By Katie Waits
*TW ÔÇô Discussions of Body-Focused Repetitive Behaviours (BFRBs), dermatillomania, and trichotillomania*
“Can you all please turn your cameras on?”
That’s such a familiar request nowadays. Some days, I’ll be happy to switch my camera on in a seminar. Other times, I dread those words. It usually means an hour of fidgeting, sitting at an awkward distance from the camera, constantly tilting and repositioning my screen in a bid to hide my skin.
The last few years of high school were among the most stressful, and this stress always showed up on my skin. The anxiety of exams, friends moving away, and university applications meant that my skin suffered and I hated it. I’d stare in the mirror or look at photos of myself and feel horribly self-conscious. It also didn’t help that I picked at my skin. Whenever a new blemish appeared, I’d pick at it. At the time, I didn’t think it was an issue. I mean, everyone probably picks at their skin from time to time, right? I thought it was normal.
That was until my hands began drifting to my face or my neck in class, while I was reading, or talking to my friends, without me even realising it. Afterwards, my skin would usually hurt. I still didn’t think it was a big deal, even when people started noticing and pointing it out, telling me to stop. No matter how good their intentions might’ve been, I’d get extremely irritated whenever someone told me to move my hands away from my face. Spots and scratches would pain me longer than they should have and would take ages to heal properly. Dark pink patches and scars wouldn’t disappear, becoming a permanent feature on my face, back, and neck.
When I started university, it got worse. With the worry of all of the change, my skin was in terrible condition. Meeting new people and trying to make a good impression made me all too aware of my appearance. I remember walking to lectures, the JOMEC building being quite a walk away, with my bag rubbing against the painful patches on my shoulders. Back at home, I would stand in front of the bathroom mirror for ages, looking for problems to ÔÇÿfix’. Regardless of the skincare routine I kept, I just couldn’t stop picking at my skin. At this point, I was fed up and extremely miserable.
Desperately wanting some advice, I booked a doctor’s appointment. I wish I hadn’t bothered. With my mum sat next to me, I told the doctor about my dilemma, how my skin was always sore, how I couldn’t stop touching it. In response, he told me it was just a habit that I needed to break, maybe I needed to buy a fidget spinner or something. It’s safe to say I was horrified. Of course, it’s fine to use a fidget spinner if you need to. Fidget toys do work for some people. However, at the time, they were something kids played with in school, something funny, a meme. Plus, by dismissing it as a habit, I felt like I hadn’t actually been listened to. I left the appointment dejected.
Looking back though, that is hardly surprising. Many people don’t really know what Body-Focused Repetitive Behaviour is, and if they do know, it is not usually taken seriously. Body-Focused Repetitive Behaviours, also known as BFRBs, are a group of related impulse control behaviours that include but are not limited to: skin picking (dermatillomania); hair pulling (trichotillomania); and, nail biting. They are certainly not just a habit. Damaging, difficult to overcome, and painful ÔÇö they can greatly impact people’s lives. Triggered by anything from boredom to stress, BFRBs can often take up a lot of time. Sufferers become fixated on what they’re doing and are not doing it to deliberately cause harm to themselves, and are certainly not doing it to annoy you. It has been suggested that as many as 1 in 20 people may be affected by BFRBs. Unfortunately, they are often misdiagnosed, undertreated, and terribly misunderstood. This lack of awareness has meant that people who experience BFRBs are frequently, and wrongly, seen as disgusting, unhygienic, unattractive, and embarrassing.
Discovering that there are actual terms for my behaviour has made me recognise that I’m not alone with this issue. I’m not weird or gross, but that doesn’t mean it’s not challenging. I still continue to struggle with my skin-picking behaviour today, particularly when I have a bad breakout. Resisting the urge to scratch at my skin, even when it may look okay, is incredibly tough ÔÇö and I get angry with myself a lot for giving in to the impulses. Living through a pandemic with a BFRB, where you’re advised daily against touching your face, has proven exhausting. It’s like having a constant argument with myself ÔÇö knowing I shouldn’t touch my face and constantly fighting against the impulse, but if I don’t give in to the urge eventually, it will gnaw at me all day.
If I walk past a mirror, I have to actively tell myself not to look for too long ÔÇö I’m still working on that. When I grow my nails long, I have to make sure they’re not too sharp. Yes, I’ve heard it all before, having long nails sounds counterproductive but strangely, as long as they’re filed, I find it’s more difficult to pick. Also, eventually, I did buy a fidget cube. I don’t use it much, mainly because the buttons that distract me best make a clicking sound that may bother people around me. However, it’s there if I need it!
I have good days and bad days, good months and bad months, and I’m beginning to learn that that’s okay! BFRBs are draining and tiring, but it doesn’t mean that you’re dirty or disgusting. There are ways to deal with them and if you struggle with BFRBs, or think you do, as clich├® as it may sound, you’re not alone. I’ve written this piece because I’ve hardly encountered awareness for BFRBs. They’re pretty much invisible, with such an unfair, ignorant stigma. Please be patient with and supportive of the people who exhibit these behaviours. Believe me, they’re trying their best.
Interested in reading more from this series? How about our most recent articles in Invisible Illnesses:
ÔÇô┬áInvisible Illnesses V: Living With a Depressed Parent
ÔÇô┬áInvisible Illnesses IV: Coming to Terms with My Complex PTSD and What Comes with It
ÔÇô┬áInvisible Illnesses III: Learning More About My Mental Health Than I Learnt From My BSc
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