Is my daughter’s skin-picking a sign of a more serious problem?

Question: My 14-year-old girl is a relatively self-confident, bright and emotionally intelligent teenager, but she has tended for some years to pick a bit at her skin when anxious. This sometimes leaves noticeable cuts around her thumbnails and on hands and legs. At times she picks obsessively at spots also.

She has had a lot going on recently. She found lockdown and being off school for six months difficult and it seemed to knock her confidence. Since being back in school she has had a falling-out with a friend and struggled a bit finding her social group. Also, a teacher noticed her fingers as she handed up work this week. I noticed them myself. She has picked the skin all around her thumbs.

The teacher took her aside and asked was everything okay and whether she was self-harming. My daughter laughed it off and said she was fine and told me about the conversation later. I don't think it goes beyond relatively minor skin-picking at the moment and I did think the teacher might have overreacted. However, it has me wondering whether I am missing something and whether it really is a sign of something more serious.

She would probably refuse to talk to anyone else about it I suspect. She has many good qualities but can be very stubborn and headstrong and refuses to listen to any advice at times.

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What would you advise?

Answer: Skin-picking is one of the many physical habits that adults and children use as a means of self-soothing, managing stress and relieving boredom. Other similar habits include, nose-picking, nail-biting, hair-pulling and stroking one's face. Many of these habits are performed subconsciously and the person is often unaware they are doing them. Sometimes these habits are associated with certain activities and occur during certain times of the day, whether this is watching television or reading or during sleep. Sometimes the habits are associated with stress and increase in frequency when the person experiences worry, anger or excitement.

Whether or not these habits are a problem depends on their frequency, their impact and how socially unacceptable they are. Your daughter’s skin-picking is making marks and causing some harm to her fingers and might be viewed as an unpleasant social habit though it may be a relatively minor issue that might fade in its own time.

Is it a sign of a serious problem?

However, you are right to consider whether it is a sign of a more worrying problem. There is an association between minor skin-picking and more serious skin-cutting. Some children who start out with skin-picking might go on to cut themselves as a means of managing distress. Sometimes this is done on hidden areas of their bodies such as their thighs so it is not immediately noticeable to parents. Even though she ‘laughed if off’ and denied the she was self-harming, it is worth opening a conversation with her about the issue.

Use the discussion with the teacher as an opportunity to talk through these concerns with her. For example, you might ask her if she knows what self-harming is, if she has heard of anyone doing it, what she thinks is the reason for it, what would she do if she felt stress like this and who would she talk to. Opening a conversation such as this (even a general one) will give you a sense of where she is at and allow you to communicate important messages about safety to her (such as that she can always talk to you if worried about anything). If you become more worried consider contacting the school and seeking mental health advice as needed.

Create new positive habits

If she is motivated you can help your daughter learn to change her skin-picking habit or at least reduce its frequency. The first step is to bring the habit into her awareness. Discuss with her when and where she does it and identify with her any triggers and associated patterns of behaviour. Rather than simply stopping the ‘picking’ habit, the key is to create a new positive habit to replace it. You want to help your daughter notice the physical urge as it develops in her body and then interrupt it by doing something else that relieves the tension. New positive habits might include rubbing her hands, self-massage, stretching her arms or getting up and moving. As you can imagine, learning these new habits takes time and practice. Skills such as relaxation and mindfulness, which teach her to become aware of the tension and sensations in her body, can also help. If she is interested you could attend an online class together or listen to a podcast or app online.

In addition, you could encourage her to adopt a new skincare routine for her hands. You could set aside time to show her how to moisturise and manicure her hands or go to a salon together – this might be a lovely mother-daughter thing to do that shows her how to care for her skin while allowing you to spend nice time together.

Continue to support her

Finally, it is important to acknowledge that she has been going through a lot recently and to consider what you can do to support her. At the best of times dealing with the pressures of school, friendships and finding your identity when you are 14 is hard enough. Now in the time of Covid-19 with reduced socialising and few extracurricular activities, it is even harder. Set aside time to think with her and the whole family as to what you can do to manage. Identify one or two positive activities that you can still engage in that bring fun and enjoyment to her life.

– Dr John Sharry is a social worker, founder of the Parents Plus charity and an adjunct professor at the UCD school of psychology. See solutiontalk.ie