Trich or Treat! It's BFRB Awareness Week!

BFRB Awareness Week is here again! Body Focused Repetitive Behaviour (BFRB) Awareness week runs from the 1st through to the 7th of October each year. This week is also Invisible Illness Awareness Week. As a person living with both trichotillomania and dermatillomania (or possibly a hybrid mash-up of both disorders), the vast majority of my health struggles are invisible. Today I want to talk about living with BFRB and hopefully raise awareness for this seriously underrepresented family of illnesses.

First of, my experiences are my own, and every person with a BFRB is different. There is no cure for BFRB. It is a chronic illness that one learns to live with, and aspects of the disorders can be improved with good physical wound care, psychotherapy, behavioural therapy, and sometimes medication to target associated anxiety/depression. The main plan of attack, for me, is to find 9 strategies that each fix 10% of the problem, and to let the other 10% go. I am not an advocate of being pick free/pull free. My goal in to make the most of life with BFRB and to minimise the time taken up by my repetitive behaviour each day. It might help to think of BFRB as an addiction. It is possible to stop performing the behaviour but the desire will likely always be there and relapse is always a possibility.

My dermatillomania  (compulsive skin picking) started in early childhood. I picked at my legs, sometimes my arms. I believe it started as a stress relieving/self soothing mechanism. I learned to hide it after I realised it wasn't an acceptable behaviour. From late childhood to puberty I continued to pick at my skin, causing minor sores. I didn't tend to focus on specific areas so no major infection issues occurred. I do remember one incident of my facial skin around my nose being badly infected, but I don't think my picking created many physical problems as a child.

My BFRB focus switched to hair at puberty. I don't think I anticipated growing leg and pubic hair. I don't think I knew about it at all. BFRB is generally about control, and my body suddenly growing new hair triggered serious anxiety and a body-horror reaction in me. This was when my trichotillomania started (compulsive hair plucking/pulling out). I would remove my pubic hairs as fast as they would grow. Eventually, they beat me, and I had to resort to secretly shaving. To this day I am so bad at shaving! Nowadays I'm a big fan of hair removal cream for my lady parts but I still have a lot of scarring from hair plucking and shaving.

I think you could describe my issues with body hair as a phobia. I just cannot handle the idea of growing hair in areas I have been conditioned to not find hair desirable. I think about this a lot, and I resent so much the cultural norm of the hair free lady. It sucks, and I feel terrible that I struggle to fight it.

I started shaving my legs (badly) as a teen. I'm a super pale Irish girl with dark hair though. So even with daily shaving, I can see the hairs under my skin. So sometime in my early teens I started using tweezers to systematically remove all the hairs I could see. This involves digging into my skin to remove dark hairs that haven't yet reached the surface. I often use tools such as needles to fish the rebel hairs out. And then I feel great, accomplished! For all of 10 seconds. Then I'm like 'Fuck! I probably shouldn't have removed so much skin to get that tiny hair out.' Totally wasn't worth it, the hole in my leg ultimately gets infected and becomes a much greater threat to my life than an ingrowing hair ever could. And then the depression hits. And this happens every time! And almost every day, to this day!

BFRBs often manifest in combination with other mental illnesses, quite often depression, sometimes OCD, eating disorders, and sometimes in those with autism spectrum disorder. This combination of illnesses can make it even harder to break the cycle of repetitive behaviour. Personally, I am in anorexia recovery. When my ED was at its worst, around 11 years ago, my skin picking was almost completely absent. My desire to control my body was completely fulfilled by restricting my food intake and over-exercising. Since mid-2014, I have been actively trying to regain control of my trich and derma, and for the first time in my life I am getting better without slipping back into ED, but every day is a battle! I am also currently going through my autism assessment process. A hugely stressful process in itself, but I feel proud of myself for sticking to my recovery plan even during stressful times.

So, besides leg focused trichotillomania, my face is under regular attack from dermatillomania. I pick out any perceived imperfections, blocked pores, etc. Unlike my trich, which is a visual inspection process, my face picking starts with touch. If my hands aren't kept occupied, they will automatically enter 'scan mode', and will find and squeeze any irregular facial bumps before I am even cognitively aware of it. In 2014, I developed a severe bacterial infection throughout much of my face. I spent the next 4 months on antibiotics and my physical health was seriously impacted. I'm not even sure how I came back from there, but currently my face picking is very minor and I hope to never get that sick again.

This is my face today. I have fairly severe scarring, particularly on the right side of my face. I could probably cover it with make-up, but I am not in anyway ashamed of my scars and choose not to wear make-up.

A lesser-know BFRB side-effect, my fucked up nails. This is the result of constantly using your fingernails as tweezers. Nails are weak and splitting constantly. It actually hurts to go without nail polish!

The last four photos show my legs as they look right now. Taken earlier today. So much improved at the moment! I feel I am the closest I ever was to getting back into BFRB recovery. My recovery plan right now involves the following small strategies...

• I try to get outside and walk everyday, even if it's just for a few minutes.
• I have minimized my caffeine intake (from ridiculous levels to just 2 cups of coffee a day).
• I am a #plannergirl, and I use my planner to check in with my recovery plans three times each day. I award myself points (in the form of stickers), for each pick-free time block (morning, afternoon, and evening). I keep daily checklists for my walking and other tasks and seeing it laid out on paper really helps me to stay on target.
• I keep my hands busy! I cross stitch, draw, scrapbook and journal constantly.
• If I am too tired to craft, I wear socks on my hands. Yes. I'm that serious about recovery ;)
• I try to sleep when I am tired (tiredness is a major trigger for me). Daytime naps and early nights. I am no longer checking my phone at night, if I can't sleep I will read instead.
• Regular eating plan! This is also important for my ED recovery. I  eat very regularly and need to follow a strict eating schedule in order to avoid my blood sugar peaking and dropping, which leads to picking.
• Therapy! I know this can be the hardest one to achieve. So much is lacking in the areas of mental health treatment generally, the world over. But please keep pushing. If it is at all possible for you to try counselling I recommend you do :)
• Support Groups! Facebook support groups are awesome!
• BFRB advocacy! I am totally open about my disorder! This is an illness and no one living with a BFRB should feel any guilt or shame. End the stigma!

Just a couple of the many great awareness posts I have been reading this week:

60 reasons why we need BFRB awareness

Dermatillomania awareness