dermatillomania

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.

stressed but not depressed

It’s been a few months since I had a true depressive mood swing. I have been a little melancholy a few times, my concentration is terrible, and I have had anxiety issues. However, my overall mood has been pretty even since December. I’m almost not sure what to do without having the feeling of the dark cloud following me. It’s easier to accomplish things and make decisions when you don’t think your world is going to end tomorrow.

I have been stressed, however, because it’s been rather busy lately:

      • We successfully found a new psychiatrist for my daughter; the doctor has plans for treating her ADHD along with the bipolar-or-maybe-schizoaffective disorder. I hope the doctor will be responsive to messages or phone calls in case things change or don’t work well.
      • We had roof leaks probably caused by ice dams on the roof. We had contractors and insurance people here last week, which was the easy part. The hard part was dealing with the three very loud fans which operated for about 5 days straight to dry out the ceiling. The three of us and the cats almost went nuts.
      • Our dishwasher died, so during the middle of the leak mitigation we had a new dishwasher installed. Actually, the second dishwasher was successfully installed; the first one was 1/2 inch too tall for the cabinet space. We bought from a local small business, so it was easier to work with them than it would have been with the orange big-box hardware store.
      • We have airline credits that expire at the end of March because we canceled a vacation due to Covid in 2020, but a major airline (starts with A) will not extend the date to use the credits. We really had no plans of going anywhere, and during spring break time it would cost more to stay somewhere fun than it would to just lose the credits. Instead, we are going to visit my mother for a few days. I haven’t seen her in over 4 years (since the Butterfly Incident), and she would be happy.

Anyway, off to work (at home), where I will fight boredom and struggle to stay focused on tasks. Yay.

mindfulness update: opening the book

I finally read the introduction and first two chapters of the book, but I have not actually done any exercises yet. My library wants the book back, so I might buy a used copy of the book. Surely some relaxed, anxiety-free person on Ebay or Bookfinder has an old dog-eared copy they would let go for a few bucks.

Here are a few disjointed thoughts:

Quote from the introduction:
… [there are] three common patterns of responding to anxiety … reacting to the painful emotions of anxiety with … self-criticism and judgement; then trying to escape the anxiety mentally; and finally, when that doesn’t ease the discomfort, trying to avoid whatever triggers the anxiety.

That sounds like my behavior in stressful situations. I have learned how to avoid many things that cause me stress, however I also miss out on things that might be beneficial, such as opportunities for professional advancement or just for fun.

The authors claim that mindfulness is a method of dealing with anxiety that will help me overcome fears and will provide me with a sense of fulfillment.

It turns out there are audio exercises to go along with the text in the book (well of course there are), but the link led to a defunct website. After some googling, I found the exercises at the publisher’s website. There are some short exercises, then there are longer ones lasting up to 37 minutes. I cut my mother off at 30 minutes on a good day, so there’s no way I’m listening to someone drone on about relaxing my muscles for that long.

Another interesting quote: “… we might recommend particular coping strategies that seem counterintuitive or that don’t immediately strike you as likely to be effective for you. We know from our own experience that sometimes all of us prematurely judge and dismiss information that doesn’t fit with how we typically view ourselves and the world.” This describes exactly what I am thinking about mindfulness right now.

money or sanity

Fuck it, I’m going to post it anyway.

There have been many changes in the past two years at work. First there was an incident where a big pipeline exploded (thankfully no one was injured or killed). There were changes in business and construction practices resulting from the explosion. There were changes in management, and employee losses through an early retirement offer to dozens of people. Then the pandemic forced almost everyone in my building to work at home.

Through it all, we just keep working, drawing construction plans, lining up contractors, and getting jobs constructed. We are well paid, we have good benefits, and we are fortunate to have continued working when many others were laid off or had their jobs simply disappear.

But I’m fucking miserable. I hate it. I want to leave.

We get more and more responsibility and workload without the hope of additional people to help. We get new requirements that make projects harder to complete, but we are expected to meet target dates. I can just barely do my shift because I am so stressed out and angry. I don’t enjoy what I am doing. I don’t like getting up in the morning and turning on the computer. I think about work when I’m trying to relax. I dream about unfinished jobs and missed deadlines. My anxiety is off the chart right now.

I looked online at different jobs on the internet this week, but that was rather discouraging. Any opportunities that exist right now would cost me as much as one-third of my current take-home pay, and would have a smaller benefit package. There’s nothing out there that is close to being as good as what I have right now, and there is no situation where I would be able to manage my mental health issues the way I am at the moment.

I talked to a friend from work Friday, and it turned out he is having the exact same conversation with himself. He feels the same way, but had a little insight for me on how to help my attitude and not get myself in a frenzy over it. He reminded me what I would be giving up by leaving this job behind without a better opportunity. He talked me down from the ledge a little, and I felt a little better about things.

Then yesterday and today happened, and I’m freaking out again.

I have zero confidence in my ability to do my job and stay sane at the same time. My supervisor is understanding, and he tells me it’s okay to talk to him when I’m feeling stressed. But of course he doesn’t know the whole story about my mental health, and I didn’t tell him I’m ready to leave no matter what it costs me.

Then there is my wife, who understands my feelings and does know the whole story. But she also told me to consider what we would be giving up, and would any other opportunities be any less stressful?

Then again, what happens if I have a meltdown and can’t work at all? Who’s paying for psychiatrist appointments and medication for myself and my daughter if I’m having a breakdown? So many questions, no answers, and another fun day of work on tap for tomorrow.

The whole house of crazy cards is teetering and ready to fall.

working with bipolar

Working with bipolar is a challenge for anyone whose symptoms are bad enough to impact their ability to work, but not severe enough to be on disability. Bipolar can limit one’s ability to work, or it can limit the ability to work at 100% during the work hours. It affects job performance, making it difficult to concentrate and complete tasks.

In my case, I went through a period before and after my diagnosis where I was not able to work full time. When I was working, I was in a constant state of mental stress, making it difficult to concentrate and perform at a high level. This affected my work relationships, my income, and in one job it got me a demotion to a lower job classification. Now, even with mostly effective treatment, I still struggle with working full time every day.

As an engineer I have always had a mentally taxing job, solving problems and working with computers. I’m pretty good at my job, not great, but I fool most of the people most of the time. At the same time I have this “other thing” going on in my brain, an illness which occupies a majority of my thoughts and mental energy while I am trying to get work done. Bipolar intrudes upon my thought processes, interrupts my work flow, disrupts my concentration, and affects my relationships with coworkers to the point where I wonder how I accomplish anything during the day.

Imagine being asked to work at a physical job, but with one arm tied behind your back. Think of the frustration and anxiety caused by knowing how to do a job, and having your best efforts be inadequate, but knowing you could so much better if it weren’t for this unseen force holding you back. That’s what working with bipolar feels like for me: I could do so much better, if I were different.