Meet Heather.

Since her teenage years, Heather tried many skin picking treatments. She went to psychologists and psychiatrists, tried CBT, other types of therapy, and medications, but nothing worked.

Then she found an alternative, me (Annette Pasternak), also known as the "Stop Skin Picking Coach".

For the first time since repeatedly seeking help from this person and that, Heather felt truly understood. After unburdening herself in our Breakthrough Session, she resonated with what I explained she would need in order to recover.

And she trusted that I'd be able to coach her to freedom from the vicious cycle of compulsive skin picking.

Heather is a physician and she was particularly excited to come on YouTube in order to help spread information and education about skin picking disorder, which unfortunately is still almost completely lacking in the medical system.

In the video below, Heather shares her story, including what things have been most helpful in her recovery, and she also shares what it's like to have patients tell you about their skin picking, even as you are dealing with your own.

I'm so happy and proud of her and I can't wait for you to watch:

Video Transcript:

Annette:                 Hi, I'm Annette Pasternak, the Stop Skin Picking coach, and I'm here today with one of my clients, Heather, from Toronto. Welcome.

Heather:                 Hi.

Annette:                 So Heather, interestingly, Heather is a physician, she's a resident doctor there, and so we're going to hear about Heather's journey with skin picking and healing from it, the process of recovering from it. We're also going to hear a little bit about what it's actually like to be kind of like dealing with this, and hearing patients tell you about it.

Heather:                 So my name's Heather, I'm from Toronto, Canada. And I have been dealing with Skin Picking Disorder, or dermatillomania, whatever you would like to call it, for probably since I was 16. I'm 25 years old now, so it's been almost 10 years with this disorder. Like most of the clients that I've seen videos for, I kind of initially self diagnosed myself before I sought help. Again, like most people, this sort of started for me when I was going through puberty, developing acne, and what I heard about people picking at their pimples, but never really tried it, because I didn't really have acne very badly. And then, I went through sort of a stressful time when I was 16 with a breakup, and during that time I did try picking at my skin. And I found that it kind of was a stress reliever, it relieved tension, and I tended to be a person who had lots of habits, and this easily became a new habit. And before I knew it, it was very hard to stop.

                                    And as I started to notice that the damage was harder to cover up with just popped pimples, or marks on my face, I ... at that point, I started to think maybe I do need some help. And at the time, my parents also noticed that I had these marks on my face. So they took me to the doctor, a psychiatrist at the one of the hospitals downtown, and at that time, this disorder wasn't really labeled yet in the DSM, or the Psychiatric Diagnostic Manual. So, I was basically just told I had an impulse control disorder, and that it was mild, and maybe try some therapy. So that was about it.

                                    So the next kind of couple of years, it kind of waxed and waned. Sometimes I would have a week where the picking was quite bad, but I could always usually cover it up with a little bit of cover up, and I kept going to school. I did eventually try therapy in high school. Which was probably just cognitive behavioral therapy. And I found it kind of hard, because I was someone who was really focused on academics in school, trying to get good marks, and I found the CBT homework kind of went to the wayside. And I always thought, "Oh I don't really have a problem." So it kind of went under the radar. And by the time I went to university, and I was living on my own for the first time, it really hit me with a force, this picking. Which it was an issue, but never this bad of an issue. And it was kind of then when it started to get in the way like activities with friends, or going to classes, because I'd have these marks on my face that I would spend up to hours picking them on my face, and then they would subsequently require hours to cover up. And if I couldn't cover them sufficiently, then I really wouldn't want to go anywhere, because I was so nervous about what other people would think.

                                    So, the years kept going by, I kept trying different types of therapies. Nothing really cut the habit. I would go for periods of weeks where I didn't pick, but then I would have very, very bad picking episodes and it kind of went all over again.

