Archive for the ‘dermatillomania’ Category

I’m still having a hard time dealing with the rampant drama in my department, and the fact that my main adviser has all but dropped off the face of the earth. He resurfaces every now and then, either because the chair of the department has contacted him to demand that he take care of some specific task (hello, prelim reading list…which I still had to get from another professor), or because he has demands of his own that he communicates through middle men who probably don’t want to play that role. I feel stuck between a rock and a hard place, because anything I do is going to entail the beginning of World War III. I’m also starting to feel like my professor is using his position to bully me into doing certain things, whether it’s taking classes I don’t need, doing research that isn’t benefiting me, or giving high marks to students that don’t deserve them (all of which he’s done in the past year, before going on sabbatical and dropping off the face of the planet).

Yesterday morning one of my professors that I don’t actually have any classes with right now dropped into my office to say hello and ask how I was doing. She asked how trying to study for my prelims was going, and whether or not my adviser had finally gotten my materials to me. I caught her up to date with the situation, which hasn’t changed much since last semester when I had a class with her, and mentioned that I was considering the possibility of changing advisers if I could convince one of the other members of my exam committee to take me on. She was very supportive of the idea, and suggested a coffee date next week to talk about the idea some more.

Then I meandered down the hall to talk to the second chair on my committee. He technically only specializes in one of my two fields, but he’s brilliant and I’m very lucky to work with him. I asked if he would consider switching to being my first chair…and he said no. For a long list of personal reasons which had nothing to do with me. Even though I understood where he was coming from, it still sucked to be told no. The fact that he recognized it wasn’t the answer I wanted to hear did strangely help, but it is testing all of my newly acquired life skills to manage the fact that even though this person has rejected one request, he is still working with me in other capacities. No matter what he thinks about this decision, I still have to interact with him almost daily. And I have to do it with a great deal of respect, which this professor rightly deserves. Not being able to resort to my habitual default plan (run, hide, cry, scream, have anxiety attacks, sleep too much, be depressed, snap at people, and skin pick, or some combination of the above), was difficult. To be honest, I did pick my skin significantly yesterday, but even this was drastically reduced over what I would have done even, say, a year ago.  I used to pick my skin until it bled…sometimes for hours at a time. Yesterday I lost perhaps a total of 20 minutes to picking. This is on the one hand basically nothing, and on the other hand a little devastating, because I wish the therapy were progressing faster. One of the things I’m still struggling to learn how to do is take a breath and just calm down for a second when things start getting overwhelming. It’s a lofty goal that’s easier said than done.

Back to the opinion spectrum. By 10:30 yesterday morning, I had two opposite opinions about what I should do. One professor said to jump off that ship before it sank any farther. The other said to stay on that ship and patch it up by whatever means were necessary. In the afternoon, in anticipation of yet another meeting with a professor who actually scares me with his enormously high standards, I went to talk to my department chair to get his feedback. He laid out numerous possibilities, some of which were feasible and some of which made me want to throw up in his wastebasket.  I didn’t, and went home to mull the possibilities (which now ran the spectrum from doing nothing to initiating World War III) and pick my skin instead. I was very very anxious about my meeting this afternoon, and lost sleep over it.

This morning, I decided to take a chance and drop by scary professor’s office during his office hours instead of waiting until my meeting this afternoon in the hopes of just getting it over with. He’s actually very nice, but I’m always afraid I’m going to piss him off unintentionally because his standards are so insanely different than anything I’ve ever experienced. It actually went fine, and I left feeling strangely relieved, even though nothing was really solved.

I’ve had four meetings, gotten four different opinions, and still have no plan of action…but I did get my Effexor prescription refilled, have lunch with a friend, and make significant progress in finishing an article that I’ve been working on for what feels like forever. I also picked at my skin a little bit this morning. Not sure what to make of this strange mix of healthy and unhealthy responses.

The bottom line: if you’re going to jump off of one ship that’s sinking, you have to have something else to jump on to. Easier said than done. Especially if you don’t know how to swim. I don’t. But I have every intention of learning.

