Don’t get me wrong, I get how having a point of reference as a comparative to build an understanding has value. Especially when you have transferable skills from OCD or Self Harm coping skills that can apply quite nicely. What is important is that this is a starting point to continue to learn about BFRBs, to remain curious about the nuances as it applies to each person living with one, and to deepen your understanding with a full respect of this distinct category of disorders classified as BFRBs.

What harm does it do?

I see the harm of assumptions and lumping together when I am sitting with clients. Regularly they process feeling dismissed, unseen, minimized, or not cared for when someone says, “Oh, that’s just like cutting.” or “Yeah, OCD, I know it.” or “I get it, self harm.” That labeling, or mislabeling to be more accurate, feels like a stopping point to the person reduced to what is “close enough” to the person claiming to want to help. And sometimes they are right, it is a stopping point. The person who assumes they “get it” doesn’t look further and just keeps treating them, clinically or as a friend responding to a friend, as if they have a disorder that they don’t.

More so, in the clinical community, one can jump in to apply OCD or Self harm treatments to the person with the BFRB. The person seeking help can be taught by a trusted professional about themselves in a way that is just not true. While they may collect a few general therapeutic tools along the way, the can do real harm to the person seeking help. Some OCD and Self harm approaches make BFRBs worse!

Further more, when it is discussed in the media or online as if BFRBs were OCD or Self harm, both people suffering in silence with a BFRB and uninformed clinicians seeking information will come across this and point them the wrong direction.  Family members may get their false assumptions validated by this inaccurate information and go back to the person with the BFRB yelling about “stop hurting yourself to hurt me” (can happen with cutting, not what BFRBs are about at all) or nagging them about worry and anxiety (OCD trigger, but not always BFRB trigger) that might not be there. We need accurate and updated media support of people with BFRBs and the research, not reinforced old myths or pop culture stereotypes.

How different are they? Enough that while I specialize in supporting clients with BFRBs for a decade now, I consider  both OCD and Self Harm completely out of my scope of competency. They are different enough that I had to research to adequately and concisely answer how they are same and different because I didn’t know enough about OCD or Self Harm. I found myself frustrated and at a loss for words when inevitably asked this directly at every psychology conference I attend. And now here it is summarized.

Body Focused Repetitive Behaviors (BFRB’s) include:

• Trichotillomania (Hair Pulling Disorder)
• Excoriation (Skin Picking Disorder), formerly referred to as Dermatillomania or Chronic Skin Picking
• Nail Biting
• Cheek Chewing
• Lip Biting

What BFRBs have in Common with OCD and Self Harm, AND How they are Distinct

BFRBs are NOT

• OCD ( but can co-occur)
• Self Harm-Cutting
• Meth Addiction (although can co-occur)
• Compulsive Masturbation
• Personality Disorders (Actually BFRBs are LESS likely to have a personality disorder)
• Body Dysphoria (Absolutely can co-occur)

I hope this helps friends and family members of people with BFRBs better understand their loved ones. I hope it helps clinicians provide better support to their clients with BFRBs. I hope it helps people living with a BFRB better understand themselves and more clearly advocate for themselves when they come out about having a BFRB. I hope. Of course it is difficult to speak absolutely about any label or disorder because there is always diversity, nuance, and a spectrum of variation in every situation.

The post BFRBs: Not OCD, Not Self Harm. How and Why. appeared first on Courage Counseling, PLLC.

If you are sheltering in place, working from home, homeschooling, or socially distancing, you are probably navigating new triggers for your Trichotillomania and Excoriation disorder. I have helped clients through Body Focused Repetitive Behaviors (BFRBs) for almost 10 years and am amazed at the creativity of my clients in what they are trying and is working well for many of them! With new circumstances and triggers comes new sets of strategies.

MOVE YOUR BODY!

