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    Dr Goldberg
    shania09 posted:
    I also met to ask you another question and I am not sure hoiw to ask it, but I pick at my face, like if I see a pimple or just anything, and I do not know how to stop. Is this just another form of BP? I haven't even told my tdoc. Make up was a wonderful invention! I has really gotton bad lately. I did tell my pdoc about my anxiety so she put me on celexa, but it hasn't helped, and I told that. I took a friends xanax a 5mg one and I could not believe the difference! Wow! I told my medical once and she said that she better not not cause of my BP and the risk of addiction is to high. What did that mean?? What does one have to do with another? Do you have a suggestion?

    Thank you
    melly2210 responded:
    Hope is that thing with feathers that perches in the soul and sings the tune without the words and never stops... at all. ~Emily Dickinson
    Joseph F Goldberg, MD responded:
    Dear shania,

    Skin-picking isn't per se something related to bipolar disorder. For some people, physical self-injury is a way to relieve tension. It's not a very adaptive one, and can cause problems of its own (eg, scarring, infection, marring your appearance). Medicines are not that helpful for this problem. Behavioral techniques and strategies to manage stress and distress work better. In terms of the Xanax, yes, it is potentially highly addictive and not for everyone.

    - Dr. G.
    An_254061 replied to Joseph F Goldberg, MD's response:
    Do you know of a specific replacement behavior to extinguish this behavior. I have been doing self injurious behaviors since I was 3 yrs old when I was badly neglected by a narcissistic/ borderline queen and my dad, frequently manic as he did not take his prescribed lithium. As a young girl, I pulled out clumps of hair. In my 50's I am stuck with the latest: skin picking even as I went thru 9 months of surgery/chemo for cancer.

    Also do you know if raking too much Provigil (exceeding the recommended dose) can ultimately cause a GI disorder such as colitis? I have been abusing this drug for 4 years but with my own chemo fatigue, my husband with acute leukemia and 3 small kids.....I pop it to get energy.

    I feel like I'm a basket case but at least I am reaching out for help!
    Joseph F Goldberg, MD replied to An_254061's response:
    Dear An,

    Some behavioral approaches that have been described as substitutions for self-injurious behavior include snapping a rubber band on the wrist, holding ice cubes on your skin until it becomes painful (or putting your hand in ice water), taking exceedingly hot showers, tearing paper, "cutting" on skin using a washable marking pen, and vigorously scratching or combing the hair of a stuffed animal.

    There have been reports of Provigil overdoses causing nausea and diarrhea, but I can't think of any reason why excessive use of Provigil would cause colitis. Agitation, moodswings, insomnia and irritability would be the most likely consequences of excessive misuse.

    Dr. G.

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