Sam has a long history of picking starting in childhood. Sam would spend her summer’s picking at various bug bites, and routine cuts and scrapes from riding her bike and climbing trees. She experienced a certain comfort in the picking, which usually happened during boring car journeys or as she watched TV.

She was usually unaware of her picking until her mother would yell at her to stop. The picking continued into adolescence when she struggled with acne, which she tried to control through intentional efforts to extract the black heads. This became a nightly ritual when washing her face. Unfortunately, the pimples continued no matter her efforts, and her picking only resulted in the creation of scars, but by then she felt powerless to control her urges to pick. By adulthood her acne had stopped, but the picking transferred to her cuticles, which she would pick at during her long rides to work and as she sat at the computer editing manuscripts for her job. Although her picking has waxed and waned over the past decade, including a few years when she was not picking at all, she has recently noticed her son copying her, picking at his own cuticles. She feels deeply ashamed at this and wants to stop this behaviour once and for all.