This is not just a walk a day or a video exercise. Throughout the day move around. Between Zoom calls do a few yoga poses. Walk a lap in between tasks. If you notice a pattern of how long before urges or habitual picking or pulling starts, set a reminder to start some big movement before that time. Get various muscle groups involved. Bend and hang so your inner ear (vestibular system) gets some stimulation. It doesn’t have to be a workout. Just engage, get some pressure on different joints, and wake up parts that have lost flow. The rag doll yoga pose is easy, releases tension, allows for swaying and shaking out your muscles and connectors and your body will thank you for it.

The “Jane Fonda” Technique

This is more movement, but specific to your BFRB. Sitting on your hands, making fists, and abruptly yanking your hand down away from where you pull or pick creating more tension. Your body has learned a soothing flow and movement completion can create so much relief! Of course, we don’t want to temp the “trichser” either. So how it works is to notice the repetitive flow of your hand/arm/posture as it goes toward the skin or hair that you most communing pick at. BUT, instead of stopping you PUSH your open hand past that spot and continue that momentum in an exaggerated movement away from your body, up and down back to your sides.

You may do this fast or slow, whatever feels right for you. This new movement is incompatible with actual BFRBs. I came up with this name because the motions start to look and feel like the 1980’s Jane Fonda aerobics videos. No, I don’t have permission to use her name. Hopefully, if discovered it is seen as flattery and that it feels good how many are benefiting from this idea. Luckily, in quarantine you can Jane Fonda all day long without your cube mates asking questions.

Wear your Mask where you Pick

This is for some people, those who benefit from the barrier of the mask for automatic picking at face, lips, mouth, or pulling nose hairs. With the skin protected the wandering hand does little harm and is often reminded to go back to the intended task at hand. Of course, if your mask is irritating, this may backfire, so use your own wisdom. There are many paths to recovery.

Joint Compression

Put a hand on each side of the joint and gently squeeze your hands towards each other. A Partner may do this to you as well. For arms you can apply pressure by putting weight on the hand or fist. Such as trying to do pushups on the wall, as if you were trying to push the wall over. Place your feet back a few feet to increase challenge. Press slow and keep breathing! Sometimes less is more; play with less effort and see how that helps you ground and feel more comfortable in your body.

Door Way Stretches

I have noticed a nearly universal posture linked to when my clients pick or pull. They are almost always leaning off center and hunched at the top and base of the spine. This is also known as the “shame posture.” There is already so much know about the benefits of good posture, but it’s a hard habit to create. To begin anew and thwart this old habit, throughout the day, stretch out the other way, slow and deep. Try this stretch: Stand in a doorway with your Forearms on a doorframe on each side of your body. Lunge through to open up so much of that over the keyboard slouch.

Sit Up, Arch back

When you are actively trying to manage urges, stretch your body up into a tall ballerina posture or even an exaggerated superhero arch. This is especially helpful when sitting on the toilet, home alone your coworkers don’t know how long you’ve been in the bathroom. The “bikini area” is one of the most common sites for pulling hair and picking skin from ingrown hairs.

Make Growling Noises and Funny Faces

Pretty much as it sounds. Much like the “Om” in yoga, play with an outward pressured sound like “voo” or anything resembling a growl. Make it a mediation and feel the vibrations throughout your body and the breath shift. Play with various and let yourself get silly! It is thought that this helps release “fight mode” in the brain. Even if not, it’s a good laugh and distraction.

Sticky Barriers

Honey, Olive Oil, Coconut oil, and other “masques” do not only soothe the tender scalp and irritated skin, but it will also make that area much less desirable to pull from or pick at. Even with online video meetings, you can really pile on gooey barriers the back of your head before it is noticeable to the computer screen during a video conference.

Radical Acceptance

This is a tricky one and a mindfulness concept Tara Brach teaches about in depth. It includes making peace with, of course not actually liking, the worst-case scenario you are fearing. Radical acceptance is about acknowledging. Once you name it and acknowledge it, you can channel your energy and focus on creating the change you wish for next or grieving what is truly over. This is not about passivity or defeat or weakness. It takes great courage and noticing the pain felt is part of the process, without drowning in the misery or discomfort.

