Lip Picking: OCD or Anxiety Disorder?

Is this obsessive-compulsive disorder, or is it caused by anxiety?

Hello, doctor.
I am a senior student.
For the past three years, my family has been constantly reminding me not to pick at my lips, but I don't know why I can't control it.
In my memory, I started pulling my hair in elementary school, and during my third year of junior high, around the time of the entrance exams, I began to unconsciously peel the skin off my lips.
I have tried using lip balm and asking my family to remind me, but I still suddenly find that I have peeled off the skin.
Often, I peel until it hurts or bleeds, and then I feel a sense of relief or comfort.
When my hands are stopped from getting close to my lips, I tend to continue peeling with my teeth.
Now, even when I am not under stress or anxiety, I still feel the urge to stop only when my lips are smooth.
When others ask about my chapped lips, I unconsciously press my lips together and come up with an excuse to brush it off.
I would like to know if this issue is serious, how I can resolve it, or where I can seek consultation.
Thank you, doctor.

GUIN, 20~29 year old female. Ask Date: 2020/07/18

Dr. Huang Xiaoxian reply Psychiatry

Dear Joseph, thank you for your question.
I can tell that this situation is causing you a lot of distress.
Many people exhibit repetitive behaviors to alleviate anxiety, such as leg shaking, nail-biting, or skin picking.
Some individuals can regulate the frequency of these behaviors on their own, but if it has reached a level that is difficult for you to control, I recommend seeking an evaluation from a mental health professional.
If you are in New Taipei City, you can also come to our clinic for an assessment.
Best wishes! We have outpatient departments in Luzhou, Tucheng, and Bali.

Reply Date: 2020/07/18

More Info

Understanding lip picking can be quite complex, as it often intertwines with various psychological conditions, particularly Obsessive-Compulsive Disorder (OCD) and anxiety disorders. Based on your description, it appears that your behavior of picking at your lips may be a manifestation of a compulsive action, which is a hallmark of OCD.
OCD is characterized by intrusive thoughts (obsessions) that lead to repetitive behaviors (compulsions) aimed at reducing the anxiety caused by those thoughts. In your case, the urge to pick at your lips may provide a temporary sense of relief or satisfaction, even if it results in pain or bleeding. This cycle can create a paradox where the act of picking becomes a coping mechanism, albeit an unhealthy one, to manage underlying anxiety or stress.

Your history of hair pulling in childhood, transitioning to lip picking during a stressful period, suggests a pattern of using physical actions to cope with emotional distress. This behavior is not uncommon among individuals with OCD or anxiety disorders, where the physical act serves as a distraction from emotional pain or anxiety.

It's important to recognize that while this behavior may seem manageable at times, it can escalate and lead to more severe physical and psychological consequences. The fact that you have tried various methods to stop, such as using lip balm or seeking reminders from family, indicates that you are aware of the issue and are motivated to change, which is a positive step.

To address your concerns, here are several recommendations:
1. Seek Professional Help: Consulting with a mental health professional, such as a psychologist or psychiatrist, can provide you with a proper diagnosis and treatment plan. Cognitive Behavioral Therapy (CBT) is particularly effective for OCD and anxiety disorders, as it helps individuals understand and change their thought patterns and behaviors.

2. Medication: In some cases, medication may be prescribed to help manage OCD symptoms. Selective Serotonin Reuptake Inhibitors (SSRIs) are commonly used and can help reduce the frequency and intensity of compulsive behaviors.

3. Mindfulness and Relaxation Techniques: Practicing mindfulness, meditation, or relaxation exercises can help you become more aware of your urges and develop healthier coping mechanisms. These techniques can also reduce overall anxiety levels, making it easier to resist the urge to pick.

4. Behavioral Strategies: Keeping your hands busy with alternative activities (like squeezing a stress ball or fidgeting with a small object) can help redirect your focus away from your lips. Additionally, setting small, achievable goals for reducing the frequency of picking can be beneficial.

5. Support Groups: Joining a support group for individuals with OCD or anxiety disorders can provide a sense of community and shared experiences. Hearing from others who face similar challenges can be encouraging and provide new strategies for coping.

6. Education: Learning more about OCD and anxiety disorders can empower you to understand your behavior better and reduce feelings of shame or isolation. Resources such as books, reputable websites, and educational videos can be helpful.

In conclusion, while your lip-picking behavior may seem manageable now, it is essential to address it proactively to prevent it from escalating. Seeking professional help is a crucial step in understanding the underlying causes of your behavior and developing effective coping strategies. Remember, you are not alone in this, and there are many resources and support systems available to help you navigate these challenges.

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