I have a professor who qualifies as one of those rare people who is both impossible to please, but generally right, making it impossible to be legitimately angry with him. I feel like every time I turn around I’m doing something to make him mad, whether it’s failing to include the correct introductory sentence in my emails or needing to leave class thirty minutes early to make it to a funeral. There are many days when I feel like I can’t do anything right, and I’m not the kind of person who can manage to not let things like this get to me.

The disconnect comes from the fact that he has impossibly high standards, but they’re also legitimate ones, and the higher he raises them, the harder I keep trying to earn his approval. In some says it’s a throwback to my childhood of always seeking approval. On the other hand, there’s really nothing unhealthy about it, and as long as I remain aware of my tendencies of constantly seeking approval, I can keep them in check without too much trouble. This is a solid indication that my therapy is working and paying off, so in that sense it’s a good thing.

At the same time, it’s hard to reconcile in my head sometimes. The fact that I’m getting to a place now where I can start to manage these things without needing medication is a good sign.

When it comes to medication, I’ve tried a lot of them. The first anxiety-related medication I started taking wasn’t directly related to my anxiety at all…I started taking Detrol LA the summer I graduated from high school. I was teased for years about my tiny bladder, and by the time I made it to high school, I had a hard time making it for more than an hour without using the bathroom. It seriously impacted my ability to function – I couldn’t even sit through a movie most of the time without having to leave half way through. I was afraid I wouldn’t be able to make it through my college classes, so I asked the doctor for a prescription. I took it for a few years, and then finally gave up because I still felt like I was having to use the bathroom all the time. I also started taking Prozac in college, before a trip to Europe that I was terrified of going on. A few months after I got home, I stopped taking it because I didn’t notice much of a difference. I had rabid panic attacks the entire time I was away, and I still had to use the bathroom all the time, so I gave up on the medication all together.

When I went to Alaska, my therapist thought Cymbalta might yield better results, so I started taking that. It was then that I learned why the Detrol LA wasn’t working on my frequent bathroom trips – I had to pee all the time because I was anxious, and that affects nerves. The Detrol works by calming muscles, so essentially not only did I have to pee all the time, I couldn’t actually fully empty my bladder, compounding the problem. Before this takes a header off the diving board into the “too much information” category, I’ll just sum up by saying that when I stopped taking the Detrol and started working on organically managing my anxiety, my tiny bladder problem improved dramatically on its own. I still have issues when I get really anxious, but most of the time, I’m just fine.

I stopped taking the Cymbalta cold turkey [side note: bad idea. Never EVER stop taking medication cold turkey. In addition to mood swings and other side effects, abruptly quitting the medication causes severe dizziness in some people, as it did with me]. when I got back from Alaska. Though my panic attacks were better while I was in Alaska, I was tired of medication that wasn’t helping me control my skin picking and wasn’t eliminating my panic and depression entirely. After about a year off of medication, I decided to give it another try, because I thought it might help me while I worked through some underlying issues (which, as it turned out, went much deeper than I had imagined). After consulting with my doctor and my therapist, we decided to give Effexor XR a try.

The first few days I instantly noticed a difference in comparison to the Prozac or Cymbalta. I felt totally numb…a bomb could have gone off next to me and I probably wouldn’t have cared. I decided to trust the therapist, who thought we should give it two weeks – if I still felt out of it and disoriented, I’d come off of it. My mood balanced out after a few more days, and I began to notice that I felt more calm and was better able to think about what was happening in a situation before reacting out of anxiety or panic. I felt more in control and level-headed. It didn’t eliminate my skin picking or my anxiety, but it did give me some breathing room to work on deeper issues.

I’m now approaching a place where I’m ready to be off of all my medication and getting back into the real world on my own. I’ve stepped down to half the dose of Effexor I was originally taking, and I’m ready to phase off of it by the summer. Scary? Yes. But also exciting. I truly believe that medication is a great thing when used properly and under the supervision of a professional, like a therapist. On it’s own, it’s not a cure-all – I’ve learned that one pill a day won’t fix everything. When that was my hope, I was, of course, disappointed. But there is a place for medication, and in the right situation it does work. I’m living (and still imperfect) proof.

