What is Trichotillomania? (TTM)
The following is a excerpt from the book 'The Hair Pulling Problem, A Complete Guide to Trichotillomania,' by Fred Penzel, Ph.d
“Trichotillomania (TTM), or Compulsive Hair Pulling, is a disorder that is only just beginning to be appreciated in terms of its complexity, the number of people who actually have it, and its powerfully negative impact on people's lives. Hair pulling is a complex problem and has a great number of inputs, each of which, in turn, can be further influenced by a wide variety of factors. For some, there is often little or no awareness of their pulling. There are some who say that this automatic pulling may, at times, be closer to a tic of the type seen in Tourette's syndrome. Another group of TTM sufferers report an extremely pleasurable or soothing feeling when pulling hair. The pulling itself is an immediately fascinating experience, and can function almost like a drug for some. Time can almost seem to stand still for them when they are engaged in this activity, and other problems temporarily vanish into the background. Others may go on to ritualize or play with the hair after they have pulled it out. There are those who report feeling no particular pleasure. Finally, there are those whose pulling is done deliberately, and which seems closer to classic Obsessive-Compulsive Disorder (OCD) or Body Dysmorphic Disorder (BDD). They feel driven to pull hairs that are imperfect or wrong in some special way. By pulling out these hairs, they believe that they are fixing the way their hair looks, eliminating hairs that do not seem to belong, and improving its appearance. Interestingly, some TTM suffers urges are not confined to themselves, and they can be seen to habitually pull fibers, hairs and strands from pets, toys or objects in their environment. One thing all these different groups have in common is the upset the person feels because of what they have done, and the fact that they were unable to stop themselves.”
What kind of treatments are available for TTM?
Because trichotillomania is a complex disorder with varying differences in when and why we pull and because there hasn't been near enough research into it's cause of treatment up to now, there is no one specific treatment or method that works for everybody. There is certainly no magic pill or specific thing that works for everybody all of the time. However, there are things that do work for people, given time and patience, and there are many people who have been able to stop pulling. And of those who have been successful in learning to stop this destructive behavior, there is no single thing they can point to that helped them, rather, it is a combination of things. And learning what combination works for you takes patience, self acceptance, self forgiveness, and support. It will take time, patience, and research. Get some books on trichotillomania, there are many available, some of which are listed on the Books link. Join the Trichotillomania Learning Center (TLC). They have newsletters, research studies, information pamphlets, support group information, and lots more. See their web site at www.trich.org. Join a support group. This online community can be very helpful, especially for those seeking anonymous support, but when you are ready, nothing beats an in person support group. Check with the TLC to see if there are any established groups in your area, or seek their help in starting your own. Be patient with yourself. Most therapy involves several weeks just of keeping a journal of your pulling. Treatment varies with when and why you pull. Keeping a journal helps you to identify those times and places, moods, and activities that will most likely lead to pulling. When you know your high trigger areas, you can help prevent pulling before it starts.
The following information was largely provided by Trichtillomania Learning Center member and board member Sue Price. Special thanks go to Sue for the time and effort she invested in providing this helpful information. I am providing said information in random order. Special credit is given to her for her contributions.
One often prescribed treatment for trichotillomania involves Cognitive Therapy.
Following are some notes posted by Sue Price onto my old BrendaCsTrichPage.
COGNITIVE THERAPY FOR TRICHOTILLOMANIA
Cognitive therapy involves identifying the thoughts you have that make pulling more likely, and working on replacing those thoughts with new thought patterns.
For example, one type of thought pattern that often leads to pulling is anxiety-producing thoughts, such as
"I'll never figure this out,"
"I'm going to fail this test,"
"I'm going to get a bad performance review" and so on.
The kind of thoughts that combat this could be, "This may take a while, but I will figure it out" and so on.
Another group of thoughts are those that give PERMISSION to pull, such as
"Just one",
"I'll feel better after I pull",
"I already pulled today."
"That white/kinky/stubby/etc. hair has got to go."
These can be combated with (for example)
"It's NEVER 'just one'. I need to keep from pulling even one."
"I WON'T feel better after I pull, I'll be upset at the damage I've caused."
"Even if I've already pulled today, that doesn't make it OK to pull any more. I can always start the day over."
