On Dermatophagia: Part 3, More Therapy

The third installation in my series on dermatophagia and dermatillomania.

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If you've just come across my blog and would like to read the first two entries on these disorders, go here.

Since the last post I made about my experience with therapy, a couple of important things have happened. First, I have been trying to do daily relaxation exercises to bring down my arousal levels, especially while at home and not with my boyfriend, which seems to be when I bite and pick most. Second, we've begun to discuss the idea of Habit Removal Therapy. I'll tell y'all all about that, too.

So. I've still been logging all my biting and picking. It's become a habit to think about the fact that I need to write down when I bite or pick, but it's sometimes quite frustrating to have to write things down. For some reason, that doesn't seem to be much of a deterrent from actually doing the behavior. On the bright side, however, I feel a lot more aware of what I'm doing to myself. I don't feel as much like I bite or pick completely absent-mindedly, to the point where I'm not really aware of what I'm doing. It's a step in the right direction anyway.

The second time I went to Dr. Longpre, my therapist, we talked a lot about relaxation as one method that might help me to overcome my biting and picking problems. We did a long relaxation exercise in his office. I almost fell asleep, as I was pretty sleepy when I got to the office anyway.

BASIC RELAXATION EXERCISE: THE LONG VERSION

1. Get into a comfortable seat-- you're going to be there for about 15-20 minutes. Close your eyes.
2. Begin by turning your focus to your hands. Make fists as hard as you can and hold them for awhile, focusing on the feelings of tension and any other feelings you might experience (physical or emotional if the case may be). After a few seconds, release your fists and focus on how it feels as your hands return to a relaxed state. Repeat once.

NOTE: If you do wish to try this at home and aren't skipping this whole listamajig, I'll let you know that the rest of the steps are basically just like step two, so I will from here on out tell you what body part to focus on/tense/relax and how you're going to do it. Every step should be repeated once.

3. Forearms: to tense them, bend your hands toward you.
4. Shoulders: to tense them, shrug and hold it.
5. Forehead: to tense, raise your eyebrows.
6. Eyes: to tense them, close your eyes really really tight.
7. Mouth: purse your lips.
8. Jaw: bite down just hard enough to create tension
9. Chest: deep breath in and hold it.
10. Abdomen/Stomach: suck in your tummy.
11. Thighs: id you're in a chair, lift your feet off the ground so that your legs are in a straight line.
12. Calves: with your legs back down, bend your feet toward you.

13. Once you've done all of the body parts-- repeating two sets of tension and relaxation for each-- go back and focus on each body part one more time. You don't have to tense and relax again; you can just think about the respective feelings.
14. When you're done, sit still, eyes still closed, and focus on your breathing for about two minutes. For this reason and the fact that there are a lot of body parts to remember, it may be helpful to have a significant other/patient friend/whomever to help you. Of course, it's not necessary and if you don't sit exactly two minutes you're not going to explode. So, sit for that two minutes, breathing deeply. With every exhale try to think the word "calm" to yourself.
15. Open your eyes. Proceed with life.

Whoo! That was long, eh? Anyway, I was supposed to do that every day for awhile, which happened sometimes and didn't happen on others. I'll be straightforward about that. I will say, however, that the process is very relaxing, and I'd recommend trying it if you've got some free time and feel like chilling out.

On the next visit, Dr. Longpre told me about a shorter version of the aforementioned relaxation exercise, which is basically (no enumerated steps necessary, I don't believe) to just focus on all those body parts, breathing calmly and generally relaxing. You don't have to tense them or do repetitions. Also, when you get to the end to do the breathing exercise, instead of a silent couple of minutes, simply count back slowly from ten to one. Every number you go down, imagine you are descending further into some kind of metaphor for relaxation, i.e. picture yourself going down in an elevator (often not very relaxing for me, unless I also go through the trouble of imagining muzak) or falling lightly through clouds or something of the sort. Marshmallow fluff, whatever floats your boat. So, if you want to do some relaxation process but don't want to have it take up 20 minutes, this is your exercise.

Also, remember when you're relaxing to do your best to dismiss any thoughts that don't relate to the exercise. Let them come into your head, but don't follow them.

Now, the really interesting part about this entry, and the most exciting part for me, concerns the Habit Removal Therapy process. Dr. Longpre and I discussed how this process will start and hopefully be amazing and something I can follow through with.

In a very basic sense (and it's a very basic, intuitive process, really) we're just going to introduce a behavior that is incompatible with biting and picking. For instance, we agreed that every time I feel the urge to bite or pick, I will make fists with both hands. I mean, you might fear that you'll look a little weird making random fists in public, but no one will probably notice anyway. The idea is that once I get the urge and make fists, it is impossible to bite or pick while the fists are held (for about 30 seconds, he recommends). It is very important that I also do the incompatible behavior every time. Serious stuff. No biting. No picking. At all.

In theory, pretty easy. In practice, I think it's going to be very, very hard and emotionally taxing. Dr. Longpre said that I have to start when I believe I'm ready (just like someone trying to quit smoking, start a diet, stop drinking, etc.)

I haven't believed I'm ready yet. The idea of changing the behavior is both extremely exciting and rather terrifying. When I think about it, I think back to a few weeks ago when my boyfriend saw me about to bite and grabbed my hands. There was a piece of loose skin I had been priming to bite just hanging there, taunting me. For some reason still unclear to me, I could not deal with seeing that piece of skin and not biting it. The tension and anxiety welling up in me became nearly unbearable surprisingly quickly. Since I never really prevent myself from biting or picking, I'm not really too familiar with what it feels like to really be restrained and told "no." But for once, instead of just telling me not to, my boyfriend physically restrained me. I thought I would cry. That kind of feeling of panic and desperation I experienced in those couple of minutes was so animal, foreign, and childlike (practically begging and throwing a mini-tantrum to get him to let me go so I could do what I "needed" to do). The thought of being so intensely uncomfortable for awhile is unpleasant. I know it will probably be a big help and that if I stick with it, I could be free of the discomfort of the very desire to bite and pick, but the idea of that temporary discomfort is terrifying.

I don't know when I'll be ready. The plan is always hanging there in my head, ready to be put into action. I just don't know when. Sometimes I doubt if there will ever be a real "ready." Maybe I just have to give it a shot and see where it goes.

I'm going to do it, and I'm going to keep you updated. I don't know when I'll write about this next, as I think the Habit Removal process will be the next "big topic" to discuss with you, but if you're interested, do send me an e-mail and I can let you know next time I put a post like this up.

You can send me e-mails at vformato@clarku.edu. I've received a bunch so far, to my surprise. Thank you for those. You can't imagine the warmth and happiness I feel when I get an e-mail from people with dermatophagia or dermatillomania to tell me their story. It's amazing, really. Also, anyone who's been commenting, thanks for that, too. The original post I made got so much more of a response than I thought it would. Thank you all for helping me to know that doing all of this is worthwhile to other people as well as myself.