I'm excited to announce that my new book, Skin Picking: The Freedom We Found, sequel to the groundbreaking Skin Picking: The Freedom to Finally Stop, is now available. Here is an excerpt consisting of the first twelve pages of the book.

Introduction

According to the TLC Foundation for Body-Focused Repetitive Behaviors (BFRB.org), “2%–5% of the population picks their skin to the extent that it causes noticeable tissue damage and marked distress or impairment in daily functioning.”

That amounts to millions of people. I was one of them.

For a couple of decades, I thought I was the only one. Throughout my twenties, I pretended to myself that it wasn’t a problem, even though I didn’t like having to cover spots on my skin with concealer, and, in the summer, wear only long shorts and T-shirts to hide marks on my arms and legs.

Year after year, I tried to stop, casually at first.

I was a research scientist by profession and, in this case, I was also the laboratory. I made a few observations early on: Aerobic exercise, like a good hip-hop dance class, made it better. Leaning into the mirror to squeeze pores on my face led to instant tension in my shoulder muscles and shallow breathing. Keeping a mini notebook in my bathroom to record when I picked my thighs on the toilet quickly led me to stop that, at least for a while.

The fact that I couldn’t seem to stop, despite short-term partial successes, made me feel bad.

In my thirties, picking became a problem that also manifested physically, more deeply than on my skin. To provide income to help me transition from a career in chemistry to a new one I planned in writing, I learned massage therapy.  I injured my forearms almost immediately because my forearm flexor muscles were so tight from repetitively gripping my fingers to squeeze my skin. The injury would not quickly resolve so I quit.

Luckily, I was able to go back to teaching chemistry. Yet despite doing exercises and self-massage to rehabilitate my forearms, they ached every time I wrote on the blackboard for a year and a half.

My skin started scarring, too. Although I had also caused visible damage when I was younger, back then, the marks would heal perfectly with no scars. Not anymore.I started to get more serious and methodical about trying to stop. After a year of teaching high-school, I did very well during my summer off, employing techniques including keeping a log of my picking, which I learned from a habit-breaking book, and weeding a garden to quiet my hands and soothe my mind by being surrounded by plants.

But all my progress was erased within a month of returning to full-time teaching. I tried to ride my bike to the beach and do other things to salvage the balance I had achieved over the summer, but with a busy schedule and the stress of teaching, I found it impossible to retain my momentum.

The following summer, I accelerated my self-help journey and learned meditation and yogic breathing and chanting, which, over time, had a transformative effect on me. The following year, without even trying to stop picking, during a one-month stint at a yoga teacher training program, I almost didn’t pick at all. Yet again, after returning home to a bathroom that was all my own, and a life in which I had to focus on earning a living and I wasn’t in a natural setting doing eight hours of stress-reducing, yoga-related activities every day, the picking crept back.

I had learned a lot in theory, but none of it was enough. I kept relapsing.

The turning point came months later, in 2010, when it finally occurred to me to search the Internet. I discovered a therapy group specifically for people who either picked their skin or pulled their hair at the OCD Center of Los Angeles, just fifteen minutes away.

I was accepted to the group and learned a few crucial things. One was that I could get better. On my own, trying to stop for decades, it hadn’t been clear to me that this was possible. But I could see that other women in the group were doing it, and I began to do it as well. I learned new practical strategies: I covered my mirror and began putting bandages on my fingers and wore my fleece zipped all the way up when I was home. Another key thing I learned in the group was that if you tolerate urges without doing the behavior, they eventually go away. Finally, no less important was the intangible healing power of being in the company of other women who had the same issue.

During the five months I was part of the group, as well as on my own afterward, I continued to explore and learn about things that could help me, from dietary changes to the Emotional Freedom Technique (EFT). Over time, my skin-picking behavior became so minimal for so long that I finally knew I was free from all the suffering I had experienced at its hands (my hands!) in the past. To this day, my body still gravitates to picking in moments of mindlessness and stress, but when I recognize what I’m doing, I take my hand off of my body or step back from the mirror.

I’m not complacent about my freedom from skin picking. Difficult times are inevitable in life, and I can certainly imagine devastating personal events that might tempt me to go back to the old comfort, the old escape. But I also know that I have other options, and that all the tools I used to attain freedom from the behavior in the first place are always available to me in case I ever start picking compulsively again.

A couple of years after starting therapy, I completed a health coach training program and designed a coaching program to take others through the process of stopping picking. To my delight, it turned out to be completely adaptable to all manner of people with different circumstances and picking habits. People found that their lives were transformed. They were grateful because there wasn’t much help available in most places, and they finally got what they needed via videoconferencing with me. I was similarly grateful because I had never had a job where I felt so profoundly useful.

