October 22, 2020

I’ve read enough anecdotes from autistic women to notice a pattern: Many of us pick at our skin or hair.

There’s plenty of advice and support available if you search for “dermatillomania” (a.k.a. skin excoriation disorder) or “trichotillomania” – but not much info about the overlap with autism. So, here’s what I’ve learned through 20 years of picking at my skin, including 4 years of knowing I’m autistic.

These habits – derma and trich – meet multiple needs at once. They’re like the Swiss Army knives of anxiety coping methods. If you want to stop, you won’t be able to find a perfect replacement. You’ll have to use different tools for different kinds of needs: Sensory, safety, and cerebral.

Sensory needs are the most obvious, since derma and trich are forms of stimming. Experiment with alternate stims, but don’t limit yourself to ones that seem similar. For example, I find compression surprisingly helpful, even though it doesn’t imitate the “picking” motion.

Safety needs are harder to notice. Try asking, “What am I afraid will happen if I leave this scab/flake/nail/hair alone?” Compliant children, in particular, may grow into adults who can’t help feeling that things are “supposed” to be a certain way. Remember that beautiful trees have rough surfaces, and it’s safe for you to have them too.

Cerebral needs take at least two forms. If my mind is overstimulated, then picking can be a calming, meditative activity. If my mind is understimulated, then picking can be a fascinating, exploratory activity. In the moment, I can’t tell which state I’m in. But if staring at a candle is helpful, then I was probably overstimulated, and if researching a special interest is helpful, then I was probably understimulated.

My current strategy, when I feel like picking at my skin, is to do one quick thing in each of these categories. If I can manage to do that without picking along the way, it usually relieves the urge!

If it doesn’t, I give in and pick. Resistance uses up willpower and raises my anxiety, making it likely that I’ll binge-pick later. I’d rather gather data about what helped (or didn’t), and then try to meet my underlying needs again when the next urge arises.

It isn’t a perfect system. I’m continuing to learn what meets each kind of need, and there may be more needs that I haven’t discovered yet. In the meantime, I want to face my failures with curiosity and compassion. An urge to pick is a message from my body, and I’m trying to learn its language.

P.S. I write from my personal experience as an autistic. What I share is not a substitute for advice from an autistic medical professional. Also, some of my opinions have changed since I first wrote them.