by Jon E. Grant, MD, JD, MPH, Scientific Advisory Board Chair
Professor of Psychiatry and Behavioral Neuroscience, University of Chicago
If you are considering taking medication for BFRBs, please understand that no drug is currently approved by the Food and Drug Administration for these behaviors, that there is limited research on the use of medications for these behaviors, and that the medications often have side effects. Having said that, many individuals benefit from medications. They may find a reduction in their urges, an increased ability to resist their behaviors, and/or less obsessional thinking about their hair or skin. In most cases, medications appear most helpful when used in combination with ongoing behavior therapy.
Individuals who pull their hair or pick their skin should receive a thorough physical examination to rule out potential medical problems, such as skin disorders. In addition, individuals who eat their hair should inform their doctors of this behavior as it may lead to serious health problems.
Because no single treatment will work for everyone, a complete psychiatric assessment will aid in identifying which medication may be helpful. This assessment should include information about the BFRB (for example, does the person find the behavior pleasurable, does the individual pull or pick because they feel depressed, etc.), other mental health problems of the individual (including drug and alcohol problems), current medications and allergies, any previous trials of medication, and psychiatric problems within the family.
Women who choose to take medication either during pregnancy or during the period when they will be breast-feeding should discuss carefully the side effects of all medications (including the risks of possible birth defects) with their physician.
The first study for trichotillomania found that clomipramine (Anafranil), a medication affecting the brain neurotransmitters serotonin and norepinephrine, was beneficial in treating hair pulling in a small number of adults. Clomipramine has both antidepressant and anti-obsessional properties. Therefore, this may be a potentially beneficial medication for those who have trichotillomania in addition to depression or obsessive compulsive disorder (OCD). Clomipramine is approved for pediatric OCD and therefore could be used in children with both OCD and trichotillomania. There have been no studies examining the use of clomipramine in skin picking, but given its benefits in hair pulling, this is also considered a potentially beneficial option for picking as well.
Clomipramine, however, may result in multiple side effects such as dry mouth, constipation, blurred vision, sexual dysfunction and weight gain. In addition, clomipramine may cause fine tremor and muscle twitching. Starting at a low dose such as 25 mg at night and slowly titrating the dose over several weeks to 150 to 250 mg/day reduces the likelihood of side effects. Clomipramine should not be used if a patient has a history of cardiac conduction disturbance or a central nervous system illness that might compromise memory. At 300 mg/day, clomipramine can cause seizures in about 2% of subjects. Clomipramine should not be used with medications such as fluoxetine or paroxetine that inhibit P450 isozymes, for they inhibit clomipramine hepatic metabolism, cause elevated serum clomipramine, and desmethylated clomipramine levels. If it becomes necessary to use these medications in combination, clomipramine levels should be monitored frequently by blood tests and by performing periodic EKGs on the person.
Selective Serotonin Reuptake Inhibitors (SSRIs)
Several studies have examined SSRIs in treating trichotillomania and skin picking. The SSRIs include: fluoxetine (Prozac), fluvoxamine (Luvox), sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro), and paroxetine (Paxil). These medications are FDA-approved for the treatment of depression or OCD or both.
Only fluoxetine (Prozac) has been rigorously studied in hair pulling and skin picking. Although the results have looked somewhat promising for using fluoxetine in skin picking, the results for trichotillomania have been largely no better than for a placebo. The other SSRIs have been used in smaller, less controlled studied and have demonstrated some limited benefits in some studies and no benefits in other studies. Individuals may report a range of improvement from dramatic reduction in behavior to no change. In general, the improvement is modest but may only last several months. These medications may be helpful in individuals with pulling or picking who also suffer from anxiety, depression or OCD.
Although the SSRIs are generally well tolerated, they may produce gastrointestinal distress, sedation, mild anxiety, headache, constipation, increased urinary frequency, weight gain, and sexual dysfunction. Fluvoxamine (Luvox) is a potent P450 1A2 inhibitor, and drug-drug interactions should be considered before it is prescribed. Given paroxetine’s (Paxil’s) relatively short half-life, the potential for flu-like SSRI discontinuation symptoms exist, particularly with abrupt cessation of high dosages of the drug. As with other anti-depressants, warnings exist for the potential association between SSRIs and suicidal thoughts and behaviors.
