Skin deep

A number of conditions are considered to be related to OCD and to fall on the obsessive-compulsive spectrum; some share the obsessive element of the disorder, others the compulsive. Amongst the latter is Compulsive Skin Picking (CSP) - also known as dermatillomania - and about a quarter of people diagnosed with OCD suffer from CSP as well.

The driving urge behind CSP is the need to relieve anxiety, which is achieved by the sufferer removing what they perceive to be imperfections from the skin. These may be real - such as blackheads, scabs or dry patches - exaggerated, or imagined. Sufferers may pick consciously or unconsciously, and will use either their fingernails or tools, such as tweezers or pins. 

Whatever the picking method, this activity invariably leads to an injury, scabbing or scarring that is far more unsightly than the original 'flaw'. The immediate relief that picking generates is, therefore, quickly replaced by distress at the consequences...which is relieved by yet more picking.

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Sufferers may go to great lengths to conceal the damage to their skin, with make-up or clothing, and this damage can adversely affect their self-esteem, and even lead to them becoming socially isolated.

Recently, I was engaged in a Twitter exchange with a fellow blogger, who writes about her experience of CSP, as well as OCD and other conditions, on her site roseversusblackdog.

I confessed to chewing the skin around my nails and she told that me this has a name, too: dermatophagia. She directed me to a website, which lists a whole raft of 'Body-Focussed Repetitive Behaviours' (BFRBs): 'An umbrella term for any chronic behaviour that causes a person to consistently cause physical damage to oneself unintentionally through a compulsive act in order to relieve anxiety.'*

I certainly recognised my own behaviour under the dermatophagia ('skin-biting disorder') heading, including biting my lip - to the point that I have caused a lump which will require minor surgery to remove! It seems, also, that my habit of picking at healing or calloused skin is bracketed under CSP.

Although I'm not aware of being anxious at the point of picking, I do know that I don't seem to be able to stop myself. No sooner do I realise that my fingers are, for once, blemish-free, than I find myself attacking them again; hunting down the tiniest bits of protruding or dry skin for the attention of my teeth or fingernails. If I'm not re-opening healing wounds, I'm creating new ones,

I know at least three people who do the same, so perhaps a mild form of this condition is relatively common. One told me that he is 'just tidying up', which is an objective I can relate to. Tidying up so often results in my making a mess, though. 

Finding out that these behaviours have a name seemed, initially, to give them more weight, but, fortunately, they don't pose a significant problem for me. Like all conditions, they manifest in more or less severe ways and, in me, very much at the lower end of the spectrum.

There is hope for those who suffer more severely, in that Cognitive Behavioural Therapy, which is used to treat OCD, can also successfully address CSP and similar conditions, sometimes in conjunction with the use of medication. 

The help is certainly out there, if you realise that this is a problem for you.

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*Skin Picking Support - this website includes information about many related conditions (BFRBs). You can also find out about skin picking on OCD Action's website.

What's up, doc?

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Health anxiety is a category of worry that only occasionally grips me, but it can make persistent sufferers' lives a misery. They live in constant fear of developing some awful, usually life-threatening, condition; a fear that may be provoked by the most innocuous of symptoms, or even ordinary bodily functions.

My latest experience of this was triggered - perhaps understandably - by my recent operation. 

Beforehand, I studied the literature the hospital had supplied about the procedure, so that I'd know what to expect, and what side effects and complications to look out for. A wise precaution, except that I'm inclined to latch on to worst case scenarios. 

'Perhaps two in every hundred women having the procedure develop an infection', I read. Over the following weeks, I conveniently forgot about the 98% who don't, and began to see this remote possibility as a strong likelihood. As this was a potential consequence of the treatment, ie tissue death, rather than purely a hygiene issue, there was little I could do about it.

What I could do, though, was buy a thermometer and take my temperature morning and night, to monitor for the first sign of trouble; exerting a tiny bit of control enabled me to tolerate the uncertainty.

However, that in itself then created a problem. I seemed to be 'running cold', with my temperature hovering around the 36.5ºC mark, instead of the more usual 37ºC. Was the thermometer inaccurate? If not, and this were my norm, would 37ºC actually represent a worrying rise? The radiologist had assured me that I'd know if I had an infection, as I would feel so unwell, but I chose to disregard that information and fixated, instead, on my temperature.

During my two weeks' convalescence, I also viewed every unfamiliar sensation as a possible indication that something had gone wrong with the procedure itself. Why did my legs and hips feel so weak? What was that intermittent twinge in my left groin? And what the heck had happened to my digestive system? Everything was a cause for worry, speculation and ridiculous misinterpretation: for a short period, I even feared that the blood supply to my legs had somehow been adversely affected.

Fortunately, time reduces the potency of any anxiety. A month or so on, my fear of infection had reduced to the point that I cut my temperature taking down to once a day. A few weeks later, I realised I'd forgotten to do it for several days and abandoned it altogether. 

At my follow-up appointment, shortly afterwards, the consultant told me that any risk of infection had long since past, in spite of my internet research indicating a need to be vigilant for up to nine months - beware internet research, especially if you're a worrier.

Most of us live in a state of denial as to our mortality. Health anxiety is just the other end of the spectrum, ie an all too great an awareness of it. Somewhere on that spectrum there is a middle ground to be had: between facing the realities of illness and death, and not letting those realities ruin your life.

