Body-Focused Repetitive Behaviors

Therapy was hard yesterday. I suppose I was already having a hard day, but there's something particularly hard about talking about my body-focused repetitive behaviors--skin picking, hair pulling, etc. I'm just so ashamed or embarrassed I guess.

It's weird, because talking about my OCD is also embarrassing. You have to say that you're incredibly anxious about something that doesn't make sense to be anxious about. Or something that doesn't even make sense at all. But there's something worse about BFRBs. I don't know if anyone uses that acronym. I just made it up, I guess.

Last session, I said that I thought my BFRBs were weird and gross. My therapist said I needed to have more compassion for myself and stop being ashamed. He said he could think of at least ten things that people did that were weirder and grosser than my BFRBs. He said that he wished people were more ashamed of some of these things. I suppose he's right. I have exceptionally little compassion for myself, which paradoxically enough exacerbates the behaviors I'm trying to stop.

So, I guess the question is how do I cultivate compassion for myself? My therapist was particularly interested in me reevaluating idea that my BFRBs are weird and gross. He told me he thought I was smart and asked me why I think that if I knew it wasn't serving me. I didn't get an opportunity at the time, but for me thinking things is about whether or not I believe them to be true, not whether or not they serve me. It seems intellectually dishonest to change what I believe to be true based on what will serve me best. I can understand not dwelling on things that I believe to be true if it serves me not to dwell on them, but I can't understand not believing them. The thing is, I do think my BFRBs are weird and gross. I can agree that there are weirder and grosser things that people do, and I suppose that helps me cultivate at least some compassion for myself.

Nibbled Around the Edges

My therapist yesterday said that OCD nibbles you around the edges when it can't sink its teeth into you. This is how I feel a lot of the time. Nibbled around the edges. It sounds better than having OCD sink its teeth into you, but I feel worn out, anxious, and sad. These too are triggers for more nibbles.

I find myself wanting to talk about my problems to people, but these days my problems aren't real. They're all fake, trivial, or unsolvable problems and I know this. I feel like to talk about what I'm having trouble with I have to say I have OCD. Then I have to explain what OCD is--no it's not just about washing your hands. It can be anything, everything, and it can happen all in your head. Obviously, it's easier just not to tell people, especially people at work. It probably isn't a good idea to tell people at work that I'm crazy anyway.

Last weekend I met up with let's just say an old friend. I told him I had OCD and he talked to me about his bipolar. I felt like we were so different, yet somehow kindred spirits. He told me about how he couldn't paint when he was on meds, so he went off of them. But his partner liked him better when he was on them. It sounded like a hard situation. He asked what my obsessions were about and I gave him a few examples. The funny bit was that I mentioned I had sexual obsessions sometimes, but didn't really explain. A few hours later, I realized that he probably imagined something much more embarrassing for me than what I actually experienced. Sexual obsession makes you think sex addict, not feeling continuously terrified that you've somehow magically stopped ever being attracted to men.

Speaking of meds, I talked to my therapist about skin picking. He told me meds could help with that. I have yet to investigate that claim. What if meds do help with it? Should I reconsider my stance on meds? I really want to stop skin picking--it's leading to scarring and it's a waste of time. Well, I suppose I'll investigate.

I have the urge to skin pick right now. It's such a shameful habit. It's gross and painful, yet I find I can't stop myself. I feel out of control. I mean, I suppose it's better to not be able to control skin picking than it is to be unable to control murderous rages.

I'm in a pseudo-open relationship. Kind of. Not really. It's been years since I've slept with anyone other than my boyfriend. I sometimes wonder if my skin picking stops me. I certainly don't think it's the only reason I don't want to sleep around. But it seems like a major mood killer to have to explain to someone you're trying to have a one-night stand with that you pick yourself in private areas until you bleed. No, no, no. It's not like cutting. You don't do it "feel" something or to inflict harm on yourself. You don't want to do it, you just can't stop yourself. These days I even have trouble getting naked in locker rooms. I'm not sure what's worse--someone thinking I have a weird skin condition or thinking that I'm a skin picker. Better to keep covered.

The conversation about skin picking with my therapist was surprisingly insightful, despite it's brevity. It's considered an OCD-spectrum disorder meaning that it often goes along with OCD and maybe has the same underlying structural causes in the brain. Basically, we really have no fucking clue but we'll pretend that skin picking and OCD are manifestations of the same thing, whatever that thing is.

