Trichotillomania and Chronic Skin Picking

"Trichotillomania (TTM) is a disorder that causes people to pull out the hair from their scalp, eyelashes, eyebrows, pubic area, underarms, beard, chest, legs or other parts of the body, resulting in noticeable bald patches. Hair pulling varies greatly in its severity, location on the body, and response to treatment. For some people, at some times, trichotillomania is mild and can be quelled with a bit of extra awareness and concentration. For others, at times the urge may be so strong that it makes thinking of anything else nearly impossible."

"Chronic Skin Picking (CSP), also known as Dermatillomania, is a serious and poorly understood problem. People who suffer from CSP repetitively touch, rub, scratch, pick at, or dig into their skin, often in an attempt to remove small irregularities or perceived imperfections. This behavior may result in skin discoloration or scarring. In more serious cases, severe tissue damage and visible disfigurement can result.

CSP is now thought of as one of many Body-Focused Repetitive Behaviors (BFRBs) in which a person can cause harm or damage to themselves or their appearance. Other BFRBs include chronic hair pulling (trichotillomania), biting the insides of the cheeks, and severe nail biting."

While it is estimated that two to four percent of people have BFRBs, they remain grossly under studied. Many to most of the more recent studies have been performed by members of the Trichotillomania Learning Center (TLC) and/or received financial support from TLC.

The main treatment is Cognitive-Behavioral Therapy (CBT). Several behavioral techniques (a subset of CBT), Habit Reversal (HRT) and Stimulus Control were first studied in the 1970's and are almost always a part of the treatment package. Increasing one's awareness is critical, as well as maintaining a commitment to not pull. Becoming more aware where one performs the compulsive behaviors, as well as what emotional states one is frequently in during the behaviors is extremely important. Knowing where may help you minimize your time in that environment as well as being more aware when in those environments. Knowing what emotional state triggers these behaviors can help develop strategies to minimize those states, ex. Stress, as well as to develop alternative strategies when one is in those states of mind.

There are no rigorous studies that have proven that any medication to be effective with TTM and CSP. Most often, anti-depressant medications are used and are very helpful to some with these behaviors. That is not to say that these medications have not proven to be helpful for many with anxiety and/or depression. Some evidence suggests that those anti-depressants that raise levels of both serotonin and norepenephrine (SSNRIs), such as Effexor, may work better than those that raise only one. An excellent article on medications is Medications for Trichotillomania and Pathologic Skin Picking by Jon Grant, MD. It also briefly touches on the promising use of N-Acetyl Cysteine (NAC), an amino acid and Inositol, a B-vitamin and an isomer of glucose. For more information and a brief video on Grant's research on NAC.

There are a handful or so books written for people with these conditions. One good one is Help for Hair Pullers by Kuethen, Stein, and Christenson. A book I really like for parents and older kids is The Hair Pulling "habit and You. How to Solve the Trichotillomania Puzzle. By Ruth Golomb and Sherrie Vavrichek. Another excellent book for parents is Stay Out of My Hair by Mouton-Odum and Golomb.

HIGHLY RECOMMENDED is Free Webinar by Martin Franklin, PhD. It is VERY informative about what is known about TTM and CSP and treatment. If you have these conditions or you have a family member with them, take 75 minutes for the presentation. You won't be sorry. You probably will have to download codec (computer code) at www.gotomeeting.com/codec for your media player to work.

Use Weekly Trich & Pick Busters Checklist to begin or add to your recovery. Here are Trichotillomania and Chronic Skin Picking Resources. For additional information on these topics, got to the Trichotillomania Learning Center (TLC).

DON'T GIVE UP! More is being learned all the time in finding more effective treatments.

Adult Group Therapy for Chronic Hair Pulling and Chronic Skin Picking

STOP Picking on Yourself!

Karen Tomoff, LPCC and I are offering a six session bi-weekly group specifically for adults with either Trichotillomania (compulsive hair pulling) or Dermatillomania (compulsive skin picking). Another six session group is scheduled to begin in 8/10. The group will meet in Rocky River at 7:10 PM.

The group focuses primarily on Cognitive-Behavioral Therapy. This therapy has consistently been found to be the most effective treatment for hair pulling and skin picking.

The group requires an assessment prior to participation, unless you are a current/previous client. Contact me for more information.

ONLINE HELP

If are unable to find or afford a therapist with special training with trichotillomania or dermatillomania, there are support groups in many areas TLC Support Groups, as well as online support groups TLC Online Resources.

Also available are paid interactive sites ($29.95/mo.) at StopPulling.com (hair pulling) or StopPicking.com (skin picking). These were written by Dr. Suzanne Mouton-Odum, Dr. Nancy Keuthen, and Dr. Allison Jones Stocker, all leading experts on these topics.

DON'T GIVE UP! More is being learned all the time in finding more effective treatments.

Copyright © 2008 - 2010. Michael Miller. All rights reserved.