My Finger Picking Compulsion Feels Just Like an Addiction

The emotional consequences of body-focused repetitive behaviors

Image by (El Caminante) from Pixabay

I’ve been a finger picker for 37 years. I was in middle school when I began to notice and pull out flakes of skin around my fingernails.

I can’t remember how long it took for finger picking to become both habit and problem. What I do know is that I was hiding it by the time I was in high school.

Still, once in a while someone would notice a ravaged finger and ask, “What happened to your finger?” I’d come up with excuses like getting burned or having picked at it just once and then getting an infection.

I began putting on a bandaid when a finger looked noticeably damaged — a great solution since the bandaid both hid the injury and gave credibility to my explanation that I’d accidentally cut myself. I’d pick under the table or when my back was turned to others.

While still in high school, I managed to limit my picking to my index fingers and thumbs. Over the ensuing decades, I’ve been able to further narrow down my self-mutilating behavior so that my left thumb is now its only target.

My left thumb became my sacrificial finger.

I don’t want to minimize the gravity of drug, tobacco, or alcohol addiction, but finger picking strikes me as similar in some ways. In fact, I often think I know what it must be like to have a substance abuse problem.

Finger picking has caused me shame and a measure of self-hatred, just as any addiction would.

Like an addict, I strive to hide my habit from others. My husband marvels at how I was able to conceal my mutilated thumb and index finger from him for months before he noticed them. I knew how to perfectly angle my hand so my ugly fingers wouldn’t show when I rested it on a surface or used it to stir, clap, hold, scratch, or whatever.

Like other addictions, finger picking carries some risk since the possibility of infection is real. Unbelievably, it also interferes with daily activities, like when I just have to peel off a bit of skin while driving or when I must be done removing a flake before turning off the stove.

Finally, there’s the question we always ask about addiction: Why, for the love of God, can I not stop?

My failure to stop picking exasperates me. I mean, even people addicted to crack, alcohol and tobacco can manage to quit.

Still, I’ve always sensed killing this habit is harder than I usually admit to myself and that the behavior is associated with my family’s strong genetic predisposition for depression, anxiety, and obsessive-compulsive disorders.

How could there not be a genetic component when three of my five sisters have engaged in serious body-focused repetitive behaviors, as behaviors such as skin picking, nail-biting, and hair-pulling are known in the literature? There has to be a genetic component to my habit.

Every now and then, I bring up finger picking with my sister Lole — whose habit is as bad as mine — and we’ll give each other suggestions. I’ll tell her, “My finger picking’s out of control lately. I need to do something!” Recently, Lole said she’ll squeeze her finger hard ten times and tell herself, “My finger doesn’t want me to do this to it.” She’s esoteric like that.

Last year, I came across an article in The New York Times that explored body-focused repetitive behaviors such as mine. The piece, Fighting the Shame of Skin Picking (9/5/2019), could not have described my experience more aptly:

“These repetitive behaviors typically emerge around the onset of puberty, though they can begin earlier, and are more common in girls and women. They tend to occur along with mood disorders like anxiety and depression, or with obsessive-compulsive disorder. Patients report feeling an urge to pick or pull, followed by a physical sensation of relief or gratification while engaging in the behavior itself.”

The way I feel about my finger picking habit has changed. Though I don’t go around showing people my damaged finger, I’m no longer ashamed. If someone asks what happened to it, I’ll say I have a bad picking habit.

If the person’s really curious, I’ll explain that my thumb looks the way it does due to a decades-old self-injurious behavior. I might also tell them my compulsion, also known as excoriation disorder, actually appears in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), classified as an “obsessive-compulsive and related disorder”.

As all obsessive-compulsive behaviors, skin picking is extraordinarily hard to eliminate. The longest I’ve gone without doing it was around five years ago when I printed out a chart to mark the days I didn’t pick. I told myself that if I managed to go 30 days in a row without picking, I’d give myself a reward. I had to start over many times but eventually got to 30 consecutive days of no picking.

I cannot even remember what the reward was. The habit, though, was not forgotten. It resurfaced. “Just this once” became” just today” until it was back in full force.

The reason I’m writing this piece now is that I’ve been picking in earnest over the past couple of weeks, and have become impatient with myself for my inability to mitigate my compulsion.

I’ve even thought of a terrible punishment technique: For every time I pick, I must donate $1 to the National Rifle Association. This could add up to a sizable donation to an organization I’d love to see defunded. Effective as this plan sounds, I just can’t do it. The thought of it makes me want to pick!

Skin picking disorder feels like an addiction and is more common than you’d think. According to the Harvard Health Blog, it affects at least five million Americans.

If you’re one of them, knowing it’s not just you might make you feel better. It did for me at least. If you’re not, keep in mind that that close friend or family member who picks their skin to death is not weak or totally lacking in will.

