her face, and she's particularly critical of her chin/jawline/profile.  She's been obsessed with her teeth for as long as she's been seeing a dentist.  She's also obsessed with her overall body, mainly the legs;  to a lesser degree she obsesses about her nose and hair.

In most cases, BDD is under-diagnosed.  It is often associated with shame and secrecy; therefore, patients often fail to reveal their concerns about their appearance for fear of seeming vain or superficial.  BDD is also often misdiagnosed because its symptoms can mimic that of major depressive disorder or social phobia.  K, like most people diagnosed with Body Dysmorphic Disorder, is shy, introverted, and neurotic. Certain personality traits make people more susceptible to BDD.  Others include perfectionism, sensitivity to rejection or criticism, unassertiveness, and social phobia.  K is bothered by all of these things.  Treatment for Body Dysmorphic Disorder includes both cognitive behavior therapy and medication, namely SSRI's.  K is currently being treated with both of these.  Writing about it now, and seeing everything in black and white, the diagnosis seems so simple and easy-to-see.  If only it had really been that easy for our doctors! Perhaps then K would be living a different life now, with more confidence and fewer mirror checks.
        

My Newest Obsession

I've mentioned before that K has an obsessive personality and tends to go overboard when she gets an idea in her head.  Well, the idea currently inhabiting her brain space is the possibility-nay, likelihood of her being diagnosed with a dissociative disorder.  Based on the clues which I seem to be leaving myself-notebooks, lists, folders on my laptop filled with helpful websites, and the all-important diaries-I was first labeled MPD/DID back in 2004.  I'm looking at the calendar and seeing that it is now 2012, which can only mean one thing: I've been in denial for about 8 years, or so it would seem. My theory is that the paranoia took over and I refused to accept the diagnosis, for I certainly didn't want to be THAT crazy...  I've been under a doctor's care-regularly, without a break-since 2002.  So that must mean that it took my therapist and psychiatrist roughly 2 years to figure out what was going on with me.  Apparently I've been misdiagnosed over and over again, for all these years, ever since I saw my first psychiatrist at age 16.  Every doctor I see takes notes and makes a diagnosis based upon the "me" that is sitting in the doctor's office.  I can't say for sure how many of the K's went to therapy, with that wonderful therapist whom we loved so much, (who later dumped me after 7 years together) but I have recalled a memory or two in regards to that period of time and my current state of mind. I thought I'd share these memories with you (plus, it'll help me remember again in the future)

I remember one time going in to see the therapist (this was about 5 years ago) and she asked me to do a homework assignment;  I was to draw a picture of the way I viewed myself.  I think the assignment was supposed to help me with my Body Dysmorphic Disorder and self-esteem issues.  Well, she was blown away the next week when I showed up with a whole handful of pictures of different K's, each with her own fashion sense and musical tastes and hobbies.  I didn't get what the big deal was; I just did the exercise as it was assigned to me.  Now I'd give anything to get hold of those drawings again.  I can see some of them in my mind, but it's all fuzzy, like it was a dream.  I think perhaps I'll do this exercise again and see what happens next time.  I wonder how many drawings there will be...?

Another interesting memory is really several similar memories, all taking place at different points in time.  I remember my therapist asking me what my name was.  I remember that well.... in fact she asked me for my name on half a dozen or so occasions that I can recall.  I never knew what to say.  I never knew the answer to the question.  Although the question stirred something within me, I couldn't put my finger on the point of it all.  So I forgot about it, until recently.  Now it's true that I've probably developed an unhealthy obsession with Google and Twitter and the web in general.  In fact, I'm so focused on doing "research" on the subject of DID that it pisses me off I have to stop for eating and sleeping.  There's no time for such trivial matters!  I'm working on a deadline here! I don't know how much longer I can stick around and take care of things.  All I can remember clearly about my being here, in this "lifetime" is that I once had my own office and kept lots of photos, to remind me of my life-literally-and when everything fell apart, (as it always inevitably does) I ran away to a different state and became a different ME.  And that's how I usually handled working a job-stay and do well until the pressure builds and we snap and disappear, go away.  But I've totally gotten off the track of our subject!  Damn!  I HATE when that happens, when I "lose my place" and have to reread everything I've written and try and figure out where I  left off.  Sigh.

I can't remember what the point of all this was, I just wanted to share with you my theory about K.  I think she's got DID, and I think she's been in denial for years because it's too frightening a diagnosis for her to bear.  Also, I've been researching and have found that DID is the same as MPD, so those 2 diagnoses, made by different doctors at different times in my life, were actually the same thing and thus gives us more reason to believe that K does in fact has this disorder.  I just wish I had read all those diaries and journals I've been keeping all my life.  So much time has been wasted at this point already...