My personal workings

 Here are the main residual things I am working with. The goal is to discover what is the best cure. The recent discovery is the part behaviorism has to play. For context I have an ADHD presentation, but have not received a thorough differential diagnosis. 

CW: I'm going to talk about unpleasant habits I have here, usually I'm too ashamed to be open about them but in the interest of honesty, accuracy, and transparency about my process, I will put the stigma aside. If you don't want to read about this, miss the localized fixations subheading.

 

1) Localized fixations. I have historically had a strong presence of various BFRBs (body-focused repetitive behaviors). One major one I developed around age 10 or so, nail biting, to which I added cuticle picking after an ill-advised suggestion by a relative that focusing on that would make my nails look better.

The main pattern i am noticing is a pattern of hyper-fixation. Maybe it is on a chapped lip, a cyst on my scalp, maybe it is an area of my gums, or a particular nail bed. The focus will start to drift to this specific region and I will often irritate it in some way so that it becomes inflamed and itchy. This further incentivizes scratching the itch, which feeds the cycle. Once the cycle starts there becomes this urgency to get rid of the offender, leading to an internal panic feeling. The reward of the behavior is relief from this mounting tension.  

a) Increasing overall nervous system regulation/capacity has widened my field of neutrality where these irritants pop up. A contributing factor is a decrease in lifestyle stressors that challenge my window of tolerance for my nervous system.

b) Judson Brewer's trigger-behavior-reward framework, coupled with Charles Duhigg's point about the reward system being more complex than just dopamine - Duhigg's suggestion being to identify the exactly qualities of the reward rather than reducing it to "dopamine". Brewer's method includes applying mindfulness specifically to the habit cycle, from the trigger to behavior to the full result, and allowing the negative elements of the result to penetrate/permeate... thus "recalibrating" the anticipated reward value in the brain, thus reducing the cravings. Using these approaches combined, as a top layer on the expanded regulation of 'a', has normalized my eating behaviors and completely removed maladaptive food habits allowing my physical weight to slowly trend downward to homeostasis. 

The combination of a and b has given me the most success I have heretofore had for stopping biting my nails, when I added no-bite stuff for a period of time to increase the strength of the negative result. This has been gloriously successful, but I am finding several months later I am really running into an issue with excessive triggers due to an intersection with a habit that is even more entrenched...

My oldest habit I have is picking my nose and eating the boogers. I developed this at an extremely young age along with my sister, and have carried it forth throughout my life despite the shame, disgust, inconvenience, etc. 

HABIT ANALYSIS

Picking the nose itself triggers include:

- difficulty breathing due to congestion, esp around nostrils and entrance to nasal cavity -

- irritation from boogers drying out in nostrils/nasal cavity 

- anxiety/sympathetic activation

Rewards include:

- relief from nasal irritation

- relief due to opened airways

- calming grooming behavior 

- pain/injuries of nose skin > bleeding + sensitivity to cold

- shame

Eating the boogers triggers include:

- having boogers on nails with no where to put them

Rewards include:

- calming eating behavior

- shame

- saliva degrades nails over time, making them more pliable and cause them to recede > pliable, receding nails in mouth lead to strong trigger for nail biting

CONCLUSION:

To me, it seems evident that the first and strongest domino here is the nasal irritation.

 

Possible solutions:

bottom-up: 

    1) reduce sensitivity to irritant stimuli (method ?? - increasing regulation/interoceptive attunement)

    2) reduce underlying hyper-fixation pattern (method ?? - increasing regulation/interoceptive attunement)

top-down:

    1) purchase nasal saline solution + tissues and keep them on me

    2) begin using no-bite polish to add to negative incentive (esp for eating boogers)

UPDATE 12/11/21:

There have been several moments along my path where I intended to write and update and did not do so due to being busy. 