                                    So basically, for some context, I'm a resident doctor in Toronto, working. And having been exposed to the medical field, I did end up trying some antidepressants. I thought I do have a history OCD, in addition to this, and anxiety. But after a few weeks and months on the antidepressant, it really helped my anxiety, but not the picking. So I was sort of back to square one again with this picking. And the way that I found Annette Pasternak, is like most of you it seems, I was sort of fed up with this picking, and me and my family members were looking for any ways, new and innovative ways, to try to stop picking. And I thought what made the most sense to me is that this is a habit, so I need to make new habits to break it. And that seemed to be Annette's, one of her approaches.

                                    So, after kind of buying her book, watching a few of her videos, I decided to bite the bullet and sign up. So, here I am after completing her program. Kind of seven months later.

Annette:                 Oh, it's been that long?

Heather:                 I think so, yeah.

Annette:                 Yeah, so great. So we have a good sense of what got you to my program. What has helped? What made the difference? Was it making new habits, and which habits helped you?

Heather:                 So, I think for me what really made the difference was going between therapy and like a health coach, is having someone who checks in with you on a regular basis. I think the trouble with therapy is that the therapist would mention an idea, and by the time I saw them in the next two weeks or so, they wouldn't really bring it up again, so I wouldn't be held accountable. Not necessarily that I needed a punitive approach, but I think that having a health coach, like Annette, where we were meeting on a regular basis, and she would always check in with me on what strategies I'm using and how they're working for me, I found that that was much more of a forward thinking approach, and I think that's what really made the difference for me.

                                    Also, with the coach accountable and keeping track of my picking, I could actually see my progress. Whereas before, I'd done a calendar where I kind of crossed off days where I picked or not, but I'd easily just kind of let it go as soon as I had a couple days with picking. But when I'm actually seeing it in front of myself on my cell phone, on a computer, I found that really nice to know. Like even though I did have a few setbacks, I was actually making progress, which was very nice.

Annette:                 And you're talking about seeing it in a graphical form.

Heather:                 In a graphic, yeah. The other thing is that, with you having gone through something similar yourself, I think there's also that degree of connection, which made the difference for me, both watching your videos and your book, and in our sessions together. It's just nice because a lot of the psychiatrists or psychologists that I had worked with before, and not they're ill meaning, they just really didn't know much, or had never treated someone with this before.

                                    For myself, as a doctor, in my medical training I have, in the past, worked with patients, some of whom I even recognized did have this disorder. And I just think that right now it's still kind of in the early stages of ... there's not a lot of options, at least medically, within the medical system, for treatment of Skin Picking Disorder, apart from things like cognitive behavioral therapy, and medications, which I tried and, for myself, I found that it wasn't completely sufficient. So that's kind of why I looked to other options, such as your program.

Annette:                 I'm glad you did. So, yeah, you've done really well. So, what do you feel like is different in you? Either like, has your perspective shifted, and how? Or has your life changed in certain ways?

Heather:                 I think perspective is kind of an interesting topic, because for me, and issue that I had was being very self conscious about the way I looked, and the skin picking certainly didn't help. It kind of started, even, back in high school, as a way for me to try to improve the way I look, even though it definitely didn't work, I kind of had that false belief that I was kind of fixing my skin in whatever way. Until that kind of became a negative behavior. And then the trouble is, is more recently, even trying to cover up these spots, I became less and less satisfied with how I looked at the end of trying to cover all these up, which made it easier for me to just say, "Well, maybe I won't go to school today, or have to miss something," etc. So now that I've completed the program, and I've kind of had to work through some of those thoughts, I do feel more confident with myself, and I realize that especially in the workplace, you're trying to be confident. I'm more than just the way that I look, and I think if I show up with a smile on and do my best, it doesn't really matter what my face looks like. And that, interestingly, also leads to less picking.

Annette:                 And you perspective, I think also, I remember it shifted as far as like just being aware that when you think your skin looks bad, probably nobody else does, or notices that point.

