Dear Alice,

My girlfriend has a terrible obsession with picking her face. It is not that she has bad skin or acne, but, when she is in a certain state, she will stand in front of the mirror for hours and pick her face to shreds. It leaves her with horrible sores and open cuts covering her face. One day, she will be fine, and the next day, she will look like a war casualty. After she does this, she feels that she has to hide for days.

Aside from these concentrated sessions in front of the mirror, she is constantly picking her face while she is studying or reading or talking on the phone. Often, the state of her picked face affects our plans -- for example, she may not come with me to see my family even though we had planned to go together. When she is particularly self-conscious about it, she forbids me to look at her. She will cover her face with her hand or hair if I am even gazing anywhere near her. It is hard to communicate when I cannot see her face, and it affects our kissing and other intimacy.

We are very close and have been together for two years. We have talked about this many times and it does not seem like there has been any change. Mostly, I have been supportive by listening to her and comforting her. But, at times, I have been upset and have let her know. Some of her family members do not hesitate to be cruel to her when she "looks like shit." But she is well aware of her problem, but cannot seem to stop. She has had this obsession for over three years, and it is really making her miserable, and is making me wonder if it will ever go away on its own.

We have talked about the possibility of some kind of therapy, but she does not feel that it could help. She seems to be terrified of having to see any kind of therapist. I feel that somewhere inside, she needs to stay feeling miserable even though she is clearly genuine when she is cursing the terrible life this habit makes for her.

I have every intention of staying with her, but I feel that her obsession and the self-consciousness and misery that come with it are keeping us from getting closer. How can I have more of a role in affecting some kind of change in this? I feel that there are things that I have no control over, but they affect me and the one I love deeply.

—No pock marks

Dear No pock marks,

What you are describing is a basic compulsive disorder. Compulsions fall under the rubric of anxiety disorders. Remember that fear is a basic and useful human emotion — it provides motivation for self-protection and learning to cope with new or dangerous situations. Only when fear is out of proportion to real danger can it be considered a problem, and this seems to be what's happening to your girlfriend. Anxiety is another word for fear, referring especially to a feeling of fear that is not directed toward any definite threat. When anxiety is experienced almost daily, or is related to life situations that recur and cannot be avoided, it becomes an anxiety disorder. Compulsions, such as excessive face picking and hair pulling, are repetitive actions, difficult to resist actions, and often associated with obsessions (recurrent, unwanted thoughts or impulses).

Treatment for compulsions range from medications to psychological interventions that concentrate on a person's conscious or unconscious thoughts or overt behavior. Fill your girlfriend in on this when she says she doesn't think therapy will help — there are so many therapeutic models that she is sure to find one that will help her overcome her face picking. Strongly encourage your girlfriend to see a therapist. Finding a good therapist — someone you can trust and believe you can learn from — is important. You can offer to go with her to keep her company at her appointment, and/or meet her up afterward. Make her feel safe in the knowledge that you support her. It's commendable that you are willing to stick with her through this; it's also important that she get some help so that she can regain control over her own life. 


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