Creating doubt in Catastrophe Thoughts

Yes, your worst-case fear might happen. There, I said it. AND there is a fair possibility that part of the scenario will turn out better or differently. Try to come up with 4 alternate conclusions with reasonable likeliness, from not as bad to totally fine or even positive. Example: Someone may have declined a video call because they hate you for that thing you said last time. Or maybe they are so maxed out with zoom meetings all day that they can’t bare another moment of screens. Or maybe they left their phone and are enjoying a walk. This helps us bare the unknown with more ease.

“What is Real Now”

Ask yourself what IS known right now. What IS happening right here and right now. What can I do right now, just the next step, toward meeting the needs of my self and my family? With so much unknown in the world around us and what the next few weeks or months may look like, our tendency to create a sense of safety by having a plan can backfire. With trusted resources or simply what is seen in your own space, focus on what is in your control.

Wandering Mind is Wandering Hands

If you are struggling to focus and find yourself starting to space out or reading the same thing over and over again, it’s time for a break and to use the healthy strategy to focus. Maybe you’re bored or hungry? Maybe you need help to understand how to take the next step? Maybe it’s been too long of a day and your body is done. When your mind wanders, you aren’t working anyway, but are VERY likely to pick your skin or start pulling out hairs in unconscious effort to override your system and force some more focused time.

Parts of Self

I see so much picking and pulling when a client is in limbo struggling to reconcile an inner conflict. Maybe a major dilemma. Usually an everyday life decision such as to lay down or take a walk. To exercise or to clean. To procrastinate or “adulting.” Imagine 2 or more separate parts of yourself each invested in their side of the dilemma. Let them express themselves and help meet their authentic needs. Parts that you may be frustrated with are likely trying to serve a vulnerable part of you.

Stop ‘Shoulding’ on Yourself

Say it out loud, yes, exactly as it sounds. The word ‘should’ is used to motivate yourself to “adult” or be well but all it does is keep us stuck and make us feel guilty for what we aren’t doing. There are many alternatives to the word should that have more innate self compassion and effective motivation. And at times, it simply changes to “I won’t today.” If you aren’t going to do it, suffering won’t make it better. Maybe “I want to…” or “I could choose to…”

“It’s just the toaster”

See this article to explain this metaphor that brings insight and mindfulness into your brain throwing you off your balance.

Challenge your Narrative

That voice in your head is not always inner wisdom. Sometimes it is internalized messages from childhood or old survival strategies that no longer serve your adult well self.  It helps to hear them out loud or write them out. They make sense in your head like a weird dream makes sense while asleep.

Tedious Task

Indulge in a jigsaw puzzle or something that has a similar function as your BFRB, where your hands scan something, fix something, you get to intensely look closely and tunnel in. Beading jewelry, cross stitch what you really want to say, pick the pills off your favorite leggings, scrape label sticker goo off glass and book covers. Personally, I have taken to slowly pulling weeds out of the lawn. Not a true chore, just bit by bit “removing the flaws.” See how that is like pulling the bad hair or “fixing” a clogged poor via picking, yet without it being on your body. No, it’s not the same, but channeling it somewhere else for your greater goals.

Trich as a Well-Meaning Messenger

Trichotillomania and Excoriation urges are rarely trying to actually hurt us. Under the urge is usually some unmet need. Metaphor: think of each urge as Lassie. Yes, the dog who barked and people heard a more important alerting to how help was needed. When your inner trichster barks, “Pick! Pull! Bite!” Pause with curiosity to mindfully consider what help you may need. In time you’ll get better at interpretation of these barks. Hints: What does your body need? What relationship tension may be lingering? What emotion are you not wanting to feel right now that may need nurturing?

Be kind to yourself, go easy, this is a learning curve we are all on. It’s ok to be doing better and worse at the same time or oscillate like a fan from ok and not. It’s a long-game played a moment at a time. Find your authentic needs, deep down, and try to nurture those parts. You don’t have to do it alone. And you are not broken or less than because of your BFRB. Even if you set aside recovery goals and work on higher priorities right now, it is ok.  Groups are still meeting online at Courage Counseling to remind you of this.