Heather:                 I think as skin pickers, we tend to be pretty hypercritical, so if you're looking in the mirror for any length of time more than like a couple minutes, you're probably going to see something you don't like. And for me, I could be looking in the mirror for an hour or two, so I was definitely going to see a few things I wasn't comfortable with. And I was also looking really close up, so normal people aren't looking at you from this distance away. So a lot of those blemishes that I saw were really magnified for me. Whereas if somebody who passed me in the street looked at me, they may not have seen that. So that's sort of another perspective shift that I had to go through.

Annette:                 Yeah. Yeah, that's super. I remember your perspective also changed as far as you went to the picking, also, for a sense of control.

Heather:                 Mm-hmm (affirmative).

Annette:                 And then by the end of the program, I remember we were looking back at your pros of picking, like what was the picking doing for you, and you said it gave you a sense of control, and we were just kind of checking in, and you were like, "Wow, it doesn't, it makes me feel out of control."

Heather:                 For sure.

Annette:                 "And what gives me a sense of control ... " I just remember you saying this, "What gives me a sense of control is doing these other habits that I have." It's been a little while, so are you keeping up with things like meditation and ... you're still covering the mirrors probably at this point too, right?

Heather:                 Yeah.

Annette:                 Yeah.

Heather:                 That was one thing ... well, covering the mirrors, for me, was I would say the most important step that made the biggest difference. I saw my picking go like ... it kind of halved in the first couple of weeks that I was doing the program. Beforehand, like before doing the program with Annette, I was very hesitant to cover my mirrors. Which, interestingly, was also driven by the fact that I was worried about what people would think of me if they came over to a house with no mirrors. If they walked into my bathroom and saw that the mirror was taped over with ... I will say it is kind of pretty, I put up some very nice looking cover over the mirror, but I was really nervous. And when I did work with Annette, I kind of realized that I just had to cover the mirrors, because that visual cue, coming home from a hard day and seeing your face, and just feeling like you want to pick, I had to get rid of that. And that actually took off a lot of stress, so I could focus on some of the other habits, just sort of replace the picking.

                                    And I still had to put on a bit of makeup, so I kind of transitioned to a small mirror, which you kind of had to hold, so you couldn't really pick and hold the mirror at the same time.

Annette:                 Yeah, that's great. Is-

Heather:                 I guess like the routines I could talk about, but-

Annette:                 If you want to.

Heather:                 For me, having routine is pretty helpful. So, Annette and I came up with like a morning and an evening routine where no matter how busy I was, or how stressed I was, I would always try to do at least five minutes of meditation in the morning, 10 to 15 at night, as long as I wasn't on call. And every morning I would put on my Keen bracelet, which, for me, picking my face, I found this very helpful just because if I go up like this, it does buzz, which is kind of a subtle reminder for that unconscious picking.

                                    And also things like just eating breakfast was part of my morning routine. Sounds simple, but the number of days that I didn't eat breakfast, and then you kind of become hangry, and you want to pick more. I found that very helpful.

Annette:                 Yeah, I forgot that I'd recommended that for you and you found it helpful.

Heather:                 Yeah, [inaudible 00:13:27]

Annette:                 I know, it's the simple things like-

Heather:                 Yeah.

Annette:                 You forget about, but they're so important. What is it like seeing patients ... you're probably not seeing them for picking, but you see patients who are picking, right? What was that like for you?

Heather:                 For me, it was a very like ... it was a difficult experience for me to someone else who's struggling with something that ... I really wished I could share more with them, but because of the physician/patient confidentiality, I wouldn't be able to tell them that I was kind of going through that as well. But I think it gave me a unique perspective and degree of empathy that I could sort of foster with them, even without telling them that I was going through this as well.

