Since childhood I have bitten the skin off my fingers, often leaving them bloody and painful. I am in my 50s now and my poor fingers look dreadful after years of chewing.

I understand this to be a form of self-harm but it is such ingrained behaviour I seem unable to stop. I feel embarrassed by the state of my hands and find myself often tucking my fingers under so people can’t see them.

I have had extensive therapy and understand why this behaviour may have started. I suffered severe anxiety as a child and my mental health was poor throughout the first half of my adult life. But I am much better now, so why does it continue?

I’ve tried hypnotism, which works for a while. Interestingly I obsessively press the ends of my fingers for weeks after I have been hypnotised – almost like I need to feel them. I stop finger chewing for a couple of months but I always start it again.

Do you have any suggestions that might help me?

I’m sorry to hear you are struggling with this. I used to do a similar thing: as a child and young adult I used to rip the skin from around my fingers and my feet – the latter sometimes so badly it hurt to walk. I still pick the skin around my fingers, but to a much more manageable degree.

I went to BACP-registered psychotherapist Emma Cullinan, who specialises on the impact of childhood events on current, at times compulsive, behaviours.

“Children are at the mercy of the behaviour of people around them,” she explained. “Unable to fight or flight, they work out coping strategies. When we are distressed, we often resort to self-destructive behaviours or try to soothe ourselves. These coping strategies are actually designed to help a child deal with difficult emotions, but as you have found, while there is short-term gain, it is followed by guilt, and in your case embarrassment.”

I wonder if you can remember what happened to trigger this. Because while coping mechanisms seem like they help, giving them up can be hard if the underlying problem is not dealt with. Otherwise what happens is a cycle of try/fail/shame/anxiety/go back to the original coping mechanism.

I note you have had extensive therapy but I wonder what sort, and when. Experience has taught me that sometimes we are only really ready to process things that happened in childhood when we are much older. I wonder if you might consider finding someone else who could help you specifically with this – maybe do some behavioural therapy alongside a talking one.

“In trying to stop using a coping mechanism,” says Cullinan, “we must face some difficult emotions and memories that have been somewhat numbed by the coping strategy. Even if you know, rationally, that you are better now and don’t need this coping mechanism any more, subconsciously you will feel that it has got you this far in life, making it difficult to let go.”

Some practical things which help me (but I have had therapy, including CBT, at varying stages throughout my life and continue to have it) are: knitting, baking, playing the piano and being on my phone. If I just sit and talk to people, I pick, even if I’m not anxious. I have found having nail clippers handy to clip off any protruding “pickable” bits works for me, but it might not for you if they are used to inflict more damage. I also rub a really lovely balm into my fingers and cuticles to keep them smooth, again so there are no bits to grab hold of. A worry ring/worry beads might also help you.

Cullinan advises: “Each time you want to pick, try to look at what preceded it and investigate what your triggers are. Were there unkind thoughts towards yourself? If you can consciously name the feeling it may help you understand what leads to this behaviour.

“It sounds as if you experienced difficult emotions at a young age which were not picked up at the time. I imagine you were not comforted so you had to deal with these overwhelming emotions on your own.”

Cullinan and I both agree that you really need to be compassionate towards yourself. This may take time. It’s not about compulsive behaviours, but I have a hunch you might find the podcast I did on dealing with your inner critic helpful. I’d also be really interested to hear what readers in a similar situation have found that works for them.

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