"It's better to have a white/kinky/stubby hair there, than to have a bald spot."
OR "Every hair has a right to be in my head."
OR "Every hair is SUPPOSED to be in my head."
I have found those last two to be VERY effective. I have actually stopped pulls at the last minute, meaning the hair was in my hand and I was about to yank, by reminding myself that the hair is supposed to be there and has a right to be there. Not all the time, but the batting average is improving!
Your mileage may vary; you need to find the ones you can relate to. It also can take some time, because you are more used to the old ways of thinking and find them more "persuasive" than the new ways of thinking. Think of it as trying to convince a friend of something. The first time you give your argument, they may not be persuaded, but over a period of time after they hear it many times, they will start to see the validity of your argument. In this case, the friend is yourself!
Several years ago now, I kept myself from pulling while completing something under deadline, for the first time EVER, by identifying my anxiety- producing thoughts and combatting them. I walked on air that entire weekend. It was the first time I KNEW, really knew, this thing could be controlled and I could do it.
Another term that is used is "cognitive behavior therapy." This is a combination of aspects of cognitive therapy like I've described, and behavior therapy such as habit reversal.
The following information was originally provided by an annonymous poster RobynAU on the old BrendaCsTrichPage message board.
The following are excerpts from the book, 'The Hair Pulling Habit and You, How to Solve the Trichotillomania Problem,' by Ruth Goldfinger Golomb, and Sherrie Mansfield Vavrichek.
“Why do people pull out their hair?
1) Some people have a strong need to fiddle and/or nibble. Pulling
hair and fiddling with it keeps their hands busy; nibbling, biting,
or eating hair keeps their mouth busy.
2) Some people pull their hair because they like the sensation they
get from stimulating the scalp and/or skin. Others pull when they
feel physically uncomfortable. Pulling hair seems to help them feel
better.
3) Many people find that they pull their hair without even thinking
about it. Like many other habits, hair pulling becomes automatic.
4) Some people find they pull in certain rooms or places. There
seems to be something about those settings, or environments,
that "trigger" pulling.
5) For some people, certain emotions create tension. Hair pulling
seems to relieve tension for the moment.
6) Many people are "perfectionists". they become frustrated with
hair that is not perfect. In addition, their imperfect efforts at
controlling hair pulling can also lead to frustration. For these
people , frustration or disappointment caused by perfectionism
increase hair pulling.
IF YOU NEED TO KEEP YOUR HANDS OR MOUTH BUSY:
INSTEAD OF PULLING, FIDDLE WITH "HAND AND MOUTH ALTERNATIVES"
If you have trichotillomania, then it is very likely that you are a
fiddler, and that you need to keep your hand and/or mouth busy most
of the time. For you, situations that trigger pulling might include
times when your body is "bored" and needs something to do. Sitting
in school, watching TV, and talking on the phone are examples of
situations where your hand or mouth might need something to do.
However, these trigger situations do not necessarily have to result
in pulling. If you keep your hands and mouth busy with something
really interesting before you get the urge to pull, then you will be
much less likely to pull your hair.
"Alternatives" are what we call the things that you can fiddle with
instead of pulling. Playing with a Koosh Ball, Silly Putty, or other
fun-to-touch toys, or fiddling around with knotted lengths of dental
floss, are examples of "hand alternatives."
If you tend to nibble or chew the hair or bite the roots, you can
chew gum or suck on hard candy instead. Some kids like to nibble on
raw pieces of spaghetti. They like the way it "crunches"! These are
examples of "mouth alternatives."
IF VARIOUS PARTS OF YOUR BODY NEED EXTRA ATTENTION:
INSTEAD OF PULLING, GIVE YOUR BODY THE ATTENTION IT NEEDS
For some people, the twinge they get as their hair is pulled from
their scalp or skin feels kind of good. If this is the case with
you, then your skin and scalp may need to be scratched or otherwise
stimulated on a regular basis. In other words, those parts of your
body may need a lot of special attention, which is also known as
sensory input or sensory stimulation.
For other people, itchy or dry scalp makes them scratch their scalp.
Touching and scratching the scalp can lead to hair pulling. For
still others, the sensation that their skin tingles, burns, or, as
some people put it, "glows," leads to touching the scalp and
pulling. Often pulling itself irritates the skin and leads to even
more pulling. This creates a "vicious cycle" of pulling, skin
irritation, and more pulling.
