Nadia, 23

Looking back, it started when I was quite young, maybe eight or nine. I used to pick at the dry skin on my lips and the backs of my knuckles. By the time I was a teenager I'd moved to my scalp. I didn't really think of it as a problem at the time - it was just something I did. A lot of my childhood involved things I did that I didn't fully understand.

I was diagnosed autistic at twenty-one, and that reframed an enormous amount. Suddenly behaviours I'd carried through my whole life had a context. The picking was one of them. It made sense that something sensory and self-regulating and repetitive would be part of my experience. I just hadn't had a way to think about it clearly before that.

For me it starts with noticing a texture. My hands move to my scalp almost like a scan - they're looking for something. And when they find something, a scab, a rough patch, a crusted area, there's this very immediate sense of having located a problem that needs to be resolved. I know intellectually that this isn't true. But the feeling is very specific and very compelling. It feels like an itch you haven't scratched yet.

During it there's a real stillness in my head. That's actually what makes it hard to stop - it works. The sensory experience of picking is calming in a way that's difficult to replicate. Afterwards I'm often surprised at how long I've been doing it, and sometimes the site is sore. But the emotional aftermath is relatively mild compared to what some people describe. I don't feel intense shame. I feel a bit frustrated with myself, and that's about it.

The arm picking is different. That one is more automatic, more absent-minded. I'll be reading or in a meeting and realise my nails are working at a rough patch on my forearm without me having decided to do it.

That it's not about anxiety, at least not primarily for me. When people hear about skin picking they tend to assume it's a stress response, and for a lot of people it is. But mine is more sensory than emotional. I pick because the texture is there and my nervous system wants to interact with it, not necessarily because I'm overwhelmed or anxious. The distinction matters because the strategies that help are different.

I've had people suggest that I just need to relax more, or manage my stress better. And that's not quite the right frame for my experience. I actually pick quite contentedly sometimes, when I'm perfectly calm. Trying to explain the sensory-seeking aspect to people who don't experience the world that way is genuinely difficult. It doesn't map onto anything they've felt.

Not as much as it might have. I work from home, which is partly why - a lot of the social situations where picking becomes complicated just don't feature much in my life. I'm not managing a professional appearance in an office every day, I'm not going to beaches with colleagues. My life has a lot of privacy built into it, not as an avoidance strategy exactly, just because it suits me as a person.

Working from home does make it harder in other ways though. There's no interruption. When I'm at a computer at home for hours on end, the picking can go unchecked in a way it might not if I were in a shared space. I've had days where I've spent three or four hours picking across different sessions without fully registering it. The isolation that makes me comfortable also removes the social friction that would otherwise interrupt things.

I've occasionally avoided wearing certain things because of marks on my arms. That's real. But I don't feel my life has been dramatically shrunk by it.

The autism diagnosis, as I said. That was the big one. It gave me a language. Understanding that my brain genuinely processes sensation differently, and that picking is one way I manage that, changed everything about how I thought about stopping. Instead of asking "how do I stop this completely" I started asking "what is this actually doing for me, and is there another way to get that same thing without leaving marks?"

That's a much more useful question. The answer involves things like textured fidget tools, keeping my hands busy with things that provide a similar tactile input without the consequences. It doesn't work all the time. But it works some of the time, and it doesn't require me to fight my own nervous system quite so hard.

Harm reduction more than abstinence. I don't think I'm going to stop picking entirely, and I'm not sure I need to. What I'm working on is reducing the duration and intensity of episodes, protecting the sites that cause the most damage, and making sure I'm meeting the sensory need in ways that are less costly.

Practically: I keep a textured silicone ring at my desk. I use a scalp massager in the shower which gives me something thorough and satisfying without leaving wounds. I try to be realistic about high-risk periods - when I'm tired, when there's been a lot of social demand, when I'm doing monotonous work. Those are the windows where I need to be more deliberate.

I've also stopped thinking of it as a moral failing. That was a bigger shift than I expected. I spent a lot of years with background self-judgement about this. Letting some of that go has made me more effective at actually managing it, not less.

Find out whether there's a sensory component, and if there is, take that seriously. A lot of the information about dermatillomania is framed around anxiety and emotional triggers, which is accurate for many people. But if the picking feels more like a sensory need than an emotional release, that's worth knowing, because it suggests different strategies will help.

And if you're autistic or think you might be, look into the overlap. BFRBs including skin picking are very common in autistic people, and understanding why your nervous system operates the way it does can take a lot of the shame out of the behaviour. You're not broken. Your nervous system has different requirements. That's not a character flaw and it's not a failure of self-control.