How to turn a trich...

January 23, 2007 1:41 PM

Advice for coping with trichotillomania? NYC therapist recommendations?

I'm looking for behavioral or mental tricks that people have used to thwart this problem.

I've had it since I was a teenager, but it didn't become a big problem until after I moved to NYC, which I chalk up to the anxiety of city living. It's definitely a big problem now.

Any time I am able to put a halt to pulling for a while, I wind up compulsively cutting my hair instead, any little bits that stick out. Almost every year I wind up giving up and shaving my head just so I don't have to think about it anymore. Which works, but I'd really like to fix this and keep my hair, thank you very much. I have health insurance and am ready to start seeing someone, but I don't know where to start and would love a referral. Most of the web support I've seen is not exactly written with 27 year old men in mind.

I don't have any other symptoms related to OCD, that I know of.

I've looked at this thread but it's mostly about supporting others.

posted by hermitosis to health & fitness (13 comments total)

Are meds an option at all?
posted by ereshkigal45 at 1:44 PM on January 23, 2007

I have begun to consider meds, as a last resort. My research says that antidepressants are usually prescribed, and I don't suffer from depression. I am very hesitant about taking on the mood and personality effects, not to mention the side-effects, of an antidepressant.

If people recommend this, I'd like to hear about their experiences.
posted by hermitosis at 1:51 PM on January 23, 2007

This doesn't seem like such a complicated problem that it would *require* therapy or medication. It is essentially just one bad habit; irregardless of the root psychological issues related to OCD, all you need to do to get the result you want is stop pulling your hair when you get the urge. I find it extremely helpful to replace one bad habit with another; I would reccomend hangnails or cuticle biting as a short-term stand in for when you're feeling really neurotic. Or maybe gum chewing, if you're worried about picking up another gross habit. But all said this is easier to stop than smoking. Just focus on your full beautiful head of hair that is impossible unless you let this one go.
posted by shownomercy at 3:28 PM on January 23, 2007

Did you see this thread a couple of days ago? It's about skin-picking, a somewhat related condition.

I too suffer trichotillomania, and Habit Reversal Training (mentioned here) is something I feel could have a beneficial effect (for me at least). I have successfully managed to stop pulling for a short period (see my answer in the previous thread), and I believe that integrating my earlier strategy with something like this could help me longer-term:

Finally, they were taught to perform a muscular movement that was inconspicuous, that was the opposite of, and incompatible with the behavior they wished to eliminate, and which would become an overlearned behavior.

(From the wikipedia article I linked above.)

(FWIW my "earlier strategy" was to keep a chart, and to reward myself with a tick every day I managed not to pull. This was based on a strategy my parents used for me when I was a child to stop compulsive hand-washing.)

I can't really help with therapists as I'm not in your area (or even country), but I do feel your pain. Feel free to email me to exchange thoughts & strategies.
posted by snap, crackle and pop at 3:45 PM on January 23, 2007

shownomercy, I wish it was just a simple problem as you say. I am 35 years old now and have had trich since I was 12. It's not as simple as "just" changing a bad habit. Many, many people would in fact be quite offended and even ashamed at your saying so. Though they would also be pleased that they could "just" stop! Which isn't the case...

There is no known cure for trich. No one yet knows what causes it. Medications are prescribed, but I do not know anyone who has been helped by meds long-term. Meds seem to help for a short time only because of the side effect they have of making you very fatigued...and the effect of slowing trich doesn't last. I have been on many medications for this and other disorders, anti-depressants, anti-psychotics, anti-seizure, and none of them work for my trich.

The only thing that seems to help at all so far, and it doesn't help everyone, is diet and avoiding certain waxes and alcohols in shampoos. This is from research that John Kender has performed on himself, and from surveys he has taken from members of his emailer list.

There is little to no research on trich, and most of it seems to still attempt to tie it to OCD. I have OCD, and I have trich. But I can tell you, as can many other dual sufferers, that what works for OCD does not work for trich, and that they are different animals.

I would suggest the diet as a first step, and also to avoid alcohols and waxes (including lip balm, which contains bees wax and is a possible reason why some people's trich flairs in the winter). If it got worse when you moved, you may also have an allergy to your new location - another theory of what may cause trich.

Do not feel shame or that you lack the willpower to stop. There are many, many people who have trich, and like me they have had it for decades, and have tried every trick (no pun intended), and have endured people telling them it's "just a bad habit" and to "just stop". This is the most important thing I can tell you at this time.

Another resource is the Trillotillomania Resource Center though I have little respect for them...but ymmv.
posted by veronitron at 3:52 PM on January 23, 2007 [3 favorites has favorites]

er Trich Learning Center...shows how often I go to their site.
posted by veronitron at 3:53 PM on January 23, 2007

shownomercy, perhaps you are right. Trichotillomania clearly isn't much of an affliction compared to the Male Answer Syndrome that is now apparently capable of crossing over into the female population.

In other news, anorexics should eat, kids with ADHD should just sit down and be quiet, and drug addicts should just say no.

veronitron, interesting about waxes, etc. I can't give up lip balm because I dry out easily in general, and actually my trich problem is often triggered in winter because of climate-induced scalp dryness.

Interesting stuff so far, but I hope more people can let me know what helps them get through a day.
posted by hermitosis at 4:19 PM on January 23, 2007 [1 favorite has favorites]

[veronitron, thanks for the info; the John Kender Diet looks interesting. I had no idea that diet might affect the condition. It looks like it might be helpful to keep a journal not just of pulling, but nutrition as well.]
posted by snap, crackle and pop at 4:23 PM on January 23, 2007

Ah I should have linked to the email list. It is John Kender's list, he is the moderator and list owner. hermitosis, if you want to hear from other people with the disorder aside from mefites, joining a list such as this one may help.

