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Dear Dr. Saltzman,

I have what I think is a very weird and worrying problem. I have an annoying, painful habit of--how do i put it?--scraping the skin off both of the right sides of my thumbs! My problem is more mental than physical. I have been doing this for as long as I remember. I am 25 years old now. I remember doing this since I was a little girl in elementary school! the result is pretty ugly--the right side of each thumb has taken on a pale whitish colour and looks like I have a skin disorder.

But that is not what worries me. The problem is that I am not even aware when I do it.It doesn't even hurt anymore. I only realise it when I feel a little bit of pain or I have pulled out a lot of skin, and subsequently take a look at the thumbs. I have also noticed that when I'm nervous, angry, or Irritated, this behaviour is increased. I want to break this habit-- it's begun to control me.

Nobody I know seems to have this problem, and I haven't even read one casy study regarding this in the five years I studied Psychology!

Please help me if you can, I will be very grateful.

Thank you.

Yours Sincerely,


TODOS SANTOS doctor robert saltzman TODOS SANTOS counseling psychotherapy

© 2006 Robert Saltzman

Hello, Zam--

Your habit is one of a large group of self-abusive behaviors which include, at the extreme, such actions as "cutting," or self-flagellation.

A range of theories tries to explain the motivations for such actions. I have touched on these in my reply to a woman who cuts herself. I think a useful way to consider the psychology behind such behaviors is to ask what benefit the person gains, or at least hopes to gain (unconsciously, of course), from indulging in such obviously self-harming procedures. In other words, these self-harming behaviors are costly to the individual, as your letter so clearly indicates, so what is being purchased at that cost? In my experience what is being purchased are such "benefits" as stress reduction, anxiety management, repression of sexuality, and expression of anger which one is afraid to manifest openly. I have explained this a little more fully here.

If you are interested in working on this yourself, without psychotherapeutic help, that is, I suggest that you learn to sit quietly with your back straight, but not rigid. A straight-backed chair will work fine, or sit on the floor if you know how to do that with a straight spine. Fold your hands in your lap to keep them quiet, or allow them to rest on the arms of the chair.

Once you have found a comfortable but not slouchy position, begin to observe your own breath. Do not try to change your breathing. Instead just watch the breath as you allow the breath--without forcing it--to soften and deepen. As you find this happening, and while continuing to maintain some awareness of your breath, turn some attention to your thoughts as they arise. Just allow each thought to rise up, gain your attention for a moment, and then subside. If you allow it, each thought will pass into the next in an endless stream, without any of the thoughts being able to hijack your entire attention. Do not try to influence this in any way. Simply watch the passing parade of thoughts as if they were waves breaking on the shore and falling away again, or leaves and twigs floating down a stream.

Done over time, this exercise can do much to relieve stress and anxiety, as well as providing conscious access to heretofore repressed anger and sexuality. As anxiety and repression become more conscious, they are likely to lose some of their grip on the personality, and you might find yourself relying less on the self-harming behavior, as well as noticing sooner when you do engage in it.

If you give this a fair try (assuming you are motivated to try it), and you still find yourself tearing at your own skin, I would suggest a psychotherapeutic interview, and possible treatment which might or might not include one of the SSRIs, like Prozac, or Paxil.

Be well.

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