Other antidepressants have been tried in the treatment of trichotillomania and skin picking. Although the data are sparse, case reports discuss the possible benefits from a range of antidepressants – amitriptyline (Elavil), imipramine (Tofranil), venlafaxine (Effexor), and doxepin (Sinequan). These medications have shown benefit for the treatment of depression and anxiety, but given the limited data for their use in trichotillomania and skin picking, these medications should not be considered first-line treatment.
Naltrexone, an opioid antagonist, is approved by the FDA for the treatment of alcohol dependence and opiate dependence. Naltrexone has been examined in two controlled studies of trichotillomania and demonstrated some potential benefit in one and none in the other. Because naltrexone reduces urges to engage in pleasurable behaviors, it may be best for those individuals who pull or pick due to strong urges and find the behavior pleasurable. It should also be considered in individuals with trichotillomania or skin picking who suffer from alcoholism, and possibly in individuals with a family history of alcohol use disorders.
Although generally well tolerated, naltrexone may cause nausea, insomnia, muscle aches, and headaches. Liver enzyme elevations are possible, especially in patients taking non-steroidal anti-inflammatory drugs, and therefore liver enzymes should be frequently monitored.
Dopamine-blocking neuroleptics have also been examined in the treatment of trichotillomania and skin picking. The rationale for their use is due to a possible link between repetitive behaviors and tic disorders such as Tourette’s disorder. A controlled study of olanzapine (Zyprexa) found that the medication was significantly more effective than a placebo in reducing hair pulling. Other neuroleptics – risperidone (Risperdal), quetiapine (Seroquel), ziprasidone (Geodon), and aripiprazole (Abilify) – may also be beneficial but there have been no controlled studies of these medications.
Neuroleptics may result in a range of side effects: extrapyramidal side effects (Parkinson-like tremor, rigidity, bradykinesia), akathesia, dysphoria, sedation, tardive dyskinesia, weight gain, and development of diabetes and high cholesterol.
Lithium, a medication approved for the treatment of bipolar disorder, has shown some benefit in individuals with trichotillomania in uncontrolled studies. Lithium may be beneficial to those who are generally impulsive or have considerable emotional instability. Lithium may be an attractive medication option for individuals with trichotillomania or skin picking who also suffer from bipolar disorder.
Lithium can produce significant side effects. Common side effects of lithium include nausea, loss of appetite, mild diarrhea, dizziness, hand tremors, weight gain, hypothyroidism (low levels of thyroid hormone), increased white blood cell count, acne, and skin rashes. Individuals should tell their doctor immediately if they develop lack of coordination, muscle weakness, slurred speech, nausea, vomiting, diarrhea, confusion, or an increase in tremors or shaking. These symptoms may be a sign of having too much lithium in the body, which requires medical attention. With long-term use of lithium, kidney damage may also occur, but it is rare. In order to minimize risk, your healthcare provider will periodically measure kidney function and lithium levels with a simple blood test.
A variety of other medications have shown early promise in the treatment of trichotillomania and skin picking.
Medications that affect the neurotransmitter, glutamate, may be beneficial. Glutamate appears to have a role in the area of the brain involved in compulsive, repetitive behaviors. These medications include lamotrigine (lamictal) (FDA-approved for bipolar disorder), riluzole (Rilutek) (FDA-approved for ALS), and the amino acid N-Acetyl Cysteine. These medications, however, are not all alike and the studies suggest there may be important differences. One study of lamotrigine in skin picking found that it was not more beneficial than placebo. Although studies of riluzole have not been performed in trichotillomania or skin picking, a study in OCD found that it was no different from placebo. N-actetyle cysteine, however, was studied in trichotillomania and in adults appeared to be very promising although the study in children was no productive. N-acetyl cysteine may be beneficial alone or in combination with an SSRI (link to NAC article).
Inositol, a B-vitamin and an isomer of glucose, has also been used in the treatment of trichotillomania and skin picking. A controlled study has demonstrated improvement in OCD using inositol, but controlled studies are lacking for hair pulling and picking (link to inositol article)
A reasonable medication strategy is to employ a systematic trial of a specific medication while monitoring side effects. The choice of which agent to use can be based on known side effects, co-occurring disorders such as depression or OCD or alcoholism, or what has possibly worked for family members. Rating scales can be used to assess the degree of hair pulling or skin picking as well as global measure of improvement. The dose of the medication should be built up over time until complete benefit is obtained or to the maximum or best-tolerated dose. An appropriate period of time should be allowed (8-12 weeks or longer) before deciding whether a benefit has been achieved. If the benefit is only partial, the medication can either be changed or another medication can be added. Always consult your physician before abruptly stopping a medication. Also, individuals should be informed that medications appear most helpful when used in combination with ongoing behavior therapy.
