I need to be brutally honest with you. At one point in my life, I thought this was a story I’d never share. I thought it was too embarrassing to let anyone know what I was doing to myself.
Anxiety by itself is viewed as a sign of weakness by so many people, and especially by men. Growing up, I learned that it wasn’t acceptable for boys to share how nervous or worried they were. This was driven home even more when I started to seriously play soccer and basketball as a teenager.
So, to admit when I was in high school or my twenties that I not only struggled with anxiety, but that I picked at my skin for hours on end, seemed like admitting to an entire stadium of people that I was a loser and outcast. It just didn’t make any sense why I would do it, and I certainly didn’t want anyone to find out.
I didn’t know why anyone would ever care to understand what I was going through.
But the more I struggled with mental health through my high school and college years and well into my twenties–the more I realized just how common anxiety actually is.
In fact, I’ve learned that 1 in 5 individuals in the United States lives with an anxiety disorder every year. It’s the most common mental illness in the country. Data is harder to find at the international level, but just know this–anxiety is unbelievably common around the world.
I also know now that anxiety disorders are highly treatable, but only about 37% get treatment.
When I was in grad school for social work in 2016 and 2017, I remember learning that anxiety is the disorder for which people wait the longest to get treatment, some studies reporting it can take up to 16 years on average.
A recent study I looked at said that the median time of waiting can range from 3 to 30 years! Three decades! This is something we have to talk about. No one should have to suffer for so long when treatment is readily available.
And I also learned that skin picking, which is what I’ve dealt with–and continue to deal with occasionally, actually falls within a collective group of disorders that is studied and treated. They’re called body-focused repetitive behaviors, or BFRPs.
BFRPs have not been studied as much as the more discussed mental illnesses, like depression or bipolar disorder, but they actually are more common in the population than you might think.
A 2020 study found that 2% of the US population currently lives with a diagnosable body-focused repetitive behavior, and 3% of the population has had one currently or in the past. Women are slightly more likely to be diagnosed with skin-picking than men. But this might be because men don’t often speak about this thing, and I only ever came across a guy who also dealt with it when I posted several times on Twitter.
Now, the data collected about body-repetitive disorders is harder to come by. Maybe it’s because these disorders are made up of a range of behaviors, from hair-pulling to nail picking, to cheek biting and lip biting.
But, for me, the one that happened to latch on to me and take control of my life is skin picking, formally known by the mental health diagnosis of excoriation disorder.
This is a mental health story about anxiety, but it’s about my anxiety in particular–and how it manifested in years and years of picking at the skin all over my body.
It’s also a story about how I learned to manage my anxiety–and about how anyone dealing with anxiety can learn to pinpoint the roots of anxiety, stop anxiety before it starts, and develop the skills and mindset to manage anxiety over the long-term.
But first, let’s talk about how my skin picking started.
It sounds like an almost innocent term, something you might read about it in a psychology textbook in high school and then never think about again. But that wasn’t the case for me. Skin picking started when I was heading into high school, and it stole many, many hours from me throughout my twenties.
I know that I was always an anxious kid, but my obsessions and racing thoughts stayed in my head. I never expected to become obsessed with finding real or imagined flaws on my body.
This is what it looked like for me.
It started with me picking at my back in high school. I didn’t know why I was doing it then. It was a mindless way to relieve something I couldn’t explain. I would sit in a private location, like the bathroom or on my bed, and pick at my back. Any bump that felt out of place became my target.
The fact that I’ve always had back acne makes it seem like an easy explanation for why I started. But I don’t think the analysis is as simple as that. The acne was the symptom not the cause. The focus was seeming imperfection and a hope for relief. And so I would pick. And squeeze. And dig. Until my skin bled or my mind snapped back to reality from someone calling my name or the diversion of a more pressing concern.
I knew my behavior wasn’t productive. I knew it wasn’t helping me. But I didn’t yet understand that I shouldn’t have been blaming myself. No one blames themselves for physical issues like a blood disease or a skin condition, so it doesn’t make any sense to blame yourself for issues that just so happen to start in your brain.
There were a couple of things that got me out of my moments of extreme anxiety. To start, I needed to get the right diagnosis.
As you’ll learn in story 7 of this series, I struggled for years with anxiety and OCD symptoms, but no medical provider ever gave me a diagnosis of Obsessive Compulsive Disorder until I was at my absolute breaking point in 2015.
Getting a psychiatrist to actually listen to me and to tell me that I had strong obsessive-complusive symptoms was huge for me. It helped to bring to light the fact that my mind could become derailed by an intrusive thought and that this was something that could be explained and treated by science.
It also finally explained my picking behavior and the checking of my skin that I would do at the mirror and by feeling for bumps on my skin.
But while that explained what was going on for me, it didn’t prevent the anxiety attacks on their own. For that, I had to come up with strategies that would work for me, in my particular situation.
To do that, I developed strategy number one. I started to take notes on where I was getting most anxious. I called them my anxiety locations. Anxiety locations, for me, are any place, or specific sets of circumstances, that cause you to get caught up in an unpleasant anxious behavior.
I realized that most of my behavior was happening in a particular behavior. And that’s not all. I also noticed that the skin picking and obsessing over my face almost always happened at the end of the day when my willpower was depleted.
This willpower-depletion phenomenon has been studied and well-documented, and I always find it harder to avoid the temptation to pick after a long stressful day. It’s helpful and reassuring to know that what has happened to me can be tied back to a scientific reality that others experience as well.
Knowing that I couldn’t always prevent long, stressful days, I figured I had to do something else to break the habit of picking at my skin in front of the bathroom mirror. This is when my reading and my learning all come together to form strategy number two.
What I did sounds almost too simple to work. But it did for me. It actually worked.
On days when I’m feeling extra anxious, I would simply not turn on the bathroom light and let the light from outside the bathroom flood the space. I also associated going into the bathroom with taking off my glasses. This simple action had several benefits. It helped me replace picking behavior with washing my face and then putting on toner or lotion afterwards.
Over time, the bathroom wasn’t a place to automatically pick at my skin. It became what it should have been–a location to primarily take care of healthy skincare and healthcare routines.
More importantly, embracing my anxiety locations in a new and healthier way finally helped me focus on my final takeaway for overcoming my anxiety–acceptance. Crafting the art of acceptance was strategy number three for me. Acceptance is the only way I’ve ever found to live with my anxiety.
I know anxiety will always be present in my life, but I don’t need to fight it. I just need to understand it, embrace it, and move through it. At the root of my anxiety was a deep shame, a deep-seated worry that I’m not good enough. The physical manifestation of this irrational belief was picking at my skin.
These days, I don’t pick as much. And I like myself a lot more.
And you know what? Sharing this story helps. It’s connected me with others who struggle with the same exact thing.
It’s reminded me that I’m not alone in my shame, I’m not alone in my anxiety, and I’m not alone in this world.
And I know that, if you are also struggling with anxiety, you can absolutely get to the same place of acceptance and understanding that I have.
Make note of your anxiety locations. Replace your bad habits with good ones. And most of all, aim to understand what’s happening to you rather than judging it. It will help you find that acceptance that you rightfully deserve.