The difference between OCD and skin picking is that OCD is a much shorter loop. OCD kind of goes trigger -> obsession -> compulsion -> obsession -> compulsion and so on. So, stopping the compulsion prevents that loop from continuing. Eventually the obsession fades if you just sit with it. Skin picking is more complicated and I guess everyone with it has to kind of figure out what the loop is for them and address it at each stage. It's obviously not as simple as preventing a compulsion.

So, I guess here's what a loop might look like for me: (Warning: this is gross)
Hair somewhere I don't want it -> pluck it ->wanting to pluck other hairs -> ingrown hairs -> irritating texture -> desire to remove ingrown hairs -> squeezing and/or skin picking to remove ingrown hairs -> scabs -> irritating texture -> removing scabs/bleeding -> more scabs -> curiosity about whether there are hairs under the scabs -> more skin picking and hair pulling.

I feel a little better with the insight that skin picking is more complicated than OCD. I mean, to stop it I have a number of links in the chain to address, and not just one. God knows that it's hard enough to not be OCD and all you have to do to stop OCD is not do your compulsions.

Rabies ... Again

If you met me, you wouldn't expect me to be the type of person with contamination fears. I'm not particularly neat, I'm not squeamish at all about things like eating raw eggs, and public restrooms really don't bother me.

I do have one contamination fear, though, and it's a weird one: Rabies. It's frustrating because I really love animals, but this obsession makes me 1) avoid touching animals I don't know or 2) feel very uncomfortable when I force myself to.

I distinctly remember not being afraid of rabies two years ago, but something happened. I can't really remember a specific event, but all of a sudden it became something I got concerned about whenever coming into contact with animals. At the height of my rabies phobia, I was looking daily for a cat that had scratched me to make sure it hadn't come down with rabies. I know, that's a weird compulsion.

Today, it resurfaced a bit. I was running with my neighbor's dog and a little dog charged out and started attacking my neighbor's dog. A fat woman came out and called her little dog back over. I don't know if any biting took place--it all happened so fast.

But now I am practicing avoidance and  having a hard time convincing myself not to. My neighbor's dog may be rubbing rabies all over my couch right now, she might give it my cat, and she's even touching my elbow. I know I really should just rub my hands all over the dog and not worry about it, but I skin-picked by pinky and it's a little bit raw and I don't want to get rabies on that finger. 

Okay! I'm going to be good. Exposure time!

Skin Picking and Other Bad Habits

I used to think of my skin picking, lip chewing, and hair plucking habits as weird disgusting things that I did. I knew that they were nearly impossible for me to stop doing for any length of time, but I didn't really see them as connected to other parts of my personality.

Well, I'm reading The Woman Who Thought Too Much, an OCD memoir by Joanne Limburg. I find it eerie how similar the author and I are in some ways. (Of course, we're totally different in other ways.) One thing that we both do is skin pick. This is apparently common among a lot of OCDers. Skin picking, hair pulling, etc. are considered to be on the OCD "spectrum."

As an aside, I actually have a lot of trouble with the word "spectrum." The idea behind using the word "spectrum" is to group together conditions that have the same underlying cause, but have different manifestations. The problem is we don't actually understand the underlying cause of any mental illness (read Unhinged or The Anatomy of an Epidemic). We have ideas and suppositions, but nothing definitive. Using the word "spectrum" allows us to talk precisely about things we aren't really equipped to talk precisely about at all.

That said, it does seem like OCD and skin picking do have some real relationship to each other, at least in that people who have one often have the other.

It's a little bit strange for me to realize how predictable I am. It's really no surprise given that I have OCD that I also have skin picking issues. I hindsight, my skin picking, which started at a young age (it has taken on various forms over the years), might have been an early indication that I would develop OCD in the future.

For some reason, my predictability makes me feel somewhat powerless. Like if OCD and skin picking are caused by some set of structural defects in my brain, these aren't easily changeable things. They're probably things I'll struggle with for the rest of my life.

However, I'm trying to be optimistic. Just because something has a structural root doesn't means that the symptoms are unchangeable. People with OCD go into remission all the time, and there's no reason that I shouldn't expect the same, particularly given my current level of effort.