Considerations for Children and Adolescents
In the case of adolescents, the general recommendation is first to use behavioral therapies before considering medication and then only use medication in severe cases. Many medications may cause suicidal thoughts in children and adolescents and therefore medications must be used very cautiously in this population and suicidal thinking should be monitored frequently.
Five factors are necessary for long-lasting change.
• accept that we have a problem;
• want to solve the problem;
• identify a solution that works;
• implement this solution–do the work; and
• perform the necessary maintenance.
All of these factors must be in place before any long-lasting change will occur in anyone. For our self, we must honestly assess the problem and acknowledge the full repercussions it is causing in our life; then we must develop a sincere desire to change. This acceptance and “want to” are great starting points but accomplish little or nothing unless followed with proper action. We must find a solution that has been proven to solve this specific problem and do the work necessary to make that solution active in our life. And there is always maintenance; the old habits and things that caused the original problem are deeply rooted and do not simply disappear; we only acquire the new and more desirable traits with conscious, persistent practice.
These five factors also clarify why we cannot make another person change. When facing a true problem, the person with the problem must accept the reality of the problem and develop a genuine desire for change. If we recognize a problem affecting the life of a person we love, we examine our motives to see if it is really any of our business; if so, we try to objectively explain the situation and the facts as we see them but always realize that each person must find his or her own acceptance of the problem and the desire to find a solution. We cannot do it for them.
Prayer: Dear God, help me to clearly see what I must change so that I can live the life you want for me. Grant me the strength and guidance to make these changes.
Dopamine is the compound that fuels our drive and motivation. It increases attention, improves cognitive function, and stimulates our creativity. It makes us more social and extroverted and helps us form romantic and parental bonds. However, dopamine, when too high, can also have its drawbacks.
What Does Dopamine Do?
The most important dopamine pathway in the brain controls reward-motivated behavior.
Most types of rewards, such as new experiences or accomplishment, can increase dopamine levels in the brain. In addition, most addictive drugs and behavioral addictions can increase dopamine.
In addition, dopamine has many other important roles in humans, including movement, memory, attention, learning,sleep, and mood.
Dysfunctions of the dopamine system contribute to Parkinson’s disease, schizophrenia,restless legs syndrome, and attention-deficit hyperactivity disorder (ADHD).
The Dopamine Diet: An Ideal Diet to Increase Dopamine
The following diet will be optimal for increasing dopamine:
Caffeine’s performance-enhancing effects are accomplished via dopamine. Caffeine maintains a higher dopamine concentration especially in those brain areas linked with attention .
You want to consume cholesterol-rich foods because cholesterol is a precursor toPregnenolone, which increases dopamine in animals [11,12].Saturated fatscan suppress dopamine. Equivalent intake of monounsaturated fats (from olive oil) protects against dopamine decreasing.
Green teaincreases dopamine in rats, including its constituents Theanine and Caffeine.
Caffeine’s performance-enhancing effects are accomplished via dopamine. Caffeine maintains a higher dopamine concentration especially in those brain areas linked with attention.
You want to consume cholesterol-rich foods because cholesterol is a precursor toPregnenolone, which increases dopamine in animals.
Magnesium has antidepressant effects that can partially be tied to increasing dopamine activity in the brain .
Curcumin, found in the spice turmeric, increases dopamine concentration in the brain [14,15,16], by inhibiting MAO-mediated dopamine break down .
Resistant starchis a type of soluble fiber that increases butyrate. Butyrate may increase dopamine levels [18,19].
Folate is needed for the production of dopamine (andserotonin). When your body is low in folate, it cannot produce dopamine and other monoamines efficiently, which may result indepression[20,21].
Nutritional orbrewer’s yeastis rich in uridine.Uridine-5′-monophosphate increases dopamine levels in the rat brain .
Seafood, which contains DHA, can increase dopamine levels in the brain [23,24,25].