Things have definitely been moving in a positive direction. My nails have become long which gave an unintended consequence of injuring my nasal tissue more than when they were short. It also becomes more efficient to rid my nostril of the irritant. I tried to paint more of the bad-tasting stuff but have noticed a negligible level of difference from that, as it is pretty easy to avoid now that my nails as longer.

The pain of picking my nose, the inconvenience of inadvertently causing bleeding, and my strong desire to no longer have this habit seem to be fairly strong negative motivators. 

As far as the underlying issues there are two currently:

- nasal irritation

- sympathetic activation

It continues to be a quick-calming button to do this activity, but the more I become aware of that fact, the more I am able to find other ways to settle my system that do not cause the negative motivators that I mention above.

As far as nasal irritation, I have tried moisturizing my nostrils with oil. I found vaseline very nice a while ago when I did it, but then read that the particles of petrolium jelly can go into your lungs = bad. I tried the saline spray but that shot too deeply into the nasal cavity and actually dried things out even more, which shouldnt have necessarily been a surprise. 

The compromise is for me to be more "on it" with blowing my nose when the need arises, and sometimes using oil or natural wax-based chapstick if the dryness is bothering me. 

The other main element is increasing my tolerance of sensory stimuli in that area (and in general when I can help it). Integrating these sensory issues and self-regulation of the sympathetic activation I think is a big part in reducing the hyperfixation impulse. 

Overall the behavior is definitely decreased, and I look forward to saying goodbye forever soon, as I have seemed to do with my nails. 

_______

New habit goal: Eating Sugar

Eating sugar is definitely a habit for me. It is a stress reliever and bringer of good feelings. Its an indulgence that I allow myself, especially after the food regulation stabilized my weight regardless of how much sugar I eat. Every woman's dream? Well many of them probably. It is quite nice I would say, being able to eat whatever I want without it changing my weight in any significant way. That is something I used to fantasize about. The key is, of course, to eating whatever you want is calibrating the amount that you want. Not forcing yourself to eat less because you're supposed to, but changing the amount that you *want* to be satiable with less.

Yet, now that that is out of the way I've run into another problem. I am a fungus palace. I get these ringworm infections and I've been battling them for two years now! I hate it so much. The only way to get rid of them is to put cream on them twice a day for 2+ week  sometimes and you have to be very diligent about it. If you're not careful they spread wherever you touch, which can be extremely random. And sometimes you can not see them for a long time while they grow in the darkness.

I think feeding them with sugar is not helping, and I suspect that is a significant reason why I am such a hospitable environment. A full list of reasons I want to cut out my daily sugar habit:

1) Too many fungal infections - way too many, for the love of god please make it stop

2) Damaging to my teeth

3) Inflames my tissues (including my knee injury which has been hurting more recently)

So far these negative motivators have been enough to already cut down my consumption, and the obstacles against it are similar to the other habits that I listed above. Sugar is very comforting and stress-relieving. Its an instant hit of good feelings. But, those good feelings are becoming less than the bad feelings, so the reward value is going down. The good feelings are very temporary and that helps. A cup of tea is also relaxing and lasts longer and leaves me feeling hydrated.

Will update with how the sugar thing is going. I will definitely still be eating a fair amount as we are in the holiday times, but once that's over I hope to cut it way back to a trickle.

2) Difficulties with conscious attentional control. 

(unfinished)

3) How to avoid a knee replacement. Aka "Oh Knee, Oh My". (12/11/21) Lately, my knee has been hurting most of the time. I am scheduled for an MRI in a week. Hopefully I won't lose my medicaid insurance next year. I was kind of being stupid when I filed for it so lets hope and pray I have insurance next year. Anyway, after I get the imaging, I'm hoping to approach this problem from multiple angles:

1) See what is going on in the tissues with a doctor

2) Reduce inflammation in body overall

3) Improve regularity of rehabilitative exercise

I want to see what the damage I've sustained to the tissues is, and then from there obviously take whatever steps I need to to prolong the life of my knee. Bloo hoo.