When trying to understand here pulling or skin picking, people often try to figure out why those behaviors are occurring. It might be that you, as the puller, want to know what things are related to your action; it might be that you, as a family member of someone who picks, want to know why your loved one is seeming to “do this to themselves”. It’s common to make the assumption that these behaviors are “nervous behaviors” and are therefore related to anxiety, but there are actually many reasons that someone might pull her pick. Here are the top ones:
1. Responding to an urge – Someone might have an unquenchable urge to pull or pick. To them, this might feel like an itch demanding to be scratched. An urge to pull a hair may feel like the hair is calling to your fingers, or that your hand simply finds its way up to your head when you’re not paying attention. Not all picking or pulling is done because of an urge (as you’ll see below), but the amino acid NAC (N-acetyl cysteine) may help reduce that urge if taken regularly.
2. Boredom –When people are bored, they are feeling under-stimulated. The drive then is to increase one’s sense of stimulation. This is typically the case for people with ADHD, but anyone can feel bored. Being physically active, talking a lot, playing with an object, moving around restlessly, getting into fights and even pulling or picking can be ways of increasing one’s sense of stimulation. Having something else to do, or trying out a stimulant-type medication (even caffeine), may help reduce pulling or picking in this case.
3. Anxiety – For some people, anxiety does drive the picking or pulling behavior. When people feel anxious, the drive is normally to decrease frustration, decreased responsibility or increase options. When none of those are available, people often turn to exerting control where they can. Frequently, this means attending to their body. This is relatively hardwired, as even animals will turn to self-grooming when they are stressed and have no other options. Figuring out how to reduce anxiety (stress reduction techniques or anti-anxiety medications) can help with hair pulling or skin picking in these cases.
4. Self-soothing – Even when people are not anxious, sometimes hair pulling or skin picking is perceived as self-soothing. It may feel comforting, familiar or reassuring. The sense of human touch is frequently perceived as reassuring and soothing. In these cases, finding something else that is also soothing may be helpful.
5. Visual trigger – Some times people find that a visual trigger is an irresistible call to action. Seeing an eyebrow hair out of place, seeing a blackhead, whitehead or red spot on your skin, or seeing a small healing scab might be interpreted as something out of place and therefore needing to be removed. Learning to not look in the first place, or, better yet, to tolerate visual differences on your skin is helpful in reducing picking or pulling in these cases.
6. Tactile trigger – As above with visual triggers, people can be triggered tactility as well. It may be that people are triggered by an incidental touch, or they may “graze” over their skin looking for a blemish or imperfection. Keeping your hands away from your face, wearing long sleeves or, better yet, learning to tolerate the feel of imperfections on your skin can be helpful here.
7. Perfectionism – In this case, we are talking about perfectionism that is broader than simply with one’s hair or skin. Technically, visual and tactile triggers can be thought of as offending a sense of perfectionism. However, there are people who pull or pick with the conscious awareness that they are trying to create a sense of perfection. Learning to tolerate imperfection, or, better still, creating an imperfection and leaving it alone can be helpful in these cases.
In addition to these “reasons” for pulling or picking, there might be environmental conditions that permit or promote that activity as well. Usually, these are conditions that either promote anxiety or boredom, or promote a decreased awareness of what one’s hands are doing. Conditions that fit into this latter category include watching TV, talking on the phone, driving or riding in the car, falling asleep or waking up, and grooming in the mirror.
Between these two (reasons and conditions), you can find the majority of your answer to Step One of Habit Reversal Training: the question of what makes you vulnerable to pulling or picking.