Oregano increases dopamine levels by decreasing dopamine break down and reuptake .
Both tyrosine and phenylalanine are found in protein-rich foods:
However, the effects seem to be transient unless meditation is done regularly.
A study shows that long-term meditation practice is needed to induce stable changes in baseline dopamine (striatum) .
3 months of practicingyogaincreased dopamine levels in men (in blood/circulating levels) .
The study revealed that yogic practices might help in the prevention of age-related degeneration….in healthy males.
Pleasurable physical contact can increase dopamine.
In rats, it was shown that stroking increases dopamine release (nucleus accumbens) .
Tickling, as a form of play behavior in adolescent rats, also increases dopamine release (nucleus accumbens) .
In early life, stimulation from touching improves spatial working memory in rats, possibly by improving dopamine function .
6) Massage therapy increases dopamine
Massage therapy increases dopamine, with a 31% increase of urinary dopamine in people .
Massage increased dopamine levels in pregnant women with depression  and in adolescents with bulimia .
Parts of the brain release dopamine when listening to pleasurable music (striatum, nucleus accumbens) [43,44,45,46].
Not just listening, but creating and performing music also produce dopamine .
Food to Increase Dopamine
8) Tyrosine- and phenylalanine-rich food
Our bodies produce dopamine from the amino acidtyrosine. In turn, tyrosine can be produced from phenylalanine . Both tyrosine and phenylalanine are found in protein-rich foods : chicken, turkey, fish, peanuts, almonds, avocados, bananas, milk, cheese, yogurt, cottage cheese, lima beans, pumpkin seeds, sesame seeds, and soy.
Bananas especially contain high dopamine and L-dopa levels [5,6].
9) Unsaturated fat
Saturated fatscan suppress dopamine. Equivalent intake of monounsaturated fats protects against dopamine decreasing .
Supplements That Increase Dopamine
Tyrosinesupplementation increases dopamine levels in the brain [48,49,50].
A study shows that tyrosine supplementation effectively enhances cognitive performance, particularly in short-term stressful and/or cognitively demanding situations when dopamine is temporarily depleted [51,48].
11) Green Tea
Green teaincreases dopamine in rats (in blood, stress model) [8,9].
Theanine, one of the major amino acid components in green tea, increases dopamine in animals [52,53,54].
Caffeine’s performance-enhancing effects are accomplished via dopamine. Caffeine maintains a higher dopamine concentration especially in those brain areas linked with attention .
Pregnenolonesulfate increases dopamine in animals (striatum, nucleus accumbens) [11,12].
Magnesiumhas antidepressant effects that can partially be tied to increasing dopamine activity in the brain .
15) St. John’s Wort
A number of studies have shown thatSt. John’s Wort, an herbal anti-depressant, increases dopamine content in the brain (nucleus accumbens, striatum) [57,58,59,60,61].
Gingko bilobaincreases dopamine and dopamine neuron activity (PVN, VTA, Nucleus Accumbens) [62,63,64]. This increase in dopamine may partially explain the improvement of cognitive function observed with Gingko supplementation.
Curcuminincreases dopamine concentration in the brain [14,15,16], by inhibiting MAO-mediated dopamine break down .
Butyratemay increase dopamine levels in animals in response to toxic injuries (striatum) [18,19]. You can get butyrate in the diet by consuming soluble fibers found in fruits and vegetables or ghee.
Folate is found in leafy greens/vegetables and is needed for the production/synthesis of dopamine (andserotonin). When your body is low in folate, it cannot produce dopamine and other neurotransmitters (monoamines) efficiently, which may result indepression[20,21].
20) Huperzine A
Huperzine A is a substance that is known to increaseacetylcholine, but it also increases dopamine levels 129% above baseline in rats (cortex) .
This substance may help with treating drug addiction .
S-Adenosyl-l-methionine(SAM-e) is an over-the-counter dietary supplement commonly used to treat depression. SAMe helps in the production of dopamine and other monoamines, causing elevations in dopamine levels .
Shilajitis a naturally occurring biomass found in the Himalayas. In traditional Indian medical practice to be useful in the treatment of nervous disorders, epilepsy and as an antistress agent.
Shilajitincreases the levels of neuronal dopamine in the brain, which has an anxiety suppressing action .