Do areas of your skin or scalp tend to bother you in these or
similar ways? Does the tingly feeling of pulling feel good to you?
If so, then you will need to give the areas where you pull sensory
input in the form of extra stimulation, attention, and pampering.
Brushing or combing your hair more often, using lotions and bath
oils, and/or using loofah sponges regularly will soothe, soften, or
stimulate your skin. Once your skin is softer and less irritated,
you will have fewer reasons to touch or scratch it, and therefore
you will be less likely to pull.
Another way for you to take care of your body's needs is to notice
the sensations you are having inside your body as well as on your
skin and scalp. Like some, you may tend to pull when you are tired,
hungry, or restless. If being hungry is a trigger situation for you
you can use the obvious strategy of having a snack. If you are
feeling restless and realize it, then you can take a walk instead of
pulling your hair. The trick is to train yourself to notice when you
are hungry, restless, or otherwise physically uncomfortable, and
then do something constructive to help yourself feel better before
you start pulling.
IF PULLING IS AN AUTOMATIC HABIT FOR YOU:
INSTEAD OF PULLING, WEAKEN THE HABIT BY MAKING IT HARDER TO PULL
Trichotillomania has probably become a strong and automatic habit
for you. There for it will be important for you to find ways to make
yourself more aware of when you are touching your head or starting
to pull. It will also be important for you to use strategies that
will make it harder for you to actually pull your hair once you
touch it. These strategies will interfere with the pulling behavior.”
The following information was provided by Sue Price, board member of the TLC, from notes she took at a TLC conference in April of 2000 and posted to the original BrendaCsTrichPage web site, an old MSN groups community.
Trichotillomania Today: Facts and Myths
Opening Session presented at TLC Conference in Arlington VA on April 1, 2000
by Dr. Charley Mansueto and Dr. Carol Novak.
(notes by Sue Price)
Dr. Mansueto is Director of the Behavior Therapy Center of Greater Washington, D.C. and is the current Chair of TLC’s Scientific Advisory Board.
Dr. Novak is a psychiatrist at Regions Hospital in St. Paul, Minnesota. She is a member of TLC’s Scientific Advisory Board and was its founding Chair.
Both were among the earliest researchers of trichotillomania, and have worked closely with TLC for many years.
MYTH: Trichotillomania is a form of Obsessive-Compulsive Disorder (OCD).
FACT: TTM is classified as an Impulse Control Disorder in the psychiatric literature. Another view classifies it as an Obsessive-Compulsive Spectrum Disorder. Either way, it is considered a “cousin” of OCD -- related, but not
the same thing.
Research has found that trich affects at least 2% of the population. In adults, at least 10% of pullers are men. In kids, gender distribution is 50-50.
Why do people pull their hair?
* to reduce stress OR to relieve boredom
* because of local sensations (itch, tingle, etc.)
* search out “unwanted” hairs
* for symmetry
* for the root / follicle
* pure habit
* sometimes people are unaware they are pulling, other times pulling is focused and deliberate
MYTH: Trichotillomania is a sign of a deep-seated psychological disorder.
MYTH: Hair pulling is no big deal, like biting your nails.
FACT: Hair pullers are psychologically healthy. One study gave the MMPI (a standard personality assessment) to people who came to a clinic seeking treatment for trich, and the results were “normal”; in other words, the
results looked like what you’d see in the general population. The MMPI results for people with other disorders treated at that clinic, such as anxiety disorder, were not as close to the general population.
BUT . .
Hair pulling is associated with low self-esteem, shame, avoidance behaviors, and feelings of phoniness. There are often co-morbid disorders:
*depression [Many people with trich also have depression; it’s not clear if this is because depression caused the trich (not much evidence of that) or because the disorders overlap biologically.]
* anxiety disorders
* eating disorders
* substance abuse
* body dysmorphic disorder unrelated to hair
* OCD -- 25% of pullers also have OCD, compared to 3% OCD in general population
* attention deficit disorder -- proportion approaches 25% in pullers, this is also higher than the general population
Summary: hair pullers can be “remarkably intact”, but there can be associated problems, and hair pulling is usually very distressing.