It’s probably time to start talking about the biggest OCD component in all of this. One of my biggest struggles in getting healthy has been learning to cope with my OCD, and learning how to manage my compulsions. Over the years, there were many compulsions that impacted my ability to function on a daily basis. The earliest that I can remember is checking numbers – mostly on the clock beside my bed. I had trouble sleeping because I’d keep opening my eyes to look at what time it was. At one point, I decided that the number 7 was awesome, and repeatedly checked the clock to watch the numbers change. Somewhere along the way I started writing the numbers down on pieces of paper because I was afraid I’d forget them. The end result was one very tired kid and lots of pieces of paper filled with a progression of noted times that meant very little.

Somewhere along the way that compulsion wore off, and others replaced it. By the time I was a teenager, I no longer placed all my faith in the number 7. I’d moved on and branched out by then, to certain even numbers…multiples of 2 and 4 were preferable, though numbers that repeated (22, 44, etc.), were not desirable.  I was most partial to 4, 12, 14 and 24. By the time I got to college, I’d started setting alarm clocks to those numbers – getting up at 7:00 was unthinkable when it was just as easy to set the alarm to 7:04, or 7:34. I couldn’t turn the car off if the clock numbers ended in 3. I’m not really sure if I thought something bad was going to happen, it just didn’t feel right to do things differently. That’s the scary part of OCD – learning to behave differently.

By far the most debilitating of my OCD compulsions has been picking at my skin. I don’t remember exactly when it started. I know that by the time I was in middle school I was chewing on the skin around my fingers until they bled, and when I reached my pre-teenage years and started to develop acne, I began picking at my face instantly. My parents were never good at following through to make sure I’d brushed my teeth, washed my face, or anything of that sort. Even if I had wanted to wash my face, our water was so full of silt, I’m not sure how much good it did. To illustrate, it got so bad by the time I was in eighth grade that I had to start rinsing my hair with bottled water when I got out of the shower to get the muddy sludge out of it. I felt dirty, and out of control. To compensate, I picked my skin.

The bathroom sink...

...and the bathtub.

I remember the exact moment that I transitioned from picking my face to picking other parts of my body – most notably my upper arms and chest. I was sitting at the dining room table working on something, and absently running the fingers of one hand over my left shoulder when I felt a little bump. I raced to the bathroom mirror to check out the situation and discovered a white-head, which I immediately annihilated by popping it. A new compulsion was born. Within a few days, my arms were a bloody, bruised, scabbed over mess.

I knew something wasn’t right, and most of my major milestones in life were marked by my desire to stop picking at my skin. I’d do it when I turned 15. No fifteen year old picked at their skin. Maybe at 16…certainly no sixteen year old did it. 18. No young adult going off to college would pick their skin this way. 21 – old enough to drink, old enough not to pick.

Now here I am, 26, and still learning how to manage my OCD…including not picking at my skin.

My OCD therapist started with the numbers. The first time I had to set my alarm clock to 7:13 I wanted to have a panic attack, but it got better. The numbers have gotten better. Learning to manage the skin picking has been a much bigger struggle, and I’m still working through it.  There’s a strange sense of calm in picking at my skin – the compulsion is like an old friend, and it’s been with me for a long time. Cutting it out of my life has been difficult.

I’m 26 years old, and I still have a hard time wearing tank tops, short-sleeved shirts, and anything that reveals too much of my chest. I’ve picked my skin so much that it’s probably done permanent damage. As my picking has lessened, with therapy and lots of hard work, my skin has healed enough to appear healthy on the outside. Learning to understand my compulsive need to pick and retrain my brain to react differently to the desire to pick, however, is a process that I’m still learning. Knowing that I’m not alone, and not the only one in the world who picks at my skin, is a powerful thing, however, and that’s a big part of my motivation to share my story. I didn’t learn the word “dermatillomania” until a few months ago, but knowing there is a medical term for what I do is an enormously powerful thing. I think if I had known at a younger age that there were other people out there like me, it would have made a huge difference. OCD is a very secretive disorder – I don’t want anyone to be able to see that I pick my skin, so I’ve grown adept at hiding it. Revealing it to the world is scary, but a very healing step. Pictures coming……