The Physical Manifestations Of Anxiety

Typing this is incredibly painful.

At times, the alternatively throbbing and piercing pain is unbearable; at others, it’s a friendly, familiar sensation that makes me feel rooted in my body and less prone to distraction. But it’s always a liability — caused by a behavior that our culture tells me is “just a habit” that I should be able to kick.

Picking at my cuticles is one of my anxiety-release behaviors. I’ve done it since I was a little kid and my mom first yelled at me to not bite my nails; she’s a rather powerful force and that’s all I needed. Without realizing it, I started scraping my cuticles with neighboring finger tips. Chewing at the skin around my nails didn’t make a sound like attacking the nails themselves; I could evade surveillance. The first time I hyper-focused on a hang nail, I was hooked. It became a compulsion.

In fact, excoriation (skin-picking) is a new-ish addition to the Diagnostic and Statistic Manual of Mental Disorders, falling under Obsessive Compulsive Disorders. My docs are still picking apart my specific diagnoses — so far, ADHD, anxiety, dysthymia, and we’re pretty sure PTSD. Obviously OCD falls into an anxiety category, but I haven’t had that diagnosed officially. (I really loathe co-opting.)

Cuticle-picking isn’t my only imperfection-elimination behavior, however; it’s simply the easiest and most accessible one. I find any number of other self-scrutinizing details equally compulsory to attend to, like stray eyebrow hairs, minuscule chapped spots on my lips, zits (and potential zits), gray or more-curly-than-its-neighbors hairs on my head, imperfect or sharp fingernails, and ingrown hairs anywhere.

I come and go from this compulsion. Only after becoming good friends with other people who share similar behaviors and frustrations have I let go of the self blame that created an endless feedback loop: The anxiety over engaging in the behavior would cause a spike in my internal jitteriness and, therefore, an increased need to exorcise it. And so on, and so on, until I’d need to seek out a more engrossing behavior — or at least one that fully utilized my hands — to cover up the impulse.

Currently, I’m in a particularly persistent patch. So much of the skin around my nails has been whittled away that my fingertips pulse constantly; my body is sending assistance in a futile attempt to heal, despite my commitment to over-paring. I struggle to hold my phone without dropping it, and even without the carpal tunnel that is greatly aggravated by this behavior, I am nearly unable to summon enough strength in my fingers to open a box or a jar.

I can trace the degree of damage to which I have unfortunately become accustomed to about six years ago. The decade I dog-walked outside in Chicago winters — while spending my indoor time with my hands in glassware sanitizer during bartending shifts — created a constant landscape of tiny dry spots, chips, partially healed wounds, and other imperfections to obsess over. Combine that with undiagnosed Attention Deficit Disorder (ADHD) and a simmering dissatisfaction with my life in general, and I was perfectly poised to take out my overwhelming boredom and unhappiness on the tips of my fingers.

Several snapped nails below the quick — thanks to the cold air and the drying sanitizer — left frustrating gaps under my thumb nails; I took to using whatever utensil was handy to scrape the space. Toothpicks and fruit spears (those plastic toothpick-length tools some establishments use to garnish drinks) were around thanks to the hours I spent standing in bars — both on and off the clock. Toothpicks became my favorite, and for a spell I allowed an obsession with what was under my nails to replace the one with the skin adjacent to them; it certainly looked better than having hangnails down to the second knuckle on several fingers at a time.

Then, as winter was melting one year, I treated myself to my first adult mani-pedi. I was hard on my feet and hands, working between 60 and 80 hours a week every week. What better way to rehab from the toll the winter took on my extremities than to have a professional soak them in healing liquids, buff off the sore spots, and toss in a bit of massage? While I watched her work on my hands, I became mesmerized with a tool she used on my cuticles: a cuticle nipper.

It had so much more precision than standard clippers! It could get at every spot no matter how small and completely removed the stray flesh and nails bits, so that the polish would be smooth and even when applied. I couldn’t wait for her to finish so I could go to the drug store and see if I could just buy one, or if I’d have to find a beauty supply place. As I walked down the nail accessories aisle, an entire section of cuticle nippers came into view. I bought two pair, wondering what the difference in price meant. I went home assuming I’d have to wait several days for the habitual running of my fingertips over the adjacent nails for imperfections to turn up anything. But with this new ability to tackle even the tiniest of annoyances, I immediately found things even the most the experienced hands of a professional seemingly missed.

Six years later, there’s always a pair next to my work or relaxing space. Often, the rawness level of my fingers and hands is the physical indicator that I’m anxious about something that has yet to fully surface in my mind. The hardwiring of my brain allows me to tend to my cuticles with one of my several available “ADHD tracks,” without taking away from other thoughts or activities — much to the detriment of my hand functionality. If I had to home in to focus and find the imperfections I assess, the pause to quickly clip would be a fully engrossing activity. The way my neurobiology enhances my multi-tasking abilities may work in my benefit a fair percentage of the time, but in this case it means I can always be doing damage.

Our culture so greatly stigmatizes aberrant behaviors that most of us who have them — no matter how minor or concealable — work overtime to keep anyone from noticing. We can’t risk being perceived as unprofessional or ill or in need of assistance or supervision. Most of us especially aren’t looking for assistance or supervision; avoiding unwanted “help” or having to reassure other people exhibiting unnecessary concern is the primary reason many of us hide.

I very much hope that the next layer my psychiatrist adds to my second line treatment is an anxiety-specific medication. I’m more than 17 months along this road of undoing misdiagnoses, adding correct diagnoses, treating conditions one at a time to determine what symptoms are their own disorders, and now altering my medication protocol. There are a lot of days when it really sucks, even if I am grateful I’m finally getting care. Some of the rough days are ones spent primarily in solitude when there are no barriers to submitting to the impulses; others are spent primarily around people where I can’t engage at all and I must expend an exhaustive amount of energy containing the impulses and the build up of anxiety. It’s an ugly Catch-22.

I’m rather done being exhausted in order to appear “fine” for the comfort of others. I’m seeking more effective treatment right now — not out of a desire to avoid sideways glances or inappropriate “humorous” comments — but to find as much healing for myself as possible, from the tips of my fingers down to my toes.