Dr. XYZ:

I don't know how to exactly bring this up, but I do have a concern about myself. I don't know if it is something psychological or not, that is why I am mentioning it to you, maybe you can help me determine if it is a “mental” problem or not, and whether I need to seek counseling or something for it.

So, at my last appointment, you noticed the sores on my arm and asked what happened. I told you that I get cat scratches and pick at them. You told me I didn't want to do that. I know I shouldn't, but I do. What I didn't tell you is I find picking at them “fun” and a lot of times even comforting. Sometimes I am fascinated at the sight of blood after picking it. It's strange, I know I shouldn't, but I can't seem to stop myself. I have been doing this as long as I can remember (even as a kid), so maybe it is just a bad habit that I need to break, I don't exactly know. When I was a kid I had a fascination with band-aids, so that might have been why I picked as a kid...but band-aids no longer interest me, so I basically just pick for the sake of picking now. I don't pick because my sores/bites/whatever itch, like some people may do. I just pick because it relaxes me.

My dad and his new wife will notice my sores like you did, but I am ashamed/embarrassed to tell them the truth, so I lie and tell them that I scratch them in my sleep. This is not true. I am fully awake when I do my picking. In my sleep is the only time they have the opportunity to scab over. I don't know if my mom and her new husband notice or not. If they do, they don't say anything to me about it. I am pretty sure other people notice as they will either stare at the sores or stare at the multiple band-aids I will be wearing. I don't like the looks I get anymore. I used to not care, but now I do. I want to stop this “sick” habit, but I don't know how. I want help.

Do you think this is a psychological problem or not? Do you think I would benefit from counseling/therapy? Would that even help me? I don't think there is any medicine that would solve my problem, and I would rather not add any additional medications anyways, unless absolutely necessary. So, the only other thing I could think of that might help me is therapy, but I wanted a professional opinion on the matter. What are your thoughts on the matter? If you feel I should seek therapy, what type would you recommend (i.e. - a psychologist, a licensed metal health counselor, etc.)?

If I should seek therapy, it would probably be best to start sooner rather than later, so if you think that is the route I should go, I would appreciate a call or letter telling me this rather than waiting until my next appointment with you. But, if you want to hold off on advising me until my next appointment, that would be fine too, I'll trust your judgment on the matter. Thank you for taking the time to read my concerns.

Sincerely,

Squirrel1983