The post 18 Tips for Quarantine with Trichotillomania or Excoriation Disorder appeared first on Courage Counseling, PLLC.

Psychotherapy is still considered both medical and essential. Of course discretion and minimization of face to face contact is still recommended.

The post Remote Online Counseling Available- Phone or Online appeared first on Courage Counseling, PLLC.

This doesn’t mean that people with a BFRB must stay limited to specialized or sensitive professionals. If you are comfortable with any facility or provider who makes you happy and you like the work or help they provide- go with it! and let me know if they need to be added to my list to help others with a BFRB!

My hopes is that publishing this is a jumping off point to discover and share more resources after hearing back from our local BFRB community. So Please, share your feedback! Priscilla@courage-counseling.com

BFRB-FRIENDLY SALONS:

Amber Shastid, Private Room in Salon and In-Home Haircuts (Professional stylist who has been trained on trich by Priscilla Elliott and who is open to doing in-home haircuts)
https://www.ambershastid.com/

Jacquie Nguyen, Stylist
512-745-2770 (cell)
joelraysalon.com

I have heard of several more in town but was unable to confirm they are still actively seeing clients in Austin.

Ricky Knowles – Hair + Wellness (Houston area) – Recommended by a group member. Mostly does wigs/extensions/etc but also haircuts for people with trich and says about 40% of his clients have trich. From a group member: “I felt completely comfortable there and really inspired that he dedicates so much of his time to help people with this disorder.”
713-623-4247
hairandwellness.com

Tattoo- Permanent Make up and Medical Tattoos

Brow Rehab: Mary Rae Arvizu
512-842-7699
www.realisticNippleTattoos.com

Massage therapists

Laura Sanders, LMT & LE
elevate.amtamembers.com
elevatewithlaura@gmail.com
call or text 512-906-9953

Aestheticians

LePa Spa

Homepage

Laura Sanders, LMT & LE
elevate.amtamembers.com
elevatewithlaura@gmail.com
call or text 512-906-9953

Dermatologists

Evans Dermatology
Erin McIntyre, NP
Colby Evans, MD
Lindsey Detwiler, PA-C
https://evans-dermatology.com/

Eye Doctors

Dr Linda M Pak
www.pakfamliyeyecare.com
512-891-9969

Acupuncturists

Paula Bruno, PhD
twoheartswellness.com

Psychiatrists

Dale Hsieh, MD
512.850.1537

Lori Fox, NP
(512) 430-1130

Denae Rickenbacker, MD
512-690-2075

Physical Therapists

Shelbi Foti, PT, DPT
512-387-4096
https://parrpt.com/

Dentists

Thomas C. Gent, DDS
(512) 593-6758
https://www.soladentalaustin.com/

I’m still seeking BFRB compassionate professionals for these categories:

Gynecologists
Nail Salons
Gastroenterologist (Trichophagia can lead to serious conditions needing medical attention)
Orthopedics (Pain and Injury is common in adults with BFRBs due to repetitive use injuries to hands, neck, and back from picking and pulling in similar patterns over years.
Ear Nose Throat Doctor (ENT- Nose picking is an often unmentioned part of BFRBs that can lead to damage or infection that needs medical treatment.)

What other referrals I’m not thinking of that you wish we had?

The post Community Resources for BFRBs appeared first on Courage Counseling, PLLC.

The most common question, is “Why would someone subject themselves to talking about their deepest secrets with a group full of strangers?!?” Conversely, clients sometimes ask, “Why would I want to listen to other people’s problems? Wouldn’t that just make me feel worse?” In both cases, the answer is that group therapy is an opportunity for clients to identify with what is universal about their life experiences, to reduce feelings of shame, and to develop resilience by witnessing resilience in how others work through shared life experiences.

