DD is picking her skin

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DD has got her face into quite a state with picking her skin. This behaviour started when she was around 11 and she used to pick the skin on her forehead. We tried to get help for her at the time - the GP said it was the school’s responsibility to help her so we spoke to the school and they organised for someone to have weekly sessions with her. DD said they didn’t help at all and that all the person said was “you have to just stop doing it”. We researched it ourselves and we tried other things like fidget toys, elastic bands round her wrist to ping etc. One of the teachers who did understand gave her a little foam ball to hold and told her she was allowed to keep it and could pick at that if she felt the need. She did do that but didn’t stop picking her skin.

It did seem to improve for a while eventually but now it’s worse than ever, but she isn’t currently anxious about anything - it used to happen in times of anxiety but I think it’s now just become a habit that she can’t stop.

It’s a difficult subject to raise with her because she doesn’t like talking about it and she says she likes doing it and can’t stop. We’re at our wits’ end and just don’t know how to help her but we don’t want it to end up getting infected or scarring. DD doesn’t even have spots, she just picks at her skin then she gets scabs and picks at them. She actually looks as if she’s really spotty but it’s all from picking.

Has anyone else gone through this? We’d appreciate any advice at all. Thank you in advance.

I have trichotillomania, which is compulsive hair pulling. It has the same root, which is body focused OCD.
She needs support. I didn't get any and still struggle in my 40s. Mine started at 12. It often switches on with puberty.
Appointment with a psychiatrist asap. It won't just go away. Therapy now will help her deal with other issues like the generalised anxiety or perfectionism that usually comes along with OCD

I do this with my hands.
I regularly have sore or bleeding fingers.

I find that using moisturiser helps. I try and apply it whenever I have a picking compulsion because it's virtually impossible to pick if your skin is slippery.

It's breaking the habit that's the key and as soon as things start to heal you marvel at how good your skin looks and work harder to keep it nice. But it's all too easy to fall back into the habit as soon as you feel anxious or even bored.

For the sores, give her a tub of sudocrem to put on at night. It really helps.

Boredom or stasis is part of it. I am particularly bad when reading or watching tvz

My DD had trichotillomania at about 12. We noticed it as she was pulling her hairline and eyelashes out. We talked about it.

Once she realised she could learn to control it with diversion techniques and coping strategies, she managed to get on top of it.

As an adult she clearly has ADHD and OCD tendencies, so it was probably that manifesting itself at the time.

She's also very self aware, which helps in her identifying unhelpful behavior and working on strategies to control it.

Don't always look for "help" sometimes it can be done in house, so to speak

I have noticed she’ll sit doing it while watching tv or when we’re visiting family. When she had her last bad spell, she was more open to talking about it and she asked us to just quietly say “you’re picking” and say no more - she said she just needed a nudge to stop because she wasn’t always aware she was doing it. But now she doesn’t want us to say that and she said she likes doing it. I just worry that when she’s older, she’ll regret any scarring and will wish we’d done something so I know we do need to step in now but she can get very defensive if she thinks we are criticising in any way, which we’re absolutely not, I get that it’s really hard to stop.

We have actually wondered for a while about ADHD and she also has issues with certain fabrics etc. I’m not meaning to drip feed, I just completely forgot to say she has been referred to the sensory clinic, and she’s on a waiting list for someone to come to the house to see us then they’ll see her at school. I’m not sure exactly what the service is - when she moved to high school she started having huge meltdowns about certain fabrics and couldn’t bear the feeling of them on her skin, or the feeling of her own hair on her scalp etc. She said it had been happening on a smaller scale for a while but she hadn’t told us, but then we witnessed two in close succession. I had to speak to the school that day because she was late due to the issues with her uniform. The pastoral lead phoned me and I told him about that and all the other things that have made us wonder if she has ADHD or something similar, and he said he could refer us for some support with everything, as well as the sensory clinic. I had a call from the service a couple of weeks ago saying she’s close to the top of the list and they’ll come out to see us at home and then they’ll see her 1-1 at school.

She has recently moved to a different high school after being utterly miserable at our catchment one, and she’s so happy at her new school but the skin picking has got so much worse 😢

Thank you for all the replies, they’re really helpful.