Uridine-5′-monophosphate increases dopamine levels in the rat brain when the neurons are activated (striatum) . Uridine is found very concentrated in nutritional and brewer’s yeast, meat and fish.
24) Fish Oil
Seafood/Fish Oil/DHAcan increase dopamine levels in the brain in rats (striatum). Dopamine levels were also 40% greater in the frontal cortex of rats fed fish oil. DHA treatment led to an 89% rise in tyrosine-hydroxylase terminals within the striatum in lesioned animals [23,24,25].
Ginsengcomponents can increase levels of dopamine in the brain and have beneficial effects on attention, cognitive processing, sensorimotor function and auditory reaction time in healthy subjects .
However, ginseng can also blunt dopamine release in response to other stimulants such asnicotineand cocaine [70,71].
Higher doses of kava (Piper methysticum) increase levels of dopamine in rats (nucleus accumbens). Individual compounds isolated from kava can both increase or decrease dopamine concentration [86,87].
However, in a couple of cases, blocked dopamine function has also been observed .
The probioticLactobacillus plantarumcan increase dopamine in the brain in mice (striatum), and could potentially improve anxiety-like behaviors and psychiatric disorders [89,90].
35) Fresh Cut Grass/Essential Oils
Hexanalis a “green” odor compound found in plants that may increase dopamine in rats (striatum) [91,92]. Increasing dopamine is a potential mechanism in which green odors, such as fresh cut grass and plant essential oils, may improve mood and attention.
Flowering quince, the fruit ofChaenomeles speciosaused in Chinese traditional medicine, increases dopamine levels by inhibiting the dopamine transporter (DAT) .
Psoralea corylifoliafruit/seed extract and its components increase dopamine [94,95]. This plant is used both in Ayurveda and Chinese traditional medicine.
The edible mushroomMycoleptodonoides aitchisoniiincreases dopamine .
Blue trumpet vine(Thunbergia laurifolia) is a Thai herbal medicine used to treat drug addiction. It works by increasing dopamine [97,98].
Prickly nightshade(Solanum torvum) increases dopamine and shows antidepressant activity .
Gardenia jasminoidescan increase dopamine by inhibitingMAO-AandB.
Hormones that Increase Dopamine:
Estrogenmay increase dopamine. Women act more impulsively in the early as opposed to the late phase of the menstrual cycle .
In rats, estrogen-induced improvements in recognition memory were shown to be due, in part, to increased dopamine .
However, dopamine’s relationship to cognitive performance is not linear – dopamine function follows an ‘inverted U-shaped’ curve, where optimal dopamine results in maximal function and both insufficient or excessive levels lead to dysfunction . That is why too much estrogen is not beneficial.
Sugar acutely increases dopamine, which, over time, leads to a reduced number of D2 receptors and possibly a reduction in dopamine itself, leading to desensitization. These effects would not be due to the acute effects of sugar, but rather would occur over weeks to months with chronically elevated and intermittent sugar ingestion .
5) Iron Deficiency
Iron is a cofactor for tyrosine hydroxylase, a key enzyme in dopamine production . Iron-deficient rats have reduced brain dopamine levels .
Low brain iron stores may contribute to ADHD symptoms because low iron levels in the brain can alter the activity of dopamine .
Weaning rats fed an iron-deficient diet showed decreased physical activity and increased anxiety-like behavior with a reduction of brain dopamine receptors .
However, some studies indicate iron deficiency has the exact opposite effect .
Trichotillomania Way of Thinking vs. Recovery Way of Thinking
1. T: I have to pull out my hair. R: I can do some thing else that is positive.
2. T: Pulling out my hair is fun. R: What is fun about being bald?
3. T: The white/kinky/thick/whatever hairs must go. R: All hairs are good hairs. I need them all for a healthy head of hair, etc.
4. T: I’ll just pull out one hair. R: This is a lie trich tells me. I can rarely just stop at one hair.
5. T: When I get that itchy or “trich sensation”, I have to pull my hair. R: I can wash my hair or scratch my head instead.
6. T: It’s ok to use the mirror to find good hairs to pull. R: Why would I want to pull out my hair and create more bald spots? I will stay away from the mirror and temptation.
7. T: It’s ok to use tweezers to get those small hairs. R: Again, why would I want to pull out new growth and create more bald spots? I will use my tweezers for the unwanted hairs only, then put them away.