                                    Because, like I said before, in healthcare this is a very new thing. A lot of people don't even know about it. So, I think there could even be some sort of negative ... maybe not necessarily that people would say anything negative, but people ... when you initially see someone with sores on their face, or on their body, you might think that they're using drugs, or something like that. And so there's still a lot of negative beliefs, I think, towards people with some of these BFRBs, even within the medical field. So I think for me, it was nice, because I kind of knew what they were going through, I knew that that really wasn't an issue for them, and I just wanted to be there as someone to listen to them. Sometimes people with BFRBs have anxiety, they have other issues that can kind of make it worse, but I find just listening really made the biggest difference for me. And just hearing their stories was kind of healing for me, which is actually really nice.

Annette:                 Yeah. Did they talk to you about the picking?

Heather:                 Yeah. Hearing them talk about the picking, and kind of in my mind just saying, "Yep, that's exactly like ... I can relate to you 100%."

Annette:                 Wow. That's really interesting.

Heather:                 Using it as self soothing, getting lost in the mirror, and then kind of struggling with their self image, and then having friends and family often say, "Well, just stop picking." But it's like, I can't.

Annette:                 Yeah.

Heather:                 I just tried to be there for whomever I worked with who had symptoms like this, and I think the best thing is to not say, "Just stop," because it really doesn't ... you can't just stop.

Annette:                 Right, you know that.

Heather:                 Yeah. And then also just educating people about this disorder, which is one of the reasons I wanted to come on and do one of your videos on the YouTube channel. Because I think, again, within the medical community, it's not even that well known. So I think the more that people are aware of it, the more we can recognize it and hopefully start directing people towards treatments that would be useful to them.

Annette:                 Yeah, super. All right. Anything else you want to share with our viewers?

Heather:                 The one thing that a lot of people do say, and I felt this as well, is just by knowing that this was a disorder, that it kind of gave me hope. And I think a lot of people have said this as well, just finding out that it has a name, and now even that it's listed in this DSM-5 as a disorder, like you just feel that ... it tells you that there's a community of people who all suffer from this, and I guess before, being told I had like an impulse control disorder, I said like, "What's that?" Like I didn't really understand how that led to me having skin picking. So, now that I know what it is, I feel like that's the first step in knowing how to treat it, and even though there isn't like a cure for this, it connects you with communities of people. And I think those communities kind of make you stronger, and within the communities, you share tips, tricks, and I think that's how people can gain control of their lives with this condition. At least that's what I found. By reaching out, and when you meet someone else with this condition, and you are able to openly share for the first time, I felt that was very healing.

                                    I had a chance to go to one of the BFRB meetings in Toronto, and I'd never met anyone in real life ... not that this isn't real life, but in person, with this before, and that really meant a lot to me, to see everyone along different stages of their treatment or healing.

Annette:                 And you're going to be at the big conference, the TLC-

Heather:                 Yes.

Annette:                 Foundation Conference-

Heather:                 I'm going to try my best, I'm still waiting for my vacation to be approved.

Annette:                 Oh, okay, yeah.

Heather:                 Then I will book my flights.

Annette:                 Okay. Yeah, so I'll be there, we're talking about the TLC Foundation for Body-focused Repetitive Behaviors. Website is simply bfrb.org, and they have a conference, I think it's April 21st or something like that ...

Heather:                 Yep-

Annette:                 21st or 22nd.

Heather:                 21st, 22nd, it's a weekend.

Annette:                 In San Francisco this year, so ...

Heather:                 Yeah.

Annette:                 Yeah, so if you're watching this, you can meet us in person.

Heather:                 Yeah, I'm really hoping I can go.

Annette:                 I really hope so too-

Heather:                 Yeah.

Annette:                 It'll be cool to give you a hug.

Heather:                 I know.

                                    Well thank you so much, Annette, for having me on your show, I really appreciate it.

Annette:                 Thank you.

Heather:                 Yeah, and if anyone has questions for me, they can direct them to Annette, I guess.

Annette:                 Thank you so much, Heather.

Heather:                 No worries.

Annette:                 And yeah, as always, if you liked the video and if you appreciated Heather being on her, give her a thumbs up, and yeah, leave your comments, subscribe if you haven't. And yeah, I guess that's a wrap.

Heather:                 All right, see you later.