study the poignant phenomenon that psychologists call dermatillomania - more commonly known

as skin picking.

Those who suffer from it will, by definition, be at the anxious end of the spectrum. Few

days will be free of great worry, sometimes a specific concern with a threat that feels

like it will be the end of us, or else a general eeriness and nameless dread.

In response, as we've probably done for years, we will start to pick. Perhaps we reach

for one of our hands and a very special zone we've almost certainly not told anyone about;

a zone of hardened skin made up of extra layers that we begin to press or squeeze at, file

down or unsheathe. Or we go to an area of our face and start worry away, pinching, squeezing,

lifting, skewering. It might equally - or also - be a part of our lips we go to or a

bit of our ankle. In all cases, the skin buckles, damages, goes sore and on occasion, when we

go too far, starts to bleed, perhaps profusely. If someone were to come into the room, they

might gasp - though we generally do a good job of covering up the blood once we're

done.

We know - of course - we shouldn't be doing any of this. But it feels, at the time, so

nice, or more accurately, irresistible, like the only thing that is going to work, like

exactly the action that will be able to deliver relief. What can it matter, in the context,

that we'll be left with a pitted face or a bleeding foot or a purple raw thumb? It's

what we had to do - and have been doing, probably, for many years. We know we do it, but it escapes

and resists direct thought. This might be the first time we've heard anyone else talking

about it.

Dermatillomania, the psychologists tell us, has to do with anxiety; that much is evident.

What is distinctive is how the anxiety is being handled. Some will act out their pain

in dramatic and noisy ways; screaming, insulting, cursing... Skin picking is a quieter, more

solitary way of trying to come to terms with alarm and self-loathing. It is an introvert's

disease.

The skin picker might well like to scream, panic loudly, tell someone to go away or collapse

in another's welcoming arms - but their characters have been shaped through aeons

of solitude. They have no faith in any possibility of turning towards someone else for help.

They are fundamentally alone. They only have experience of directing anger and sorrow in

on themselves. They are taking their pain out on the only character they can reach.

Knowing all this helps us to imagine what a cure might look like. For a start, it will

involve recognising the degree of solitude that has inspired the masochism. No one ends

up picking their skin raw who had an early consistent experience of tenderness and attuned

care. One does this kind of thing because absolutely no one was around or those that

were did a lot of humiliating. It may help to recognise that one is still now terrified

pretty much all the time. The targets may shift - losing one's job, being made fun

of, being sexually rejected, ridicule - but the essential drift is that one is a terror-struck

person; we tend only to be in a position to acknowledge our distress when someone is on

hand who could understand.

When we can compassionately realise that the picking is about fear and self-disgust (the

legacy of neglect or cruelty), we are in a position to start to 'see' rather than

merely be compelled by our pain. We need to find a better way of being worried. We are

trying to gain control over a cruel-seeming and cold world, but turning our index finger

raw or taking a penknife to our heel isn't where the issue lies. We need to know that

this isn't some un-analysable quirk. It's a known and very moving problem, one of the

many things a sensitive mind will do in response to a lack of love and to a basic fear that's

had to be borne alone. We need to start to pick at the real source of the agony and learn to leave our innocent bleeding body in peace.