Can you tell me what the diversion techniques were? We have a skin picking problem here too.Thanks

Try her on this supplement:
NAC (N-acetyl cysteine)
Many desperate to break this cycle have had success with NAC. A decent naturopathic orientated chemist should stock it, or maybe Victoria's Health (sorry, I'm not living in UK atm.) Well done for supporting her rather than just getting cross and frustrated about it (although it is an extremely frustrating & stubborn condition to experience.)

Does she have a skincare routine?
I didn't at that age but I know it's very popular nowadays and I'm wondering if you could introduce some skincare steps in her morning/bedtime routine she might be more aware?

I do this. It’s linked to OCD and/or being ND. I’ve had troubles with contamination OCD in the past and when reading about autism as I suspect my DS is autistic I’ve come to think I probably am too.

I actually like doing it too! I’ll be searching for any scabs or rough skin, pick them off and they feel smooth again. It feels soothing until I look in the mirror and hate what I did to myself (but cover it in makeup).

Anyway, things which help stop me picking holes in my face…

Firstly, stopping my hands reaching my face at certain points of the day. My worst time for doing it is when watching tv or scrolling on my laptop in the evenings. So I try to remember to have a squeezy stress ball or tangle toy. I wrap the tangle around most of my fingers on the hand I pick with; tie them up so I can’t pick!

Secondly, I’m searching for rough patches to make smooth again. So moisturising helps. I wash and moisturise my face a couple times a day and that both reduces any rough patches/roughness of scabs and makes anything there hard to pick.

Thirdly, short nails and nail varnish. I keep my nails super short and, if the first two points aren’t working, I’ll paint my nails. Sounds weird but four coats of nail varnish (base, two coats of colour and a top coat) make my nails less scratchy and hard to pick with them. She might not be allowed to have nail varnish on at school though.

Also, not sure if this is linked, but I do it less when I get lots of exercise.

My DD does this. Mostly her skin around her nails and her lips. She is currently being referred to see if she has ADHD. (We’ve thought this for a good while tbh but as usual any sort of intervention takes forever)

I would go back to the GP I don’t think they should’ve fobbed you off to the school! It can also be linked to OCD.

Thank you all so much, this is all really helpful.

The hardest thing about it is broaching the subject because she just shuts down and says she likes doing it. We never want to push the issues because we do have an amazing relationship and she does talk to us and we want to keep that.

@CatamaranViper she has had a skincare routine for a while but I don’t think she’s really doing it at the moment, I know it’s getting her down despite her saying she likes picking her skin, and I think she’s just given up on her skincare routine. One morning last week on the way to school she started crying and saying she felt really fragile and that her skin was a mess 😢

Thank you, I’ll look into this. I’ve not heard of it before. I’ll have a look online. The only kind of shop in that line that we have locally is Holland and Barratt, I don’t know if they’d be likely to have it…

At first we did this....

First as soon as she noticed it she would call me straight away. I'd spend time with her simply helping her do something else and praising her for noticing it so quickly. As time went on we looked at it growing back and the improvement from not doing it. We.noticed it was always in bed before she fell asleep.

Later she managed it herself with things like reading or those colouring books with patterns.

Whilst we didn't go on about it, we did regularly.check in on her progress and how nice her hairline was looking now.

It felt to me like me biting my fingernails and I gave up that soon after too.

I agree with others about getting help from a professional. In the meantime, look up pick pads, which might help with redirecting her hands. If she needs a pain sensation as part of the stim, perhaps have a hairbands on her wrist to ping.

We ordered some pick pads - thank you! They arrived today. We had a chat in the car coming home from school yesterday and she said she just feels she has to be picking at something and just now it’s usually her face because she’s created scabs from picking and then she picks those so it feels smooth again.

DD is also a picker. What professional do I look for to help this, will pay privately. Already assessed for ASD, didn’t meet enough criteria and they said def no to adhd.

The problem with the liking it thing is real. She's not masking/deflecting. I still really enjoy the sensation of pulling my hair. The only way I can stop is by getting up and doing something else entirely - and this is as an adult. I also have really thick hair which helps as I probably do have small patches but they're not in any way obvious

DD is a hair puller and scab picker. Gave herself bald patches.