MYTH: Pulling causes pleasure, therefore pullers are hedonists.
MYTH: Pulling hurts, therefore pullers are masochists.
FACT: Pullers usually do not feel pain when they pull, and are not doing it to hurt themselves. There can be pleasure associated with pulling, but that’s not usually the reason for pulling (see the reasons listed earlier.)
MYTH: Infants who pull are destined to have trichotillomania.
MYTH: Kids will grow out of their pulling “phase”.
FACT: The majority of pullers who start under age 5 may stop. But 15-30% of adult pullers started that young.
MYTH: Trichotillomania is the parents’ fault.
MYTH: Trichotillomania is due to childhood trauma.
MYTH: Trichotillomania reflects unconscious desires.
FACT: There is no evidence to support any of these statements.
MYTH: Trichotillomania is caused by a chemical imbalance.
FACT: They do think it’s neuro-biological. Serotonin may be involved but it’s not as clear-cut as it is with OCD. Serotonin Reuptake Inhibitors (SRIs) have been “disappointing” in treating trich.
Trich may have different causes in different people. There may be different neurotransmitters involved. In some cases, children have started pulling after a strep infection. We have yet to find the “smoking gun” that
pinpoints the physical processes underlying hair pulling.
Most pullers do NOT have family members who pull. That’s not to say there is no genetic component, but there is no “pulling gene.”
Medications: Dr. Novak cited a patient who got 2 years pull-free just from taking a medication, but this kind of result is “quite rare.” Medications usually don’t have this dramatic an effect, and effects that do occur often
fade.
Medications CAN be beneficial: they can help pullers with co-morbid disorders such as depression, anxiety, or OCD; by helping alleviate the other disorder, it can help the puller control the pulling. Medications can also increase
awareness, and decrease urges or make them easier to resist.
But: “No medication or combination of medications has been found to reliably end hair pulling.” Medications are more effective when combined with behavior therapy.
Dr. Mansueto discussed behavior therapy, and augmenting it with cognitive techniques. It’s a broad approach and can be quite effective. . .but it isn’t foolproof.
MYTH: Any treatment for hair pulling is as good as any other.
FACT: Only medications and behavior therapy have been tested in controlled scientific studies and found to be effective in treating trich. There have been anecdotal reports of many other things that have helped pullers:
hypnosis, biofeedback, diet, many others. Dr. Mansueto even knew of a woman who credited an herbal enema for her pull-free state!
The doctors said: “behavior therapy, medications, and support groups are wise choices.” The jury is out on the rest, but augmenting your treatment with other things may help.
MYTH: Pullers could just stop if they wanted to.
MYTH: Once you start pulling, you will never be able to stop.
FACT: BULL FEATHERS!
Will my hair grow back?
Originally posted to BrendaCsTrichPage by TLC board member Sue Price.
A friend's notes from the "Everything You Wanted To Know About Hair" session at the 2001 TLC retreat:
I just attended the TLC retreat, and also a session on Hair Biology with Dr. Novak. She gave lots of interesting information on hair biology. PLUS, MOST people DO have the capacity for hair regrowth. Most TTM people who do not think that their hair will regrow is because they HAVEN'T been in recovery LONG enough, so they think it won't fill in, so they actually keep pulling. According to Dr. Novak, the largest % of people HAVEN'T damaged their follicles enough to stop regrowth.
More importantly, there were Successful TTM'ers AT THE Retreat, who had pulled hair for 20+ years, been in recovery for 10 years, and had ALL their hair back! I met them in person, and saw their BEAUTIFUL HAIR!
Peach fuzz or thinner than normal hair is a GREAT sign because it means your follicle IS still ALIVE! It does also mean it is temporarily traumatized, and that your hair is in a state of HEALING. Peach fuzz is a precursor to regular size hair, just as in babies.
Kinky hair also is a GREAT sign because it means your follicle IS still ALIVE! It does also mean a temporarily traumatized follicle, and that your hair is in a state of HEALING. The waiting game is LONG for these to go back to straight. I have hair almost to my waist, and as I have
changed my head criteria, I have foot long hairs that are at least 6 inches of kinky before they went back to straight.
