I am possessed of a very minimally disabling form of Obsessive-Compulsive Disorder. I hesitate to say I suffer from it; it would be more accurate to say I am mildly inconvenienced by it. I share this not to divulge a dark secret, but on the off chance that someone else out there has a similar problem and does not know why.
The name of my particular flavor of OCD is dermatillomania. It is an impulse-control disorder, specifically of the compulsive grooming variety, which also includes trichotillomania, trichophagia, onychophagia, dermatophagia, and the generic body-focused repetitive disorder (in order, the scientific names are hair-pulling, hair-eating, nail-biting, and skin-chewing). There is some debate over whether compulsive grooming truly falls on the OCD spectrum, but from where I sit, it definitely qualifies.
Dermatillomania is, from the Greek: derm, skin; tillen, to pull; and mania, madness. It has other names depending on source material and medical specialty but is best described by one of the most basic: compulsive skin picking. Disgusting? Yes. Unladylike? Certainly. Do I wish I could stop? More than anything. Can I? Not for more than a day.
The science: In the psychological field there is a technical difference between an impulse and a compulsion, but they tend to overlap in this particular realm since it is the impulse that frequently begins the behavior but the compulsion that renders us unable to stop. Like any behavioral trait, compulsive grooming manifests slightly differently in each sufferer (and some do suffer, significantly). Some, in the more traditional OCD vein, feel they must do it to prevent bad things from happening, but most do it because they simply have to.
The reality: Remember I said I was mildly inconvenienced? Trichotillomania sufferers pull out their hair, many until they are bald or left without eyelashes, eyebrows, or even pubic hair. Dermatophages chew the cuticles of their nails and the skin of their knuckles until they are left with bloody, swollen and discolored scar tissue. There are all manner of variations on this theme, but common to all is the inability to stop. In my case, I chew the insides of my cheeks, dig holes in my scalp, and peel skin from my lips and the bottoms of my heels. This is a mild, bordering on moderate, form of the disorder. Some have far more visible locations they harass, or noticeable scars from previous episodes. Some use tools, like tweezers or scissors, to better achieve the goal of removing the offending bit of skin. There are even those who deliberately harm themselves in order to have more damaged skin to pick (not to be confused with cutting for self-harm purposes, an entirely different disorder with an entirely different source).
Do not think we do such things because it doesn't hurt. It does hurt, every single time. The drive also varies slightly person to person, but usually centers around removing something dirty or uneven (like a scab or hangnail) from the body. The paradox is, of course, that by doing this a person only prolongs healing, and therefore the presence of the offending object. Neither impulse nor compulsion concern themselves with logic, however; or bow to pain, and so despite knowing they are working against themselves, and despite causing bleeding, scars, sore fingers, headaches, infection or illness, sufferers cannot stop. Truly. I have tried, every day of my life since I was fourteen years old. It is like scratching an itch that never quite goes away, one inside your brain so you can never reach it.
I first noticed the compulsion to pick at my scalp my freshman year of high school, followed by an episode the last year of college, both of which resolved not so much from effort on my part as the fact that my young, healthy body healed more quickly than I could damage it. My current relapse has lasted two years, touched off by a sunburn that caused just enough peeling for the need to pick to come roaring back to life. Two years I am deeply ashamed of, two years in which I have discovered that there are far more hair-related activities in daily life than the average person might imagine.
I can't get a haircut. I can't color or highlight my hair. Some days I can't wear my hair down because people will see giant ugly wounds. Some days showering is so painful I can barely stand it. If the hairbrush nicks one of the sore spots, it brings tears to my eyes. Often it hurts to lie in bed or against a sofa cushion in a particular position because it puts pressure on the damaged areas. My boyfriend can't even pet my head as a gesture of affection. And that's just the scalp. As for my lips and cheeks, most days I look like someone split my lip, and I am well aware I look incredibly stupid out in public contorting my face to bite just the right spot on the inside of my mouth. I have become an expert on walking with my denuded heels just above the ground so that it looks normal but no pressure is actually on the raw areas, but flip-flops are usually out of the question and a pedicure would be laughable.
It is a disgusting thing, I do know. I know I risk serious infection from having prolonged open wounds. I know exactly what sorts of microbes thrive in each and every environment on my body and under my fingernails. I am also grateful that this disorder as it manifests in my life is not more serious. Tonight I will tell myself, as I always do, that tomorrow will be different. Maybe it will; it usually isn't, because that furious need to peel back flesh digs in its claws until, if I resist, I am ready to jump out of my skin and run screaming into the night.
