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Fighting the Shame of Skin Picking.

Mary Anne Cohen, LCSW, BCD
PTCNY member Mary Anne Cohen recommends the this New York Times article: "Fighting the Shame of Skin Picking."
The article can be found HERE.

Ms. Cohen writes; "Many patients - especially those with eating disorders - engage in a continuum of self-harm behaviors or repetitive body-focused behaviors."

In addition, her published comment on the article read: "As Director of The New York Center for Eating Disorders, I have worked with many people who pick their skin and pull their hair, and it is often part of an eating disorder syndrome. Compulsively trying to manipulate your body is akin to compulsively trying to diet, use laxatives, vomit, or excess exercise. The distress with one's body may be a result of trauma, sexual abuse, or OCD. Medication and psychotherapy can help alleviate these self-harming behaviors."

A compelling companion piece to this discussion about clients' skin picking and body-focused self-harm is this latest article in The Fix on "Childhood Trauma, Body Dysmorphic Disorder, and Plastic Surgery Addiction." Self- harm behaviors reveal a connection with childhood trauma and attachment disorder issues. Here's the link:

In addition to the range of bio-psycho-social treatment methods we use, we also need to be aware that self-harm behavior – skin picking, hair pulling, cutting, bulimia – are all expressions of psychic pain written on the body. These behaviors represent a somatic language that needs to be decoded in the therapy. One patient explained why she keeps repeatedly picking her scabs in order to continue to make them bleed, "I am not allowed to heal." This simple comment laden with meaning, came from the daughter of Holocaust survivors and revealed many layers that helped to deepen our work as to why she was not entitled to heal.

As I discuss in my book, French Toast for Breakfast: Declaring Peace with Emotional Eating, eating disorders, like other self-harm behaviors, are also psychic languages that need to be decoded in treatment: "The language of pain comes in many dialects. Emotional eating problems and the fear of being fat is one such dialect in which we recruit our bodies to express what we cannot utter in words. Eating problems become a vehicle to communicate matters of the heart that have no other channel. The language of food and fat is a symbolic one, a way to express inner emotional battles over feelings of emptiness and fullness, vulnerability and protection, urge and restraint, desire and despair." (French Toast has been turned into a continuing ed course of 9 credits for social workers:

Please stay tuned for my upcoming book published by NASW Press, Treating the Eating Disorder Self: An Integrated, Comprehensive Treatment Model for Social Work Clinicians, in which I cover how to work with clients who self-harm and how to decode the unique meaning for each person

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