trichotillomania learning center Center for Emotional Health

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The Trichotillomania Learning Center TLC is a non profit organization. devoted to ending the suffering caused by hair pulling disorder skin picking dis. order and related body focused repetitive behaviors BFRBs. TLC is advised by a Scientific Advisory Board comprised of leading researchers. and clinicians in this field,This pamphlet is a project of the. Trichotillomania Learning Center s Scientific Advisory Board. Contributing Authors,Ruth Golomb LCPC,Martin Franklin PhD. Jon E Grant JD MD MPH,Nancy J Keuthen PhD,Charles S Mansueto PhD. Suzanne Mouton Odum PhD,Carol Novak MD,Douglas Woods PhD. Illustrations for TLC by Maxine Lu,2011 Trichotillomania Learning Center Inc.
All Rights Reserved, The information in this booklet is not intended to provide treatment for Trichotillo. mania or Skin Picking Appropriate treatment and advice should be obtained directly. from a qualified and experienced doctor and or mental health professional. TLC is a 501 c 3 tax exempt organization and all contributions are tax deductible. Our Tax ID number is 77 0266587,Expert Consensus,Treatment Guidelines. for Trichotillomania Skin Picking,And Other Body Focused Repetitive Behaviors. Table of Contents,Introduction 4 Other Treatment Approaches to. What is Trichotillomania 4 Augment CBT treatment 12. What are BFRBs 5 Acceptance and,Commitment Therapy 12.
What are the symptoms of BFRBs 5,Dialectic Behavior Therapy 14. When do BFRBs begin 6,What causes BFRBs 7, What other problems are Treating Children with BFRBs 15. sometimes confused with 0 5 years old 15,TTM and other BFRBs 8 6 9 years old 15. How are TTM and other 10 13 years old 16,BFRBs treated 8 14 18 years old 16. What can families and friends,do to help 8 Medications for BFRBs 17.
Daily Medications 18,Psychotherapy 9 Medications Used as Needed 18. What is CBT 9 Skin Medications 18,Habit Reversal Training 9. Maintenance Treatment 18,Comprehensive,Behavioral Treatment 10. Treatments That May NOT Work 19,Assessment Self Monitoring 10. Techniques Chosen That,About TLC 20,Directly Relate to Behavior 11.
Addressing the Environments 11 Selected Books Videos 20. Handling Feelings in a,Productive Way 11 Additional Resources 22. Dealing With Thoughts,That Are Not Helpful 12,The Complex Behaviors in BFRBs 12. The Toll of BFRBs 12,Introduction, If you or someone you love is suffering from trichotillomania TTM or another. body focused repetitive behavior BFRB such as skin picking you may feel. alone confused frightened and in need of help Many professionals have out. dated or simply erroneous information regarding effective treatment options. Members of the Scientific Advisory Board of the Trichotillomania Learning Cen. ter TLC have reviewed the latest state of the art treatments and provide these. guidelines for individuals seeking treatment for these problems. Until the past 20 years BFRBs have received little attention in the psychological. and dermatological literature Despite the data showing that TTM and skin pick. ing are quite widespread 2 5 of the general public suffer from TTM 5 from. skin picking few professionals have current information about effective treat. ment for these conditions Oftentimes clients or family members pursue treat. ment with more accurate information than the treatment provider This paper. will summarize information about the nature of BFRBs and provide treatment. recommendations by acknowledged experts in the field In addition information. is provided for families in which a member is exhibiting these behaviors. What is Trichotillomania, TTM also known as Hair Pulling Disorder is characterized by repetitive pulling out. of one s hair from the scalp eyebrows eyelashes or elsewhere on the body Ac. cording to the Diagnostic and Statistical Manual of Mental Disorders 4th Edition. of the American Psychiatric Association TTM is defined as meeting the following. five criteria, 1 Repetitive pulling of one s own hair that results in noticeable hair loss.
2 A feeling of tension prior to pulling or when trying to resist the behavior. 3 Pleasure gratification or relief while engaging in the behavior. 4 The behavior is not accounted for by another medical dermatological or psy. chiatric problem such as schizophrenia, 5 Hair pulling leads to significant distress or impairment in one or more areas of. the person s life social occupational or work, Although these criteria have been very useful for describing the problem there. are concerns among the clinical and scientific communities about whether they. all are present in every case It has been acknowledged that many people. suffering from hair pulling do not meet all of these criteria For example many. hair pullers do not experience tension prior to pulling hair or pleasure gratification. or relief while engaging in the pulling Also some people pull hair from areas. of the body that are not visible such as the pubic or chest areas yet they still. experience significant distress, A very common experience reported by people with TTM is isolation Because. people with TTM often feel ashamed of their behavior they don t talk about it and. may try to hide the problem As a result many sufferers feel isolated confused. and reluctant to seek advice or treatment from professionals Unfortunately this. secrecy contributes to a general misperception that the behavior is less common. than it actually is,What are BFRBs, BFRBs a term that may be new to you and new to many professionals are repeti. tive self grooming behaviors in which pulling picking biting or scraping of. the hair skin or nails result in damage to the body Common BFRB behaviors. include skin picking of scabs acne or other skin imperfections for example. cuticle or nail biting or picking and lip or cheek biting These behaviors share. similar characteristics which are described below and are all considered BFRBs. for that reason,What are the symptoms of BFRBs, Many people who engage in TTM or other BFRBs find that these behaviors often.
occur during sedentary activities These activities include but are not limited to. lying in bed reading listening to a lecture in class riding in or driving a car using. the bathroom talking on the phone using the computer or sitting at a desk at. work However there are some,individuals who find that these. behaviors take place during more,active times walking or putting. on make up for example,In addition there are times when. a sufferer might engage in the,BFRB behavior in a fully focused. way for example planning to go,home and pick a scab or pull hair.