There must be an end to this. I graduate from my Well-Respected Nursing Program in early August. I refuse to permit such a disorder to permeate my new career. My deadline is July 31; this cannot continue.
The name of my particular flavor of OCD is dermatillomania. It is an impulse-control disorder, specifically of the compulsive grooming variety, which also includes trichotillomania, trichophagia, onychophagia, dermatophagia, and the generic body-focused repetitive disorder (in order, the scientific names are hair-pulling, hair-eating, nail-biting, and skin-chewing). There is some debate over whether compulsive grooming truly falls on the OCD spectrum, but from where I sit, it definitely qualifies.
Dermatillomania is, from the Greek: derm, skin; tillen, to pull; and mania, madness. It has other names depending on source material and medical specialty but is best described by one of the most basic: compulsive skin picking. Disgusting? Yes. Unladylike? Certainly. Do I wish I could stop? More than anything. Can I? Not for more than a day.
The science: In the psychological field there is a technical difference between an impulse and a compulsion, but they tend to overlap in this particular realm since it is the impulse that frequently begins the behavior but the compulsion that renders us unable to stop. Like any behavioral trait, compulsive grooming manifests slightly differently in each sufferer (and some do suffer, significantly). Some, in the more traditional OCD vein, feel they must do it to prevent bad things from happening, but most do it because they simply have to.
The reality: Remember I said I was mildly inconvenienced? Trichotillomania sufferers pull out their hair, many until they are bald or left without eyelashes, eyebrows, or even pubic hair. Dermatophages chew the cuticles of their nails and the skin of their knuckles until they are left with bloody, swollen and discolored scar tissue. There are all manner of variations on this theme, but common to all is the inability to stop. In my case, I chew the insides of my cheeks, dig holes in my scalp, and peel skin from my lips and the bottoms of my heels. This is a mild, bordering on moderate, form of the disorder. Some have far more visible locations they harass, or noticeable scars from previous episodes. Some use tools, like tweezers or scissors, to better achieve the goal of removing the offending bit of skin. There are even those who deliberately harm themselves in order to have more damaged skin to pick (not to be confused with cutting for self-harm purposes, an entirely different disorder with an entirely different source).
Do not think we do such things because it doesn't hurt. It does hurt, every single time. The drive also varies slightly person to person, but usually centers around removing something dirty or uneven (like a scab or hangnail) from the body. The paradox is, of course, that by doing this a person only prolongs healing, and therefore the presence of the offending object. Neither impulse nor compulsion concern themselves with logic, however; or bow to pain, and so despite knowing they are working against themselves, and despite causing bleeding, scars, sore fingers, headaches, infection or illness, sufferers cannot stop. Truly. I have tried, every day of my life since I was fourteen years old. It is like scratching an itch that never quite goes away, one inside your brain so you can never reach it.
I first noticed the compulsion to pick at my scalp my freshman year of high school, followed by an episode the last year of college, both of which resolved not so much from effort on my part as the fact that my young, healthy body healed more quickly than I could damage it. My current relapse has lasted two years, touched off by a sunburn that caused just enough peeling for the need to pick to come roaring back to life. Two years I am deeply ashamed of, two years in which I have discovered that there are far more hair-related activities in daily life than the average person might imagine.
I can't get a haircut. I can't color or highlight my hair. Some days I can't wear my hair down because people will see giant ugly wounds. Some days showering is so painful I can barely stand it. If the hairbrush nicks one of the sore spots, it brings tears to my eyes. Often it hurts to lie in bed or against a sofa cushion in a particular position because it puts pressure on the damaged areas. My boyfriend can't even pet my head as a gesture of affection. And that's just the scalp. As for my lips and cheeks, most days I look like someone split my lip, and I am well aware I look incredibly stupid out in public contorting my face to bite just the right spot on the inside of my mouth. I have become an expert on walking with my denuded heels just above the ground so that it looks normal but no pressure is actually on the raw areas, but flip-flops are usually out of the question and a pedicure would be laughable.
It is a disgusting thing, I do know. I know I risk serious infection from having prolonged open wounds. I know exactly what sorts of microbes thrive in each and every environment on my body and under my fingernails. I am also grateful that this disorder as it manifests in my life is not more serious. Tonight I will tell myself, as I always do, that tomorrow will be different. Maybe it will; it usually isn't, because that furious need to peel back flesh digs in its claws until, if I resist, I am ready to jump out of my skin and run screaming into the night.
There must be an end to this. I graduate from my Well-Respected Nursing Program in early August. I refuse to permit such a disorder to permeate my new career. My deadline is July 31; this cannot continue.