Although many people suffer from this disorder and seek help from dermatologists, general practitioners, psychologists, and psychiatrists, skin picking was not designated as a disorder in the Diagnostic and Statistical Manual until the most recent edition (DSM-5) in 2013, at which time it was classified under the umbrella of obsessive-compulsive disorders. At the time, very few medical and psychological professionals had any idea how to help patients with the disorder. There was also no single full-length book devoted solely to the topic, with the exception of a memoir, Angela Hartlin’s Forever Marked.

Almost from the beginning of my coaching career in 2011, I wrote handouts for clients to read between sessions. These would form the backbone of the book I planned to write.

One day, I was cleaning my apartment while listening to a webinar from the TLC Foundation for Body-Focused Repetitive Behaviors. It featured the founder, Christina Pearson, and I heard her say, “There’s no book on skin picking, so if anyone out there wants to write one….”

“I’m working on it!” I hollered, though the only one who heard it was my cat. Although Cookie’s response was underwhelming, I kept writing.

My first book, Skin Picking: The Freedom to Finally Stop, was released in 2014, nearly seven years ago. Thousands of people have read it. In addition, with my coaching services, I have personally helped hundreds of women (and about a dozen men) find freedom from skin picking. Each one has their own unique journey, yet there are many similarities.

One unfortunate similarity is the fragility of our hope when we’re stuck in the thick of this compulsive behavior. When we pick less, we feel better. We are hopeful, but only for a time. We tend to completely lose hope as soon as we inevitably start to pick again. We become discouraged and stop taking the actions that were helping us.

The road to recovery is bumpy. We need to expect slip-ups and setbacks and stay hopeful because that is essential to keep us returning to the long-term efforts needed to reverse the progress of this disorder.

How can we stay hopeful? We work at it, giving ourselves new encouraging input. Some people have told me they read Skin Picking multiple times to help them stay positive, to glean new insight they weren’t ready for in previous readings, and to be reminded that full recovery is possible.

That book includes a longer description of my journey and a systematic roadmap of tools and techniques that are helpful for my clients.

The purpose of this book is to offer you a variety of perspectives from people who are on or have been on the same journey to freedom. There are many ahead of you on the path, and their stories, suggestions, and guidance can provide continual inspiration and comfort for you.

In contrast with looking to social media for company, which often leads to more hopelessness than hope, this is a “best-of-the-best” compilation of helpful information and inspiration in a single readable (and rereadable) book.

The material in this book has come from various sources. I sent a survey to my email subscribers, fifty of whom generously responded. I am especially grateful to those of you who wrote detailed paragraphs of insightful information. I hope you enjoy seeing your contributions here and I trust that they will be valuable for others.

Another source of material was interviews with my clients on my YouTube channel. I liberally extracted from these transcripts, and, in two cases, conducted follow-up interviews to see how the clients were doing a few years later.

I’ve shared experiences from my clients (with their permission). Occasionally, I include quotes from people who emailed me personally, or publicly reviewed my other book, eager to share what they’d learned with the world.

I’ve occasionally incorporated material from social media, usually from comments made on my YouTube videos pages. In case anyone objects to being mentioned, I’ve changed people’s names.

Not everyone quoted has fully recovered. However, regardless of where these contributors are in their journeys, I’ve included all their contributions that seemed helpful.

I have taken the liberty of editing quoted material for grammar, usage, spelling, clarity, and readability.

This book is meant to be educational and inspirational. It is not to be taken as medical advice. Do not hesitate to seek out the proper medical and psychological care you need.

I hope you find this book chock-full of all the goodness your body and soul are craving. You are beautiful and whole, whether you realize it yet or not.

Love and support,

Annette

Chapter One: The Shame of it All

It is autumn 1989. Christina Pearson is thirty-three years old and living in Santa Cruz, California. She has been pulling her hair out since age twelve and picking her skin since fifteen, and it has been absolutely devastating.“

I was told when I was very young that I was quite intelligent and could do just about anything I wanted,” she says. “But I couldn't. I couldn't stop my body from engaging in these behaviors.”

One night, Christina was up for hours at the bathroom mirror. “I picked the shit out of my face,” she says. At about midnight she got in bed, where she pulled her hair. Afterward, she cried herself to sleep, and upon waking, had a vision of herself. “I was old and dying, and I was bald and my face was scarred. The worst part was that I was cold and there was nobody around.”