However there are other times,when the same individual might. engage in the behavior in a less,focused manner only realizing it. when he she discovers a pile of,hair scratches on the skin open. scabs or bleeding fingers,For some there is a sensation. that draws the fingers to the site,of picking or pulling These sen.
sations can be itching tingling, pain or other such experiences For others there is no sensation prior to engag. ing in the picking or pulling behaviors the fingers simply find their way to the. site and the behavior begins Many people report that they are searching for a. particular irregularity of the hair thicker coarser bumpier or skin rough jagged. bumpy in order to remove or fix the perceived problem. Many people will also find that searching behaviors are part of the process such. as rubbing the fingers over the skin in the hair on the eyebrows etc to find a. hair or skin irregularity on which to focus Picking or pulling will ensue and some. individuals will examine the product of their pulling or picking by looking at it. closely rubbing it on their skin face or lips smelling it chewing or swallowing it. or rolling it between their fingers, The severity of these behaviors varies greatly Hair pulling can result in small areas. of thinning hair bald patches or in some cases extensive baldness that is difficult. to conceal Many people who pick at their skin develop scabs or sores that do. not heal because of repeated picking Sometimes skin can become infected or. scar resulting in an appearance at the picking site that can exacerbate feelings. Although pulling hair and picking skin may seem to some to be harmless habits. when they are done in excess they can cause serious medical problems For those. individuals who swallow pulled hairs gastrointestinal distress or even digestive. blockage caused by a trichobezoar or hair ball can occur and may even require. surgical removal It is critically important therefore to see a doctor if you or your. child eats the hair Regarding skin picking it is important to keep wounds clean. and treat them with antibiotic cream to prevent infection In some cases the. behaviors may result in repetitive motion injuries. In addition to these physical and medical problems most people who engage. in BFRBs also experience some degree of shame secrecy isolation interference. with intimate relationships avoidance of activities that they would otherwise. pursue and possibly interference with work or study. When do BFRBs begin, The majority of individuals start engaging in hair pulling or other BFRBs between. the ages of 11 and 13 Over time the problem may wax and wane in severity. Some children begin pulling earlier than age 13 For this group the numbers of. males and females who pull hair is about equal However among adult hair pull. ers females outnumber males The current research indicates that many more fe. males than males begin pulling around the time of puberty although the reason. for this is not known It is possible however that adult males are not as willing to. seek treatment for their symptoms as females and that the male to female ratio. may actually be somewhat higher than it seems There are some individuals who. start engaging in BFRB behavior well before adolescence Some parents have. reported observing their child engaging in hair pulling behaviors as early as 9. months old When children of pre school age or younger engage in hair pulling. the behavior is sometimes known as baby trich This behavior is often but not. always accompanied by thumb sucking It is thought by some experts to be less. likely to develop into a long term behavior than hair pulling that begins at a later. What causes BFRBs, Why do some people engage in these behaviors while others do not Research. indicates that some people may have an inherited predisposition to skin picking. or hair pulling Several studies have shown a higher number of BFRBs in imme. diate family members of persons with skin picking or hair pulling than would. be expected in the general population A recent study examined hair pulling in. identical and fraternal twins and produced results consistent with a significant. inherited component in TTM Given the possibility that some or all BFRBs have a. genetic origin researchers are currently studying the genes of people suffering. from TTM in an effort to isolate gene markers that may clarify the origins of these. Even if a predisposition to,ward BFRBs is inherited there.
are certainly other factors,involved as well including. temperament environment,age of onset and family,stress factors One interesting. point is that other species en,gage in similar behaviors Pri. mates such as the great apes,or certain types of monkeys. will pull hair overgroom and,pick at nits and other insects.
on their own fur and the fur,of others Birds will pull out. their feathers mice will pull,fur or barber themselves. and their cage mates dogs, and cats may lick their skin or bite at an area removing fur until there are bald. spots Researchers interested in animal models of BFRBs are trying to understand. these behaviors in animals in order to shed some light on the complex neurobiol. ogy that underlies the human experience of BFRBs,What other problems are sometimes confused with. TTM and other BFRBs, Some professionals have speculated that TTM is a form of obsessive compulsive.
disorder Over the last fifteen years this view has fallen out of favor Although in. dividuals with BFRBs engage in repetitive seemingly compulsive behaviors there. are enough differences to suggest that these are quite different disorders. Before BFRBs had received much scientific attention it was common for profes. sionals to assume that hair pulling and skin picking were symptoms of other. deeper disorders or even the result of early trauma Current evidence suggests. however that these behaviors are not generally an indication of deeper issues. or unresolved trauma Furthermore BFRBs do not appear to be associated with. problems such as self mutilation or eating disorders as some writers have sug. gested As such BFRBs are separate and distinct disorders However it is not un. usual for many individuals who struggle with BFRBs to experience anxiety and or. depression thus adding to their difficulties in coping with the BFRB. How are TTM and other BFRBs treated, The most important thing that a person can do to address a BFRB is to first be. come knowledgeable about the problem and its treatment The Trichotillomania. Learning Center www trich org provides up to date information regarding TTM. and other BFRBs with guidance from its Scientific Advisory Board comprised of. 2 The Trichotillomania Learning Center TLC is a non profit organization devoted to ending the suffering caused by hair pulling disorder skin picking dis

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