Massively improved after seeing a psychologist, giving her access to fiddle toys at all times and a significant bribe to motivate her to stop.

Also being screened for OCD, ADHD...

Child psychologist or councillor / therapist? She has couple of other sensory issues which would be good to address at the same time

The only thing that stops me is a thick, regular coating of vaseline over the scab until it heals. Tiredness and stress increase unconscious picking, but like PPs, there is something nice about the feeling so even if I'm aware, it can be very hard to stop myself. The vaseline stops my nails getting any traction.

I think you're already realising this, but just to spell it out: you need to vary your approach depending on your DD's level motivation to address it. You can't control her picking - it will only improve when SHE wants it to and all the good suggestions in the world won't help otherwise, you'll just risk creating distance and her getting better at hiding it.

You say "the hardest thing about it is broaching the subject because she just shuts down and says she likes doing it." So right now, broaching the subject is the wrong thing to do. Focus your efforts on making her feel accepted and supported - no pressure to tackle it, but she knows you're there to help if ever she does.

When that time comes, you've had many good suggestions on this thread that you can share. The only one I have to add is the technique that's worked best for me - I grade each of my picks in terms of severity (e.g. 3 = really bad, 1 = almost healed), add up the total and challenge myself to reduce it a little each day. I find that much easier than trying not to pick at all - it's not the end of the world if I slip up; heck, I can go to town on some of them if I want to, just as long as I leave others alone - and although I'm still picking, it's still gradually improving little by little each day.

I said "when that time comes", not "if" - I'd put money on her wanting to address this before too long. Wanting to do it versus wanting to stop varies over time. So I'd also put money on this being something that improves, rather than resolves - prepare yourself that this will likely never go away completely. But if it's any comfort, my teenage years were definitely when it was at its worst and I've found it far milder as an adult.

To pick up on another couple of comments - you said you worry that when she's older, she'll wish you'd done something more. I don't resent my parents for that - as I said above, changing this can only come from the picker themselves. But what I do resent my parents for is failing to understand it and making me feel ashamed (hence my NC for this post). You also mentioned scarring - in my experience, scars from picking can take a while to fade but they're not permanent.

Finally, a few people on this thread have described it as a habit, which is not helpful. It's a compulsion. Why does the difference matter? Because you can beat habits with willpower, but compulsions are a whole different ballgame. Lumping them both together downplays the compulsion and implies that the person suffering from it is weak for not being able to overcome it, and that's very counterproductive to tackling it.

Hope that's some help - happy to answer any further questions.

I’m a skin picker and have tried so many things but to no avail. I have suffered with depression and anxiety since around 14 and the GP described my picking as self-harm. It can be really bad at times when I have low mood or stressors then will ease for a while. My arms and back are covered in scars unfortunately. I found applying creams to make the skin too slippy to pick at helpful as it acted as a barrier. I also would ping an elastic band instead. I really struggled as a teen but as an adult I have learnt to knit/crochet and I do this while watching tv etc instead which keeps my hands busy. I would definitely try push for therapy or an assessment as it can be really debilitating. I was the same as your DD, would get upset at my parents for commenting as I wanted desperately to pick but then I’d feel so low afterwards when I’d be covered in marks and scars. I hope you get the support you need x

"But if it's any comfort, my teenage years were definitely when it was at its worst and I've found it far milder as an adult."

Same for me with my trichotillomania mania

My dd is autistic and she picks the skin on her face or a scab on any part of her body if there is one.

She is only 6 but has a pot of theraputty on her desk in school and also a strip of Velcro that she can pull at .
At home we use playdough and squishy toys in her hands . We cover any cuts even on her face with plasters.
We also just keep reiterating no picking and redirect her hands.
I appreciate this is all from a much younger child.

I do feel the gp was wrong to refer this back to the school. Schools do not have the knowledge or expertise to understand these things. We sought advice from her OT and passed this onto the school.

ADHD picker here. I've done it all my life. My skin was constantly a mess though fortunately I don't scar. Started on meds recently took me a few weeks to realise that I'd stopped doing it - that alone has been life changing! Do get her assessed, OP and best of luck.