Link: Trich Emailer
posted by veronitron at 4:58 PM on January 23, 2007

Kiehls makes a lip balm without wax.
posted by brujita at 9:26 PM on January 23, 2007

Received by email so mefite could remain anonymous:

"I really wanted to share this tip/trick with you that I just discovered in the last few months, after suffering, as you, for DECADES!

My scalp "crawls" and it causes me to pull at the roots because I love the feeling of release when the hair comes out. But one day I had a pick in my hand because I have really curly hair and a comb will make me look like Roseanne Roseannadana - anyway I scratched my head with the pick where the scalp was crawling and OMG it felt SO FRICKING AWESOME. It feels 99% almost better than pulling the hair in the first place- to have the scalp stimualted in this way. I keep the pick by me at all times now (when I am at home any way - the trich never seems to bother me in public - Odd duck
the trich is.)

I hope you give it a try. And if you think this has any value please post the tip to Mefi as it may help the other suffers - It feels sooooo gooooood!!!"

Thank you!
posted by hermitosis at 7:22 AM on January 24, 2007

Posting for my gf, who has trich:

I have personally collected dozens of tips/tricks/strategies, many of which are cognitive behavioral therapy techniques. Last summer I compiled a list of strategies I was currently using (about 50 total) and strategies I could try (about 45 total). It would be too many to list here. By far the most effective has been support group – having a group of people with whom I can discuss the challenges and details without (or with less) shame and embarrassment. Plus, people discuss strategies and suggestions all the time – some we discussed recently include Band-aids on your thumb, sayings that work, exercise, diet, family support, triggers, logging urges/responses/triggers, etc. There’s just too many to list them all here.

There's definitely an active support group in NY. (The NY group facilitator recently moved to LA, so I don’t know how the NY group is going these days, but it had been a good resource for many people for many years.) Going to conferences, retreats, etc. can provide similar support if a support group isn’t available to you, or start your own group! There are also lots of online support groups. Doing searches in yahoogroups or online should yield them, or ask TLC.

There is no medication that has been demonstrated to successfully treat trich. (This is one of many ways trich is different from OCD: in studies, x% of OCD patients respond a certain way to various meds, but trich patients don’t respond the same way when lumped into OCD studies.)

TLC (Trichotillomania Learning Center) is a powerful resource for many with trich, including me. I have to put a plug in for them because they’re making a serious difference. Their activities include the following (which if not helpful for you personally, are probably still impacting all trichsters):

* Workshops so medical professionals get training/guidance to treat trich & other BFRBs (Body Focused Repetitive Behaviors – yes skin picking, nail biting, cheek biting etc are all currently thought to be related).
* Annual retreat for trichsters
* Annual conference allowing researchers, therapists and trichsters to network and interact – you can get some really interesting info about what folks are doing to start uncovering the source of trich
* Brochures to educate schools, teachers, hair salons and others about the situation
* Recently in conversation with NIH to figure out how to get trich on the radar for further study – since NIH so far doesn’t consider the problem worthy of funding, it’s been difficult to get studies done. (Most progress has been made by accident…one person looking for limb deformity switched around genes and found all her mice started barbering…another was researching Tourrette's and accidentally found trich in the families as well.)
* Providing trichsters with lists of support groups, therapists, hair care professionals, etc. in their area.
* Distribution of the trich-related documentary, Bad Hair Life.

The process of busting through the shame, isolation, confusion, etc. is a daily process. It's hard, but worthwhile.

Diet probably plays a big factor. We can't get more than anecdotal evidence until studies are funded and the placebo factor is taken into account. Individuals have certainly had success reducing urges by modifying diets.

Keep looking for resources – I hope you find resources and tools that work for you!

posted by expialidocious at 3:19 PM on January 24, 2007

Another emailer who wished to remain anonymous:

"I have a similar background to you, it seems, my trich started with eyelashes and eyebrows when I was 6 and moved to hair when I was 12. I
found a great therapist who specialized in behavioural modification (sometimes called CBT- cognitive behavioral therapy). Unfortunately she moved to CA and I haven't been able to find anyone good since, especially not in NY (I tried about 6 therapists before giving up last year, which was probably not the right thing to do.) I had one pychologist here who said "You pull your hair out? But why? You are so
pretty!" Not helpful.

Anyway, what the good therapist did was make me write up worksheets that broke my waking days up into 5 minute increments, and for each time period, I would have to tally how many times I pulled. The effect of this was to make pulling more annoying than not pulling, and to show what parts of the day were the most dangerous for me. It was
really hard. I hated carrying around those sheets and I hated seeing those tick marks of failure, so it really curbed the habit for me. Problem was though, that it was hard, and I didn't want to follow up with it once she was gone.

She also put me on Luvox (fluvoxamine, related to the prozac family but esp for OCD which I don't display other signs of either). The drug was ok, it made me nervous for the first 2 weeks but then I settled into it. I don't really know if I can fairly comment on its effects, though, because I moved to Australia at the same time, and had a much less stressful life there. I'm not sure if the lack of pulling was due to my better environment or the Luvox."

I want to thank those of you who have sent referrals to therapists. I have received several and am curious to see what comes of it.
posted by hermitosis at 12:03 PM on January 25, 2007 [1 favorite has favorites]