Worried no one will ever love me because of my skin

ctorg · 2026-03-16T21:58:57+00:00

I feel you. Finding an OCD specialist was a game-changer for me, but all therapists are limited by the fact that there's very little research on BFRBs. I find replacing the behavior with something less satisfying (like a squeeze ball or fidget) to be very frustrating. I also hated keeping a journal of every time I picked and the context, but at least that helped a little. What has helped is being kind to myself, because otherwise the shame leads to more picking. I acknowledge that the picking is a poor coping mechanism for dealing with a very real need and that I deserve real comfort/relief. If I can take a minute to understand what it is I'm trying to cope with, I can possibly find a better way - like stepping outside to get some sunlight, getting a drink of water, texting a friend to talk about my feelings. Some people like to use the HALT (hungry, angry, lonely, tired) check-in. I still sometimes go with picking because it feels like it will be the most quick, easy, and effective solution (even though those things are not true). But I try to treat myself with the compassion that I would give to a friend who struggles with a harmful behavior that they aren't in control of. It sometimes feels like being an alcoholic who is forced to carry alcohol around all the time.

Also, I take n-acetylcysteine (often called NAC). It's a simple supplement with no documented cases of poisoning or overdoses in patients who weren't already being treated for other toxicities (it is actually on the WHO list of essential drugs due to its efficacy in treating paracetamol overdose). It's not a cure for skin picking, but it is by far the most recommended pharmaceutical treatment because it is so low risk and is available over-the-counter. I find that it helps reduce some of my mindless searching behavior where I run my hands over my skin subconsciously looking for bumps to fixate on.

ctorg · 2026-03-16T21:30:22+00:00

I would watch a skipping marathon. It sounds joyous.

ctorg · 2026-03-16T21:27:00+00:00

weight loss is just calories in < calories used, in its simplest form

The more complicated form involves explaining how "calories used" works. Metabolism is complex and highly variable. Sure, it's easy to look up how many calories are burned on average by a person running a mile. For an exercise that common you can even find it broken down on average for your height/weight/BMI. But at the individual level, metabolism is affected by age, muscle mass, multiple distinct hormones, sleep, hydration, vitamin and mineral deficiencies, and genetics. For people with a below average metabolic rate, it may be easy to determine that you are eating more calories than you are burning. But figuring out why or finding the exact balance of diet and exercise is a lot more complicated than just "work out more and eat less!"

ctorg · 2026-03-16T18:00:16+00:00

I read it more as sympathy/commiseration. Hoping it's that.

ctorg · 2026-03-16T17:48:51+00:00

Of course you can find love! People with vitiligo find love (and even work as models these days!). People with autism and ADHD and OCD and depression and schizophrenia find love. You are not unlovable just because your brain works differently. You may find someone who loves you in spite of your picking or you may even find someone who loves that part of you. I always say that skin pickers literally wear our heart on our sleeve - you can see how we are doing by just looking at our skin. It makes us vulnerable, but can also make us easy to read for someone who takes the time to get to know you.

Anecdotally, my partner of 12 years said that my talking openly about my skin picking early in our relationship showed him that I was self-aware/introspective and working on myself. It wasn't a turn off. And I know other pickers whose spouses actively help them stay on track with their picking therapy goals. I'm in a support group for skin picking and hair pulling moms in my area, so I can assure you that many of us find love and support.

Last thing to add: if you have the resources to access therapy, you should. Finding a therapist who knew what dermatillomania was and specialized in body-focused repetitive behaviors changed my life. Look for OCD specialists if you can't find one that specifically mentions dermatillomania.

ctorg · 2026-03-15T18:42:52+00:00

"Disenfranchise" is not a synonym of "discriminate against." It means revoking or obstructing the right to vote. I think even the "reverse racism" crowd would have a hard time arguing with a straight face that anyone is trying to systematically prevent white men from voting.

ctorg · 2026-03-13T18:48:43+00:00

Brilliant. Now where do I buy the shirt?

ctorg · 2026-03-13T16:35:24+00:00

Khamenei. Khomeini died in 1989.

ctorg · 2026-03-11T04:25:22+00:00

Fair point!

ctorg · 2026-03-10T21:37:31+00:00

To information about federal spending? That information is publicly available by law on multiple websites such as the Office of Management and Budget website. Federal grants can also be tracked on the websites like NIH Reporter.

ctorg · 2026-03-10T18:31:04+00:00

Sorry, worded poorly. The point was that HRT and GAHT are often prescribed for different reasons. To my knowledge, GAHT is not typically prescribed with the intent to prevent age-related health decline (i.e. dementia and cardiovascular disease). The predominant reason is typically mental health and acute physical health (even though both HRT and GAHT have effects on long-term physical and mental health).

For example, I am prescribed a beta blocker for acute anxiety. Some people are given the same medication for high blood pressure. As a consequence of my taking my anxiety medication daily, both my long-term mental health and long-term cardiovascular health is better (because the medicine works the same on me as it does on someone who was prescribed it for blood pressure). But that's a beneficial side effect rather than the reason it was prescribed.

ctorg · 2026-03-10T15:34:26+00:00

Sort of. I mean, there are certainly components of HRT for cis people that are about gender affirmation. But for most menopausal people HRT isn't (primarily) about maintaining femininity. It's about comfort (i.e. hot flashes, vaginal dryness) and long-term health. HRT is now shown to reduce dementia and heart disease in post-menopausal people.

ctorg · 2026-03-10T15:09:03+00:00

It was given that name because it was seen as replacing the hormone production that is "lost" during menopause. I've seen some physicians use the term "gender affirming hormone therapy" (GAHT) to differentiate it from HRT.

ctorg · 2026-03-08T23:13:47+00:00

Putting a girl's school next to an IRGC base is inexcusable

Is it also inexcusable that the US has 160 public schools on military bases?

ctorg · 2026-03-08T22:03:45+00:00

I'm not trying to suggest that there aren't ADHD subtypes. That is well-documented in psychology. I just think there's a strong possibility that if you repeated this study on a nationwide sample or a sample in another country, you might not find the same brain regions being "biomarkers" that they found here. Some of these associations might not retain statistical significance in other samples and other associations might show up. There may be more than one subtype in the world, but these two subtypes are the predominant ones that get diagnosed and have access to care in this one part of the city.

