Understanding the Urge to Pick

Skin picking is more than just a “bad habit”. Skin picking disorder (SPD), also known as excoriation disorder or dermatillomania,  is a body-focused repetitive behavior (BFRB) where someone recurrently and compulsively picks at their skin to the point of injury. The urge to pick can be quite intense and seemingly without reason. But, where do these urges come from and just what do they mean? In a recent skinpick.com webinar, Dr. Vladimir Miletic takes a closer look at the urge to pick.

What is Meaning?

Meaning is central to the human experience. Our experiences and the meaning we assign to them shape who we are. When describing urges to pick, it isn’t unusual for someone to describe the urges as “irrational” or not making sense to them. Dr. Miletic suggests that rather than urges being irrational, they may be better understood in the context of meaning. What is the logic behind them? Thinking in this way can pave the way for progress.

Meaning looks at the function of something, in this case, urges to pick, the context in which it occurs, and how function and context intersect. So to understand a person or behavior, we have to understand the meaning within the proper context. This meaning tells us how and why something is logical and makes sense within that context. When you understand the meaning of something, you’re less likely to dismiss it as irrational or unreasonable less likely. Why? Because when you understand its meaning, it makes sense. And, when you understand why something happens, you can then begin to address it in a logical way.

Why Meaning Matters

Meaning gives us a way to understand how and why something is logical and reasonable. What has meaning for us lies in the experiences and the thoughts and feelings we have about those experiences. We organize our experiences in constructs that hold meaning for us and help to show us the logic behind our actions. We may not always be readily aware of the meaning of something though.

Dr. Miletic conceptualizes an urge to pick this way: On the surface, urges are vague, intense, non-verbal sensations or distress. The clear resolution is to pick. Picking alleviates the distress but it returns and the cycle repeats. The “vagueness” is a non-verbal construct. The intense, unpleasant feeling is a superordinate construct meaning it is of considerable importance. “Picking” is the translation of “I need to pick” to alleviate this distress. Alleviating the distress by picking validates the action. “Hey, I understood these feelings and when I picked, they went away.” So, you’re likely to do it again. This recurrent behavior supports that the behavior meets a psychological need.

As he often does, Dr. Miletic turns to Dr. George Kelly and constructivist theory to explore the psychological dynamics behind picking and urges to pick. Dr. Kelly believed that psychological life takes place of different levels of awareness. Some things we are aware of, some not so much. To change, what is non-verbal should become verbal. By consciously identifying what’s happening, by putting it into words, you can directly change where you want it to go. We all have psychological needs, but you can always find more and healthier resources. Having multiple ways of coping can help you to effect the change you want.

Kelly likened these multiple needs to packages. According to Kelly, the best way to deal with your needs is to put them in a lot of “small packages” and send them to as many addresses as possible. When one resource isn’t available, you have others that you can access. You can use resources as you need to and don’t have to rely on just one to alleviate your distress, in this case, picking behavior.

So, behaviors like picking serve a purpose – to alleviate distress. Of course, that doesn’t always mean they will remain useful or are healthy. So, what happens when you want to change a behavior? Well, according to Kelly, you must address it in a way that the mind and body will understand.

Understanding Your Urges

The first step to understanding urges is to put them into words. It is a process that takes time. You’re not looking for a single “thing”. Rather, you’re looking for the elements that are part of your urges. As Dr. Miletic explains, the question isn’t WHY. The question is HOW and WHAT do the sensations feel like.

One of the best ways to begin this process is through journaling. Pay attention to what you’re feeling. Journaling or logging them can help you to gain insight into your urges and what needs they may be meeting.

Dr. Miletic also discusses his use of mindfulness techniques such as body scanning, and visual imagery or artwork to explore urges. Each time, you’re collecting pieces of a puzzle to help you understand your urges to pick, and what needs they may be serving.

Peeling the Onion

Dr. Miletic describes the process of understanding psychological needs associated with urges as peeling an onion. It is a process of gradual discovery. Each layer reveals clues about the meaning and needs associated with your urges. The longer you’ve had the behavior, the more layers you’re likely to find.

The first step to understanding your psychological needs is acceptance. We all have needs. You may not like the needs you have but they are there, nonetheless. Acceptance allows you to face them and deal with them in constructive ways. Ignoring your needs doesn’t make them go away.

Understanding your needs is accomplished via a process of verbalizing and exploring. Cognitive-behavioral therapy (CBT) is an effective therapeutic approach to help you explore your needs and find ways to meet those needs in healthy ways. That’s those multiple addresses Kelly was talking about.

Finally, the webinar concludes with a question-and-answer section that provides additional insight into understanding urges to pick and help for skin picking disorder.

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