Seven Benefits of Group Therapy

Hope

Most of us are impacted by real stories of real people. It is easy to dismiss statistics or platitudes as further examples that most people do not understand our experiences. In group therapy, clients are inevitably in different stages of their recovery from mutual symptoms. Getting to know someone who doesn’t pick their skin anymore or someone who hasn’t pulled their hair in months can show that it is possible. Even seeing others make degrees of progress can inspire clients to change. And when setbacks happen, which is normal, clients get to see someone show up anyway, instead of hiding in shame. They also see clients who have setbacks receive acceptance from the group. Watching others slip and then get back on track shows group members that not only can they recover from regression, but they can confidently follow examples of people who have been through it before them and achieved those goals. While some aspects of personal growth are individual, and not every strategy works for every person, witnessing the way others they have grown to know well in therapy have navigated the journey can help motivate participants without pressure. Alternatively, reading success stories of someone on the internet can sometimes backfire, making a person feel worse because there is no true witnessing of real-time life struggles that have led to success.

Universality

Universality is especially important for clients with BFRBs, such as Skin Picking Disorder and Trichotillomania (Hair Pulling Disorder). Clients tend to feel so alone, isolated, and ashamed, as if they are the only people who pick or pull. Clients can believe they are gross and that no one would accept them if they really knew the nitty gritty details of their picking and pulling rituals. Group therapy shows clients that they are not, in fact, alone.

When I meet a new picker or puller, I am quick to reassure them, saying “Nope! What you are describing is all standard BFRB stuff!” However, it feels so much better and more believable to hear it from a room full of people who are in their own process towards recovery than to hear from just one therapist who you paid to discuss it. Not only do others pick and pull, they like doing it, and many even eat it! Instead of judging others or feeling shame, clients quickly sigh relief and start laughing at themselves. A handful of “me too’s” is a great antidote for shame.

Imparting Information

This is what some new-to-group clients expect from group. They imagine it as a classroom or a workshop setting. I have even started new groups very much in that form, giving clients a chance to build comfort with each other and develop a common language before diving in with vulnerable information. I am a proponent of psychoeducation in counseling. While coming to new insights and solutions organically can happen and is quite powerful, some things can simply be answered or addressed with suggestions of things to try.

An example would be information about what is known to be true, based on research about trichotillomania. Other examples might be what strategies are helpful in the car for picking and pulling, what is the ABC method of managing skin picking disorder, etc. Group is a great environment for these questions to come up and to learn information about the disorder. Other participants ask questions you might not even think to ask, which is where that group setting element is helpful. When someone thinks to ask a question or build on someone else’s point, the information becomes available to everyone in the group. Cognitive Behavior Therapy and other methods shown to be helpful for skin picking and hair pulling have many informational elements that function well in a group therapy setting.

Altruism

It feels good to help others. When it comes to secretive behaviors as skin picking and hair pulling, it is rare to get such an opportunity “in the wild.” A sense of purpose is developed when a person can turn their suffering into much needed help for others. Clients don’t have to be perfect or even in recovery to be helpful. I watch group members help each other each week, the receiver gets wisdom and/or comfort. The helper gets a sense of pride, competence, and meaning, as they were able to have a positive impact on someone’s helplessness, worthlessness, and shame. Shame for both participants starts to dissolve. Sometimes it is specific advice or lessons learned the hard way. More often, it is a heartfelt disclosure, a moment of being real, without the intent of actually affecting others, that lands just right on the ears of the person that needed that message the most.

Social Skills

You can read about social skills and watch how-to videos, but lasting learning comes from practicing social skills first-hand. Group Therapy is a safe setting to work at building relationships with others and to interact awkwardly with opportunities for second chances. Practice communicating badly, without judgment, as you develop grace and tact. We discuss social elements from “real life” and curiously link them to patterns seen in “real time” during group. Are you using passive behaviors at the office and resentfully ruminating while pulling hair at night? Group is a great place to learn about assertiveness, among other social skills, and to practice actually asking for what you need directly from others in the room. Group therapy will provide the support of the therapist and other members, whom understand you, are also worried about being accepted themselves, and want you to succeed. Everyone involved will have the opportunity to experiment with new behaviors without fearing rejection.