Christina understood her vision of dying alone to be a message:

If I don’t get real and honest about what is actually happening in my life right now, that will be me.

I woke up in terrible sorrow. My heart was fracturing and I got out of bed and on my knees. I was naked and crying. I started talking to God and I got angry. “Why did you give me this?” I knew then that I needed to own every part of my life, because I believed my life was a gift. I was sober three years, and in those three years had worked hard to fix the things I messed up at, learning to be honest.

Christina had just had enough. A switch flipped inside her and she made a fateful decision: if this was a part of her life, she wasn’t going to hide it anymore. “I started telling people I have this problem,” she says.

That morning, she went to an AA meeting and told the group of fifty people what she was doing. A handful of them came up to her afterward and told her that they were struggling with the same behaviors.

By January, Christina had organized a support group that began meeting weekly.

In May, she received a call from Channel 4 News in Seattle. They were doing a show about trichotillomania. The producer said, “We know you pull your hair and want to know if you'd be willing to speak about it.”

Christina had no idea how they knew, but she flew to Seattle to do the show.

“For me, it was unacceptable that there were no resources,” she says. “I had a business with an answering service and a voicemail system at the time, so I took a telephone number with me, and I said, ‘Put this up as the Trichotillomania Hotline.’ When I got home, I had more than 600 messages. That evening and the following week, I got more calls. People were desperate and crying.

“It cost more than $1,000 to call people back, but it was the best therapy I ever did, because I was hearing, out of other people's mouths, my experience.”

This sense of connectivity gave Christina a profound sense of relief, because, she says, “Although we're told we're not alone, it's very different from the direct experience of hearing from people who get what's going on.”

As you read this book, though you won’t hear other people speaking directly to you as Christina did, I hope you will experience the same sense of connectivity and relief from reading their words.

Jayne experienced this phenomenon through reading: “I remember reading something about getting ‘lost in the mirror’ when I was in my thirties, and I was relieved to know that I was not the only one.”

Disorders like skin picking thrive in isolation. They are behaviors that become more severe and affect us on a deeper level when compounded by shame, self-blame, and the feeling that we are alone in this particular misery.

“The biggest thing for me was the shame that I carried around because of skin picking,” says Jodi. “It was like a cycle where the shame would trigger it and I would do it and then I would feel more ashamed.”

“I didn’t tell anybody about it,” says Genevieve. “I kept a diary every single day, and I told everything to my diary but I wouldn’t tell my diary about my skin picking, I was that ashamed.”

Most people who pick their skin feel ashamed about it. Of the people who come to me for coaching, nearly all are ashamed at the start of our work together. But shame can be shed. It can dissolve. Shame is optional.

We don’t have to be ashamed. The truth is that the behaviors we refer to under the umbrella of skin picking—scratching, digging, peeling, squeezing, popping—are normal grooming behaviors that have gone awry for some reason or another, or often for a combination of reasons. Almost everyone picks a little.

Animals do it, too. Monkeys groom each other for hours; it’s an everyday social ritual.

Grooming behaviors can frequently get out of hand with animals, too, especially when they’re stressed. Lab mice and rats commonly “barber” or overgroom their fur, even to the point of infection. Cats and dogs do it. Chickens in captivity sometimes pluck their feathers out.

So many people engage in these behaviors that, at some level, there is actually a lot of understanding out there. Most people at least relate to finding it hard to resist popping pimples, picking a bit at their cuticles, or biting their nails.

Daniel says that after stopping picking, he noticed that, “In meetings, when I started to look around, there were so many people biting nails, pulling hair, picking skin. I never realized that before because I was busy picking my own skin.”

We live in stressful times. Our stressors include isolation, not enough exposure to nature, not sleeping enough, eating too much processed food, sitting too much, being exposed to too much electronic stimulation, suffering from information overload, getting too little exercise, pharmaceutical side-effects, and societal factors such as traffic and people being rude (because they are stressed, too).

All of these strain our bodies and nervous systems. I could go on, and I haven’t even begun to mention the stress we create with our thoughts. No wonder we’ve come up with all sorts of potentially addictive coping mechanisms like skin picking.

I hope understanding that normal behaviors can easily spin out of control is already reducing the shame you feel. Sometimes we simply need to be presented with information that’s at odds with what’s been rattling around in our heads (possibly for years).

I want you to know that your picking does not mean you are weak, of poor moral character, at fault, or guilty.

Are you liking it so far? There's a lot more in the pages that follow! Purchase the book here.