It's 5:40 A.M., and I'm applying concealer before a run. Never mind that it's still dark enough for a head lamp—I have to spackle the zit I've picked into scabrous oblivion.

Picking is my evening ritual. I'll scan for a blemish or a blocked pore, then attack. I'll continue to poke and prod at dozens of barely-there flaws until it's time to let my husband in the bathroom to brush his teeth—or I need to get the first aid kit to tend to the gory mess I've made.

I started picking my skin when I was around 11. I figure I've spent 15 minutes every night since then in front of the mirror, which means I've wasted about 2,192 hours of my life on this icky ritual. I can't tell you how many times I've repeated these steps: Squeeze bump. Curse pain. Await scab, tear it off to reveal...fresh skin! Once, I had to wear a bandage on my chin after attempting to lance a pimple with a needle. And at the restaurant where I used to work, I mangled a blemish so badly while on break that I had to cover it with the orange chalk we used to write out the daily specials.

"Everyone picks," says Jon E. Grant, MD, a professor of psychiatry at the University of Chicago and chair of the scientific advisory board of the TLC Foundation for Body-Focused Repetitive Behaviors. "It's when picking interferes with your life, and results in lesions that make you feel like a pariah, that it becomes a disorder." And the consequences can be serious: Grant says some patients need skin grafts because their mutilated skin can't heal; others contract systemic infections after bacteria from under their fingernails get into their bloodstream.

My scars tend to fade, but over the years, I've avoided sex, swimming, parties, and brightly lit sporting events because I was embarrassed by the damage I'd done to my face. "NEVER AGAIN," I'd scrawl in my journal—and then be back at it that night. The picking hit a tipping point after I left my office job to work from home. I suddenly had the flexibility to postpone face-to-face meetings until my skin cleared up—which I never gave it a chance to do. My private habit started to affect my livelihood.

Picking, which psychiatrists call excoriation disorder, is considered a body-focused repetitive behavior (BFRB), like hair pulling and nail biting, and is typically a closet condition. "Many sufferers are ashamed, or they think they're the only one with this problem," says psychotherapist Tom Corboy, the executive director of the OCD Center of Los Angeles.

In 2013, experts essentially legitimized compulsive picking by including it in the Diagnostic and Statistical Manual of Mental Disorders, under "Obsessive-Compulsive and Related Disorders" (one study found that 21 percent of OCD sufferers also have a BFRB). Yet you don't hear people joke about the habit in the same way they might say they're "a little OCD" about their desk.

I wish I could pinpoint why I pick. Experts say BFRBs are partly genetic (research with twins suggests the same genes may confer risk for both skin picking and hair pulling), and I do know of two other pimple obsessives in my family. But my best explanation is that purging clogged pores makes me feel productive. I also find that focusing on my face distracts me from worries in my head—I pick slightly more during times of intense stress. Then again, I also feel the urge when I'm happy, angry, or waiting for my laundry to dry.

Grant advises patients to shift their focus from the "why" to the "what can I do about it," because while some people pick to cope with depression or anxiety, many do it mindlessly. And current evidence suggests picking isn't generally an indication of unresolved trauma. Think of it this way: "When a dog keeps licking one spot until its fur comes off, we don't wonder whether it was unloved as a puppy," he says. "We know it just doesn't seem to have an off switch for a common behavior."

The recommended treatment is cognitive-behavioral therapy (CBT), which helps you tweak your actions by learning to argue with yourself: I need to pick because I'm stressed about work! becomes Is this project really that daunting? Pop some Bubble Wrap instead. CBT is sometimes supplemented with acceptance and commitment therapy, which means making peace with the desire to pick rather than trying to banish it, or habit-blocking strategies, like dimming the bathroom lights or clipping nails short.

Around two years ago, I started seeing a psychotherapist about my chronic worrying. If she noticed my facial wounds, she never mentioned them. But keeping quiet about such a huge part of my life felt dishonest, so I finally worked up the nerve to tell my therapist I pick...and can't seem to stop.

She recognized that my issue wasn't related to a lack of willpower. We'd already talked about how I always stop at one square of dark chocolate and never miss a workout. In fact, my therapist suspected that I probably have too much self-control. She suggested I practice "feeling my feelings"—my anxiety as well as my urge to pick—rather than trying to banish or act upon them. The idea is to treat each pimple as a Buddhist would: Acknowledge, but don't respond.

Admitting my problem made me take it more seriously, and my therapist's response helped me see that no amount of discipline could fix it. I realized I'd need to tackle my addiction from a few different angles, and kicking it would take time.

My therapist is helping me accept myself as I am, zits—and my compulsion to pick them—and all. I've also come up with some antipick tricks: I remind myself that while picking may let me zone out in the moment, it's not worth the shame and frustration I feel afterward, and I practice habit blockers like using a face oil at night that makes my skin too slippery to pick, then hiding any intriguing blemishes under a pink drying lotion. During the day, I try to stay at least a few feet away from mirrors or avoid them altogether. Before bed, I use the time once devoted to picking to read a magazine or apply eye gel and neck cream.

I'm happy to report that most nights I manage not to pick, even though it's still disorienting to skip this crucial step in my routine. And a few months after my camouflaged predawn run, I can now tie up my hair in the morning without feeling compelled to touch my face.

I don't think I'll ever be able to overlook a glaring whitehead, but that makes me pretty typical. "Though treatment works for many people, that doesn't mean they stop picking completely," says Grant. "They do decrease it substantially, so they feel like they get their lives back." In other words, we learn to pick our battles.

scratching the surface At least 3.4 million Americans suffer from skin picking, according to the Diagnostic and Statistical Manual of Mental Disorders, and three-quarters or more of them are women.

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