Corrective Relational Experiences

Failure is an excellent teacher, but so is success. Corrective experiences come up in therapy in so many contexts. For example, most of us have had a relationship end unexpectedly and in an ambiguous way. Having a relationship end in a therapy setting, such as a group member finishing and saying goodbye, allows us to have a healthy goodbye. It’s not a big a major life loss, but just a meaningful enough grief to provide an opportunity to learn how to experience healthy closure as a personal relationship ends.

Also, boundary-setting is a huge corrective relational experience in group therapy. How often in your childhood and current life are you wishing you could ask for your needs to be met? Or express feelings of resentment over non-reciprocated support? It can become a default reaction to freeze instead of speaking up, speak in a way that others can ignore, or get stuck in situations in which your boundaries are habitually not respected. In group therapy, especially in groups for BFRBs, group members are encouraged to practice their assertiveness skills in real time and set boundaries.

Participants learn what it is like for the group to hear and respect such needs so that they can learn to project self-worth outside of the group. It is a safe setting to learn to do this for the first time, to do it badly, and to tiptoe and stumble until you figure it out. Wouldn’t it feel nice to suddenly find yourself asking for what you need at home and at work! You might find it’s not nearly as scary as you once imagined. In fact, the new way of communicating could reduce anxiety and drama in your everyday life. Less anxiety and less drama can help you cope with less skin picking and hair pulling! There are so many subtle ways that interpersonal dynamics influence BFRBs, which can be shifted towards health in group therapy.

Social Microcosm

One of the key differences between group and individual therapy is the social microcosm. In individual therapy, you may retell stories from social interactions and some may be seen between you and the therapist. Ultimately the therapist has to guess at some level what is observed and thought by the other parties involved. In group, there are enough other personalities participating that relationship dynamics that you struggle with at home, work, with friends, or even within your family will start to evolve amongst the group members. But instead of seeing that tension lead to screaming matches across the dining room or avoidance and political games of the office, you get to discuss what is happening in a mature fashion. Let’s be honest, most of us have picked or pulled when mulling those events over! Learn how you contribute to these patterns and identify what triggers are shifting you away from making choices that are in your best adult interest.

Ready to Join a Therapy Group?

Group therapy helps with so many issues, even beyond mental illness, and improves general wellness and relationship health. At Courage Counseling, our groups are specifically for adults who are living with a BFRB (Body Focused Repetitive Behavior) such as skin picking, trichotillomania, and nail/cheek/skin biting.

If you believe you may benefit for any of the reasons above, please contact me today to learn more about joining a therapy group!

Sources

Yalom, Irvin D.,Leszcz, Molyn. (©2005) The theory and practice of group psychotherapy /New York : Basic Books,

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A whirlwind of perfectionism and “should” thoughts are a fast track to sabotage your meditation goals. While there may be certain meditation methods that hold some requirements, ultimately all you need is a regular mindfulness practice to lead to the healing brain changes you are looking for. So drop the word “should” from your vocabulary and start on a very bumpy road of the learning curve. You will be bad at it at first- for some time really, and that is OK!

What matters in a mindful meditation is:

• Intending where your Attention is directed
• Attendance to the Here and Now
• The act of coming back when you wander off from the above two. Let us be real, this one happens a lot and is exactly where many people give up.
• Some consideration of body or senses

The Metaphor

 I think everyone has that one drawer in their house, usually in a kitchen or rarely used office, which is just full of miscellaneous things that we might need, do need, or have long forgotten about.  You go into it regularly looking for that 1 thing, maybe your neighbor’s key to feed their cats. And you have to dig through, touching each random item while saying “not that” as you filter past koozies from old memories, cold paper clips, and sharp edges of that broken gadget you will fix one day. It is easy to get off track, forgetting about the cat entirely and taking on some new “should do” organization project or mindlessly wandering off on a tangent thought. But you are a functioning adult and eventually find that key and be a good neighbor.

So How do I Start Meditating?