Lesson learnt

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Some of my posts end with a lesson learnt from my latest run-in with OCD or anxiety. Often, though, even as I type the words, I wonder whether I'll actually be able to put the lesson into practice.

It's all too easy to profess to learn from an experience, only to go on to make the same mistake; sometimes over and over again. We see it on a wider scale all the time: from child abuse deaths to gun massacres, we just keep letting them happen.

My post Home Invasion! Part Deux dealt with the trauma of having a new boiler installed; the stress of strangers being in my home and the ensuing mess.

The piece concluded with the realisation that repeatedly visualising a challenging event only makes the experience worse, in that you live through it dozens of times (albeit in your mind). It was better, I decided, just to endure the horror once, for real.

So, when the gods of domestic chaos struck again, I resolved to do things differently this time.

My washing machine had begun making a funny noise during the spin cycle, prompting me to book an engineer before it failed completely. Three visits - and a sorry tale of incompetence later - they decided that it would have to be replaced, under the terms of my cover agreement.

Although I had already survived a succession of engineers invading my flat, now they would actually have to carry machines in and out, which was a much more daunting prospect.

In order to clear a path for them, I would have to move rugs and furnishings in two rooms, as well as the hallway I share with my next-door neighbours. I would also have to empty the cupboard under the sink - for the fourth time in as many weeks - to allow them access to the necessary plumbing. 

All of the disturbance to my environment would be bad enough, but what about the mess? There was, at the very least, the risk of scraped paint and spillages of water or, worse, gunk.

In fact, I didn't dwell on any of that: instead, I just spent a few minutes considering the practical implications, ie what I had to move. Then, every time I found my thoughts straying to the impending delivery, all I allowed myself was the simple acknowledgement 'Yes, I am having a washing machine delivered on Tuesday.'

As the day drew near, the event certainly loomed larger, but I didn't lose sleep, my appetite or any weight; all of which happened with the boiler installation. Arguably, this delivery was a less disruptive event, but, in my OCD world, any intrusion of this kind is a big deal.

Yes, I spent an hour and a half putting things straight afterwards - reclaiming my territory, rather than clearing up any substantial mess. Yes, I cringed when one of the delivery men planted his dirty glove on an internal wall (previously 'hint of white', now 'hint of grimy handprint'). And, yes, my heart sank when I found a chip in the newly painted wall of the shared hallway. 

Nevertheless, I think I'm allowed to claim the experience as a lesson learnt in how to manage my anxiety.

And, relax...

To tie in with the World Cup, the organisation I work for launched Healthy Workplace Month in June, with both mindfulness and relaxation sessions amongst the activities on offer. As I've been looking into mindfulness courses, it was a great opportunity to try out this meditation practice, which originated in Buddhism, but is now also used in a secular context. 

Core to the practice is 'being in the present moment' and it has proved successful in reducing anxiety and stress, and in helping to address aspects of OCD, such as intrusive thoughts, as part of a wider treatment programme.

Unfortunately, 'being late' is the cultural norm in my workplace, which the facilitator clearly wasn't prepared for. By the time everybody had ambled in - the last one 10 minutes after the scheduled start - she looked more stressed than any of us. I suspect, however, that she wasn't the only one taken aback by the woman who unpacked a sandwich and a bag of crisps (quickly abandoned when she realised what the session entailed).

After this somewhat disrupted start, the experience proved to be involving and interesting. We engaged in various exercises, including: clapping our hands and focussing on the resulting sensations; tracking our breathing; and 'eating the raisin'. For this last one, the facilitator showed us, through directed tasks, how to use all of our senses to really study an object.

I found it hard to focus on anything for long, without other thoughts intruding. We were encouraged to be non-judgmental about this 'failing' - easier said than done - and to gently guide our focus back.

The following week, I also joined in the relaxation session, which centred on breathing exercises. 

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Again, people arrived late, one asking 'Is this the relaxation session?'; I'm not sure what else we'd have been doing, sitting in a circle with our eyes shut. Again, someone wanted to eat - this time for medical reasons, but I still found it an odd expectation, given the nature of the event. She was encouraged to come back when she'd finished. 

This time the facilitator was a fellow employee, so knew what to expect of the participants and the environment. From the outset, she warned us that there would be noise and distractions and told us just to try to bring our attention back to ourselves. 

I found this immensely difficult, as a herd of tyrannosaurus rex appeared to be stampeding through the corridor outside - high heels have a lot to answer for - the person next to me was breathing as if they'd run a marathon and someone kept coughing. As before, it seemed that I could focus for no more than a few seconds at a time.

She told us to extend 'loving kindness' to ourselves and then to the others in the room. I tried to picture what that might look like, but all I could visualise was a giant octopus with tentacles reaching out to strangle everyone; I'm pretty sure that's not what she meant.

In spite of everything, both sessions were useful, and I'll definitely investigate mindfulness further. Hopefully, with practice, I'll achieve better focus, but even just taking this kind of quiet time out will be beneficial. 

Oh, and you don't have to sit a yoga position, so lack of flexibility is no excuse...

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Find out more about mindfulness on the Mental Health Foundation website.