So, it is not an overnight process. Pulling out the kinky hairs is a mistake because you are actually making them more kinky each time, and traumatizing the follicle more each time - so it will take that much longer for it to go back to straight. It is possible, although NOT likely, that kinky hair might stay that way. In other words, for MOST people, once it is kinky, it probably WILL eventually go back to normal.
(It is the eventually that we have a hard time with.)
If your hair is growing in white, it will probably change back to its color after awhile. Means the color sac is (usually temporarily) traumatized, and will start producing color again. Age also was a factor in this. I have also had this experience. Some of my hairs go 1 inch and half Grey before changing back to dark brown. Again, a small % of people could permanently experience loss of color - usually older people closerto the normal graying age.
Now I can't find my notes, but different areas of hair have different chances for recovery speed.
Lashes - FULL recovery, some people can get them in 6 months, if you have been pulling for years and years - could be 2- 4 years.
Eyebrows - Can't remember time frame, think shorter than lashes, this is an area easily damaged and not regrow totally back for some people.
HEAD - FULL recovery, 2-6 years for Normal Hair! Think about it, your hair only grows 1/4- 1/2 inch a month, and you have to wait for each hair pulled to start its growing cycle again. Plus, if it is growing in kinky or "peach fuzz", you have to wait a long time (my experience 6 months), for that phase to change back to regular hair. And then you have to grow length again. I think the Doc's time frame also takes into
account people who are in the process of recovery, and having ocassional pulling relapses.
On possible damage forever - the doc talked about this as a rarity although possible. Even in this chance, it would be pretty rare for someone to be able to damage every follicle on their entire head! She emphasized that there are usually physical signs on your skin (not the pulled out hair) if you have permanently damaged follicles. If you had scabs and scars, that could be a sign for those particular spots of
possible permanent damage. You would STILL have to wait to recover from TTM behaviors, and stop picking at those areas for MONTHS before you would know for sure. Female pattern baldness areas are the easiest permanent damage area, and some people in recovery do have thinning and damage in those areas. But again, that is not the experience of MOST people! You can't even begin to evaluate that until you have been pull free for months to years!
HAIR BIOLOGY
I will try to explain the biology but kinda hard without pictures...
1a) We are ALL root pullers. If we weren't the hair wouldn't come out.
1b) The opposite of a root-puller is cutting with the scissors or breaking off.
2a). The white thing is NOT the root, it is the white thing, (sorry, just forgot my vocabulary). The white thing is only present in Growth Stage 1 of hair (youngest stage).
2b). The part you pull out is the root, the root sometimes has the white thing around it, sometimes not.
2c). Normally, when hair falls out, the root falls out, and the hair grows back completely. You can't damage the root by pulling, because it is gone. The root has nothing to do with regrowth.
3a). The root sits in the hair follicle (the hole in the skin it sit in). The hair follicle can be temporarily traumatized by pulling, which could slow down or change regrowth.
3b). The hair follicle has a LARGE capacity for healing, although slow.
4). At the very bottom of the hair follicle, is a blood vessel. If this is permanently damage, (pretty rare), then you won't get regrowth.
5). VERY IMPORTANT - people see weird things on the roots, and think they are seeing a spot from the blood vessel. You CAN'T see that, and you wouldn't. There are tons of things that go in that make the root look
different at different times in the growth stages - size, shape, color stuff attached to it, etc. If you have a spot of blood on your root, that STILL doesn't mean that you have damaged the blood vessel.
6a). So, Pulling lots of the white things means you are pulling all the "Youngest" hairs. It may mean it takes longer for those hair follicles to gear up again since they normally wouldn't regrow until that hair died and fell out naturally.
6b) Pulling the kinky hairs can further traumatize the hair follicle, making it even more kinky, and further SLOWING down the healing process for that follicle.
6c) Pulling the extra thin (peach fuzz) hairs makes the healing process START over, you would have to get a new extra thin (peach fuzz) hair, before you could get a regular hair, so you are SLOWING down the healing process.
6d) You can see from 6a-6c how our own pulling patterns can make us think we are not getting hair back, when in fact we ARE!
|
All information and art (graphic or literate) belong to the individuals with all rights reserved. For express permission to use anything within please email the
site administrators
Any and all materials, information, views, or opinions of the members are not necessarily those held by the administrators.
This website is created and maintained by
Sandra Perron & Brenda Horner . All right reserved. |
|