So today I talk to you about what I call the “Junk Drawer Meditation.” How it works is that you observe your here and now state, be it bodily sensations, thoughts, five senses, or emotions. In this mediation we are looking for “coherence,” Coherence is the body’s signs of feeling OK, safe, and flowing with some degree of health. The “not that’s” that we are filtering past are pain, illness symptoms, urges to pick your skin,  compulsions to pull a hair out, thoughts of any sort. We touch and briefly feel each thought we find, just long enough to give it a label and continue digging for what you KNOW is in there. Coherence: a sensation that is not pain. Coherence: a moment of calm, a fiber of strength. It is in there somewhere! Keep looking. Get off track and back on again. And when you find it, observe it curiously as long as you can. Then, watch for more coherence to come into awareness. When you drop it, start digging again, “not that, not that, not that…AHHHH! There it is.”

But Where? When? I’m busy!

You may not have a serene setting or even a quite space. You may be washing dishes or speed walking on your way to the next thing on your list. Maybe sitting in a functionally parked car on the highway waiting for traffic to move. The here and now is not always sexy, it is where you actually are in your real life. Start today and make it a daily habit. A few moments, then build up as it works well for you. The research says 7 minutes is where you start to see significant changes on brain scans. Buddha says that everyone needs to meditate 10 minutes a day, and if you are too busy for that than you need an hour! You may wake up early before the house starts to rustle. Or fall asleep meditating at the end of the day. I have even heard of making a habit of meditating every time you sit on the toilet. Waiting for the perfect time and place will just lead to waiting forever.

So give mindfulness a try. Meditate badly. Then meditate again. And again.

Oh yeah. And don’t forget to feed the cat!

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If there is a medical element that triggers your skin picking, getting that condition managed can make your recovery from skin picking disorder much more achievable. Even if that is not the only thing you pick at. Recovery is hard enough without something itching or irritated! This may be with the support of a dermatologist or a well suited hygiene routine. To be clear, I am not a dermatologist or an esthetician. However, as a psychotherapist I treat skin picking disorder daily, which frequently involves discussion of skin care.

We each have our own specific skin needs that change over our lifetime. What was best for someone at 18 may not be a beneficial product at 30 or 60 years old. If it has been a while since you have evaluated your skin care routine, it may be time with a curious approach to revisit this topic. These suggestions below will not cure skin picking disorder. Hopefully these tips reduce some triggers, aid in healing, and help you reach your goals.

13 Skin Care Tips that tend to be helpful:

1. Wash makeup brushes at least monthly- more frequently when wounds are open. Liquid dish soap can do the job quickly and easily.
2. Use a clean face cloth and towel each time you wash. 
3. Learn proper first aid for your skin and picking related damage.
4. Use fresh pillow cases when possible so old oils and rubbed off hair products don’t irritate your face.
5. When conditioner is setting in your hair in the shower, tie your hair up with a large clip so it does not get too much on your back or shoulders.
6. Let a dermatologist address underlying medical conditions.
7. If a wound from picking develops signs of serious skin infection such as crusting, pus, tenderness, unusual warmth, and/or fever, then please go see your primary doctor or dermatologist.
8. Use products consistently for at least 6 weeks. Unless you have an allergic reaction to it or other cautions from your doctor.
9. Try something different- if for the last 10 years you have been trying various brands of similar products- try a new approach.
10. Harsher products are not always better. If a product is too irritating, drying, or itchy, it could trigger more picking.
11. Gentler products are not always better. Some skin conditions do call for chemical/medical intervention to see progress.
12. Natural products are not always better. There are plenty of all natural and completely organic ingredients out there that we may be very allergic to or our skin may simply disagree with.
13. Avoid the use of tools, like tweezers or needles, to pick if at all possible. If you cannot avoid this yet, a solution of 1 part bleach (Clorox) to 10 parts clean water can be used to soak instruments. It will not clean them as well as an autoclave or sterilizer, but may help some.

To learn more about skin picking disorder treatment click here.

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What are fidgets?

Fidgets, also called fiddles, are novel things to play with instead of picking or pulling.