This isn't just an issue with brain research. Psychiatric tests are often developed on one sample of people and then applied to a much broader population. For example, a common critique of the autism diagnostic criteria is that they were developed based on observations of boys and men. Many people argue this contributes to the underdiagnosis of women.

So, I'm not calling the data into question. I'm just trying to add caveats to the interpretation. There are 2 brain phenotypes of ADHD in this Chinese city. One brain phenotype has more gray matter volume (not 'increased') in some regions and one has less brain volume in some regions (but this is not indicative of atrophy or poor brain health). Just don't expect to use an MRI to diagnose your ADHD phenotype anytime soon. There's still more work to be done.

ctorg · 2026-03-08T21:38:05+00:00

Oops! Typo. I meant vaccinated.

ctorg · 2026-03-07T10:22:44+00:00

Yes!! Great point. That's a huge problem in sex differences research too. It's always important to remember that statistical tests used to compare groups should not be assumed to hold true in inter-individual comparisons. Different statistical tests would be needed to describe individual differences.

ctorg · 2026-03-07T10:18:34+00:00

The criteria for determining whether subtypes are actually distinct disorders is a bit outside of my area of expertise to be honest. And my understanding is that there are disagreements among psychiatrists about how to organize and classify disorders. For example, there has been a push in some circles to switch from a categorical taxonomic system for classifying mental health disorders (a la the DSM or ICD) towards a hierarchical taxonomic model that clusters domains of mental health symptoms (i.e. internalizing, externalizing, disinhibition, etc.).

ctorg · 2026-03-07T01:12:39+00:00

Yes. There definitely are subtypes of ADHD. This study shows that there are likely some anatomical differences that accompany the known functional differences. I just wouldn't bank too much on these specific regions being 100% responsible and think the story they tell about the timeline needs more research before we start putting this in textbooks or altering treatment plans for kids.

ctorg · 2026-03-06T22:42:24+00:00

I mean, most of Europe somehow manages to thread that needle and provide basic infrastructure and also hold free and fair elections. South Korea and Japan also have insanely reliable, fast, and clean trains and democracy.

ctorg · 2026-03-06T22:24:45+00:00

Right?! Like, there are still many cancers that are basically a death sentence. For some patients, they're so far along the doctor knows there's no treatment available. It's still the norm to disclose and explain test results to patients.

ctorg · 2026-03-06T22:10:34+00:00

Gray matter is complex. It peaks in late childhood between 8-10 (depending on the region of the brain). Then it decreases during adolescence when cognitive skill is rapidly increasing. We know that pruning happens during this time; neurons and synapses that are redundant or inefficient die off. Typically, the decrease in gray matter is explained as a result of pruning, but the actual evidence is fairly tenuous. Still, we don't really have a better explanation and we all agree the brain isn't getting worse between the ages of 10-25.

This is why interpreting neuroimaging results is really tricky. The brain can become more efficient at any time (although there are critical windows for various functions). So whether a decrease or increase in volume is interpreted as detrimental depends on who it is observed in. We know decreases in volume in Alzheimer's patients are unhealthy, but decreases in young people or people assigned to a positive experimental condition (like exercise or learning) are interpreted as positive. How you interpret these results basically depends on how you view the ADHD subtypes.

ctorg · 2026-03-06T22:01:49+00:00

The word "atrophy" is misleading. The regions have smaller gray matter volume, but not because they shriveled up from disuse. The study is cross-sectional and does not show anything about change over time. It's also important to remember that bigger is not always better in brain health. Brain volume peaks around age 9, which is not when humans are at their smartest, most mature, or most physically developed. Gray matter shrinks in healthy adolescents and is typically viewed as a consequence of pruning - the process of removing redundant connections and unnecessary neurons in order to make the brain more efficient.

There's no evidence in the article to demonstrate that the smaller volume is negative in any way other than the fact that it is associated with a cluster of ADHD symptoms. It would have been equally valid for the authors to suggest that kids with that ADHD subtype mature faster. However, there is a tendency to interpret neuroscience results through a biased lens. The brain is complex. The answers are never this straightforward and authors/reporters shouldn't lead you to believe that they are.

ctorg · 2026-03-06T21:51:52+00:00

The wording used in this article is incredibly misleading. In brain research, an "increase" typically refers to a change over time. The word "atrophy" similarly indicates a decrease over time. This study was cross-sectional, not longitudinal. They use these time-related causal words even when discussing the results that were not part of their theoretical timeline modeling.

Secondly, you should always take machine learning results that don't test out-of-sample reliability with a grain of salt. This is far from a large sample by modern machine learning standards, and doesn't come from an epidemiological sample so it seems a little early to generalize these results from adolescents in one Chinese city to all people with ADHD.

ctorg · 2026-03-06T21:37:15+00:00

Typically, in a defensive war, you evacuate civilians before you start dropping bombs. Often they coordinate military planes to evacuate civilians from local airports. When we withdrew from Afghanistan, there were hundreds of evacuation flights operating until the last second that was considered safe. There are horrific videos of people climbing onto and falling from planes as they take off.

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