|
Upcoming
Workshops
Topics include:
- Living with
Trichotillomania
- Coping with
Social Anxiety
Remember to
bookmark our site and check for workshop announcements
|
Trichotillomania
by Suzanne Feinstein, Ph.D. and
Ori Shinar, Psy.D.
 It
is common for people to express frustration, anxiety or even boredom
by muttering phrases such as “I feel like ripping my hair out” or ‘I’m
jumping out of my skin”. Most often, these expressions are used
figuratively and people find other outlets to alleviate physical
tension like punching a wall, yelling into a pillow, venting to a
friend, taking a walk, etc. However, there are people who literally
rip their hair out and attack their skin in an attempt to alleviate
tension. Hair pulling and skin picking can involve any area of the
body and frequently are accompanied by like-behaviors such as pulling
apart split ends, nail biting, and cuticle picking.
Hair pulling, known as trichotillomania, and skin picking are
behaviors which are not well understood by most therapists.
Diagnosticians currently struggle to decide on the most appropriate
category in which to group these disorders. Some argue that
trichotillomania and skin picking most closely resemble obsessive
compulsive disorder (OCD) and should be categorized as an OC Spectrum
Disorder. OCD is an anxiety disorder in which people perform
repetitive behaviors or compulsions to alleviate distress brought on
by recurrent thoughts, feelings, fears or preoccupations known as
obsessions. Common examples of compulsions include frequent hand
washing to alleviate a constant feeling of being unclean, checking the
stove to assuage one’s doubt of leaving on the gas, and excessive
arranging of items in an attempt to satisfy the need for perfect
order. Many people engage in hair pulling and skin picking compulsions
to satisfy their need for symmetry (“I have a lesion on my left cheek
so I need to even it out by making a mark on my right cheek), their
need for exactness (“This hair feels more wiry than the others so I
need to pull it out”) or magical thinking (If I don’t pull my eyelash
out by the root, something bad will happen”).
However, not all people who pull or pick report obsessive thoughts or
physical tension to be the reason behind their behaviors. Some people
claim that these behaviors are not triggered by stress; rather they
occur most frequently when they are involved in sedentary (low stress)
behaviors such as watching television, surfing the web, reading,
talking on the phone, etc. People frequently report being in a
trance-like state when they pull their hair or pick their skin. Thus,
therapists recognize that trichotillomania and skin picking cannot be
categorized exclusively under an anxiety disorder such as OCD.
Diagnosticians have stated that hair pulling and skin picking can be
defined as “impulsions” instead of compulsions since these behaviors
are not always triggered by thoughts or fears, but rather by an
inability to control simple urges or impulses. Thus, certain
therapists argue that it is more appropriate to classify
trichotillomania and skin picking as impulse control disorders, and
feel that they should be grouped with other impulsive disorders, such
as compulsive gambling, binge eating and substance abuse.
Needless to say, the ongoing controversy about how to properly
classify hair pulling and skin picking and the scarcity of literature
about the disorders leave most therapists stumped about the most
effective way to treat these problems. Many therapists make the
mistake of implementing a cookie cutter approach in treating hair
pulling and skin picking and see little or no improvement in the
people they treat. It is important for therapists to understand that
each person has a different motivation behind the pulling or picking
and treatment needs to be tailored specifically to the needs of the
individual.
At Advanced Behavioral Health, LLP, we pay close attention to the
triggers (thoughts, feelings, impulses, urges, images) that precede
the behavior. We are extremely thorough in collecting every detail
about the behaviors through questionnaires, tracking diaries, and
special monitoring devices, and formulate treatment plans accordingly.
And most importantly, we recognize the sensitivity of these disorders
and provide the utmost sympathy and professionalism in treating our
patients. It is truly rewarding for our therapists to witness new hair
growth, clearer skin, and an improved self-image in our patients. We
hope that this message speaks out to anyone who has been struggling
with hair pulling or skin picking, and that you can acquire a newfound
confidence that treatment works.
Please contact us to learn more about how we
use short-term Cognitive Behavior Therapy to effectively treat
Trichotillomania, understand how to navigate your insurance policy,
and inquire about available appointment times.
Call (646) 345-3010 or (917) 806-0155 or e-mail
AdvBehaviorHlth@aol.com |
