I have been picking at my fingers since I was a kid, but until recently I didn’t know there was an actual name for this. Dermatillomania is a real disorder in the DSM-5, and is diagnosed when someone causes repetitive injury to the skin through scratching, picking, or biting that results in an injury, with an inability to stop. It is related to OCD, but differs in that people with OCD perform compulsive actions to relieve anxious thoughts, but skin-picking is often more pleasure or sensory-based. [Link]
Picking at my fingers is something I feel the need to do despite the pain, blood, and embarrassment. I find visible or perceived imperfections and have the urge to pick the target area. I also look for fingers that seem “too perfect”. I pick at and mutilate my fingers and cuticles, usually with a fingernail, my teeth, or tools like tweezers or a push pin. There is never a time when my fingers don’t have some level of injury, and I have permanently damaged a couple of fingernails due to the repeated picking.
It’s an uncontrollable compulsion that is always present; in the moment I know what I am doing, and I know I should stop, but it feels good to remove that imperfect piece of skin. However I can’t always remove just the imperfection, and I make the problem worse. I know when it is going to hurt and bleed, but I follow through anyway. I do it even though I know my fingers will look horrible to anyone who notices. Sometimes it is bad enough that I have to use band-aids to stop the bleeding or to help heal the raw areas. When I take the band-aid off, the skin is moist and pliable, and sometimes I go right back to picking in that spot.
I think the urge to pick increases during stress or anxiety episodes, or during a hypo or mixed mood, but I pick when I am feeling well also. I keep score of how many fingers are bloody at a given moment, and it correlates directly to my anxiety level. Today my score is a 6, but tomorrow it could be 7 if there’s a nice juicy cuticle that needs picking. Sometimes I can temporarily will myself to stop picking, or put off the urge, but eventually I will do it anyway.
It’s not a harmless habit, but in the big picture it is a minor problem. In the moment I enjoy the picking, but later I regret doing it. Having people see my bloody and mutilated fingers is occasionally embarrassing, and covering multiple fingers with band-aids is noticeable, but I don’t seem to obsess on that thought.
I searched for ways to help stop this behavior; several resources focus on combinations of therapy (sometimes CBT) and stress reduction using mindfulness (oh fuck, not that again). The Cleveland Clinic even suggests substituting different behaviors such as going for a walk. One, I can pick my fingers while walking; and two, if I could substitute another less harmful behavior, I would already do it. I’ve thought about wearing a rubber band on my wrist and giving myself a good snap, but that would be less satisfying.