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I’m Thankful My Depression Responds to Medication

Because one of its symptoms can be deadly

It all started in my late teenage years, around 1988. I’d had my adolescent ups and downs, exacerbated by the fact that I had scoliosis and wore a hideous back brace all through high school. But I truly came down with Depression half way through college. Yes, come down with, as in coming down with a cold or chickenpox.

You see, my family is a perfect case study of the genetic predisposition for this bizarre malady we call Depression. According to Stanford Medicine, twin studies suggest that “Heritability is probably 40-50%, and might be higher for severe depression.”

One by one, I’ve seen my father, some of my siblings (I have six of them), and a few nieces and nephews come down with depression.

I had already seen what a severe episode looked like in my dad when I was around 12 years old. He hardly ate or talked, as if moving his face muscles were a mighty effort. He did not walk but shuffle. He lost weight overnight and his clothes were suddenly big on him. 

I also knew that my aunt had been in the hospital at least once because of her depression. No one discussed it with us kids, but I’d heard enough to know what was going on. 

Over the years, however, I’ve learned that depression need not appear as obvious as I just described. In many cases, one can function with depression. It’s very hard, but you can pull it off – until you can’t. 

In college, I functioned with depression for a pretty long time. I got As and Bs and was able to socialize without anyone noticing. But the effort this took was monumental.

Eventually, I developed severe anxiety. When I was in a social situation, I could see the interactions unfolding as if from above. It felt like an altered state of consciousness where your brain cannot be in the present. You must harness so much energy just to remain standing, understand what others are saying and formulate a response. 

Most tasks were hard, but the act of socializing was the most effortful of all. Still, as far as I know, no one noticed.

That is, until I came home for a break and either I told my parents or they noticed – I can’t recall which. I went to the psychiatrist that treated my dad and he put me on Med A (made up name!), which actually heightened the anxiety and triggered my first panic attack. 

I can’t say exactly how long the medicating process took. What I do know is that, while still in college, I ended up trying Med B, which worked well for me.

DSM 5 bookUnfortunately, we didn’t get to this “solution” in time for me to avoid the most hideous, most maddeningly cruel part of depression: suicidal thoughts.

Suicidality is considered a secondary symptom of depression, meaning that it need not be present for a person to be diagnosed with the illness.

Depression affects how you feel, think and act. Suicidality, unlike other symptoms, can obviously cause death if you actually act on the thought. Too often, it does. According to the  DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), “Major depressive disorder is associated with high mortality, much of which is accounted for by suicide.”

The trance

Painting of water
Oxygen – Valerie Montague Fine Art

My first suicidal thought came one fine day when I was running under a bridge. I can’t describe it well, because the thought was wordless and revealed itself in an instant. Here’s the best I can do: Would it not be a huge relief to jump off this bridge? Does it not make perfect sense to end this suffering?

From the thought of suicide to the action there is much to overcome, luckily. The natural instinct is to cling to life. For many, there’s the fear of God. I, for one, could not overcome knowing how much my mom would suffer. Plus the thought is not constant, so you move on to the next thing.

Letters from a Stoic book coverI am not unusually afraid of death – for myself or for others. As Seneca, the stoic philosopher, notes, “Every life without exception is a short one.” (Letters from a Stoic) I am, however, terrified of death by suicide, or, to be more exact, of death by depression. 

Suicidality is a trance that blinds you to the possibility that the suffering could end. The trance is so strong that it has this effect even if you know people who have overcome it, even if you’ve gotten over it yourself before! It is indeed a cruel trance.

Since college, I’ve had depression more than once. In fact, it has come back every time I’ve tried to go off medication. This is why I’ve been on meds most of my life ever since I first came down with depression. I’ve wished I didn’t need them, but have accepted that I do. At this point in my life, I’m thankful that a class of meds works for me. 

In my case, suicidal thoughts have been a symptom only twice. The second time was also related to a bridge, curiously. There’s an overpass where you first drive into the neighborhood we used to live in in Caracas. You drive up and, at the top, the overpass forks like a V and you must veer left or right. The thought of driving straight into that angle of the V would just pop into my mind and try to persuade me: It could all be over. Just turn the wheel a little and the suffering will end. 

Hardly anything saddens me more than hearing about a person who succumbed to this trance. As long as there is life, whatever the cause of the illness, however long it may take, it is almost certain that a treatment (and there’s a lot more beyond meds) that works will be found.

I know Depression well and I recognize its approach like a person who gets migraines recognizes an incipient one. You suffer deeply and in a very peculiar way when in the midst of depression. When it lifts, you will of course continue to experience some pain and suffering – just like any human being. But you will also be able to pursue and experience bliss.

A moment of bliss will make it all worthwhile.

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