They keep our hands busy so fingers are hopefully less likely to wander into searching for the next pick or pull. They sometimes meet sensory needs, such as amusing a bored tactile system. This is like eating a healthy food when you are hungry instead of junk food, except for your 5 senses. Other times fidgets function as a behavior replacement strategy, so you train yourself to play with the fidget instead of your skin or hair. Fidgets are also used to support focus for ADHD and can be calming when stressed out. In my clinical experience, fidgets do have their place in many treatment plans and do help a lot of people; However, they usually work best within a more comprehensive treatment approach.

Since many fidgets are kind of goofy looking and are far from subtle, clients ask about more covert ways to use fidgeting as a strategy, especially for public and professional settings.

Ways to Fidget without a Fidget:

• Explore and play with regular, everyday items that are already in your environment.
• Cell phone cases with bumps, ridges, or textured decorations.
• Pillow cases with ruffles, sequins, beads or embroidery.
• Move your hands or arms mindfully in a way that feels good or interesting
• Jewelry is great since it is as accessible as your own hair and skin! Find an everyday piece that keeps your interest and is tough enough to hold up to stretching, scratching, and bending.
• Clothing, you wear fidgets everyday! Seams, scarf tassels, folds in the fabric, frays on your jeans.
• Nail art- especially glitter polish or little stones glued on.
• Finger tip covers found at office supply stores

Strategies Beyond the Fidgets:

• Mindfulness. Mindfulness. Mindfulness! A quick meditation or mindfully engaging in the task at hand.
• Self Talk
• Self Compassion
• Problem solving the stressor instead of procrastinating
• Take on what you have been avoiding by picking or pulling, a hard conversation or an emotion maybe?
• Assertiveness & Boundaries. Ever notice how we frequently ruminate over conversations we wish we handled better while picking or pulling?
• Exercise, even if its just a short walk around the block
• HALT! Are you Hungry (or thirsty), Angry, Lonely or Tired? Meet that need directly.
• Somatic Experiencing techniques found at the bottom of this linked article

For more on skin picking disorder treatment click here.
For more on hair pulling (trichotillomania) treatment click here.

The post Think Outside of the Fidget Box appeared first on Courage Counseling, PLLC.

This is a day time group, perfect for graduate students, professionals with flexible schedules, or  moms who can most easily take time for self care while their kids are in school.

Learn more here: http://courage-counseling.com/counseling-services-austin/group-therapy/

“This group sounds perfect for me, but…”
Please don’t hesitate to reach out to me with any questions or concerns before signing up. These may be logistical, about readiness, severity of issues, or whatever is on your mind. What is important is that you get the help that you need, so let’s discuss what that might be.

Contact me today to reserve your seat in this group. Only 6 slots available!

The post New BFRB Group Starts Sept 17! Sign up today! appeared first on Courage Counseling, PLLC.

While this allows the child to take more control of treatment process, it doesn’t mean they don’t need an adult support. Hopefully, while the adult lets go of policing the picking and pulling behaviors, they can shift that time and focus to appreciating their kid as a whole person, with many interests, talents, and emotions. Its important to never loose sight of the relationship, which also heals the inherent shame that most people with Trichotillomania and/or Skin Picking Disorder struggle with.

Download this Free Log Here:  BFRB Log for Children

While logging body focused repetitive behaviors (BFRB) is a common part of trichotillomania treatment and Skin Picking Disorder treatment, it is not appropriate for all cases. Some are not ready for this level of focus the BFRB, and may need to spend time working on other issues first. Some find logging to induce an overwhelming amount of shame, so they may need to work on acceptance and self compassion first. Logging IS NOT a punishment, its a tool to learn more, objectively track progress, and thus get on a path towards recovery.

Looking for the adult, more comprehensive version of the picking/pulling log? Find it here!

For more on skin picking disorder treatment click here.
For more on hair pulling (trichotillomania) treatment click here.

The post Child Version of Picking & Pulling Log appeared first on Courage Counseling, PLLC.