8. T: When I’m stressed I need to pull out my hair. R: I can take deep breaths, meditate or go for a walk to relax my body, or I can destress with a nice bubble bath. I can do so many other healthy things to relax my body instead of pulling. Pulling really doesn’t help me to feel less stressed any way, because I know that by pulling I will be creating new bald spots. Everyone has stress in life. I must learn to be with my stress with out pulling out my hair.
9. T: When I’m bored I need to pull out my hair. R: Can’t I think of some thing more fun to do than pull out my hair when I’m bored? Why not do a hobby, a sport, a puzzle, a craft…any thing but pulling!
10. T: When I’m tired I need to pull out my hair. R: I can go to sleep instead. How many times do I stay up way past when my body tells me that I am tired, only to start pulling out my hair? I must go to bed!
11. T: When I’m depressed I need to pull out my hair. R: I can get help for my depression from a psychiatrist and/or therapist. Pulling out my hair will only increase my depression, because I feel sad when I have bald spots.
12. T: I have to make both brows look the same. R: Symmetry is not important. New growth is! In time, once my brows have had a chance to come back, both brows will look the same. By trying to make both brows even, I risk pulling more than I want to.
13. T: Now that my hair is filling in, I can lose a few hairs with out any noticeable damage. R: No I can’t! Once I start pulling, I have a hard time stopping. A few hairs a day over time will still lead to bald spots. Small or large amounts of pulling are both dangerous behaviors.
14. T: I’ll quit pulling tomorrow. R: You know what they say…”Tomorrow never comes!” I will make today the day that I stop pulling.
15. T: I can play with my hair this time with out pulling. R: Touching my hair leads to playing with my hair, playing with my hair leads to pulling. I will keep my hands down!
16. T: I love to play with the hairs after I pull them. R: Playing with the hairs only reinforces my trichotillomania, so I must not do this. I must break the trich rituals in order to be free of trichotillomania.
17. T: Some day my trich will go away, until
then I will continue to pull. R: Trich is for life. It will not magically go away. I have to work at my recovery in order to break free of this disorder.
18. T: I can learn to live with this longer hair, even if I am pulling right now. R: When I am pulling, it is hard to stop. I must cut my hair short so that I can get a break from the pulling. I have no urges when my hair is really short. I won’t risk more damage to my hair, which will take longer to grow back.
19. T: My hair will grow back, so I can pull out my hair today. R: Just because my hair will grow back doesn’t mean that I can keep pulling. Why would I want to postpone my regrowth and my recovery?
20: T: I’ll keep on pulling until I see significant damage in the mirror. R: It’s not ok to keep pulling! Any damage means that it will take longer before I get all my hair back. Trich makes excuses so that I keep pulling! This is one I have told myself often.
21. T: I have to check the mirror to see if my hair is regrowing. R: This is obsessive and obsessiveness leads to pulling. I take pictures of my hair now once a month and stay away from the mirror and obsessing.
22. T: Concentrating on individual hairs makes it fun to pull and keeps me in the trich way of thinking. R: I concentrate on thinking of my hair as a whole unit. I need all those hairs to make a full head of hair, a set of brows or a set of lashes.
23. T: I need to pull out my hair when I procrastinate. It bothers me that I am not doing what I need to do, which creates a stressful mood and then I want to pull. R: I can get up and do 5 minutes of what I need to do. I can do some thing for 5 minutes! Then once I am started, it will probably be easier to keep going and I will get what I need done and feel good about myself. Even if I quit after 5 minutes today, if I work 5 minutes on what needs doing each day, soon it will be done, therefore eliminating my stress and helping me to feel better about myself.
24. T: My hair will never grow back, so what is the point in trying to stop pulling! R: It takes 2 to 6 years for hair to grow back for some one who has pulled for 20 years or more, but the good news is it will come back, which is great!
25. T: I can’t tell any one about my hair pulling, because then they will think I’m crazy and stop liking me. R: By telling others about my trich, I will lose my shame and guilt associated with it. It is not my fault that I got trich or have a hard time dealing with it. By telling others, I see that having trich is no big deal. Every one has something! And most people are very understanding and supportive once they find out more about this disorder. This was the big surprise for me when I “came out”. Also in letting others know about my trich and have them accept me any way, helps me to accept and love myself.
26. T: My hands have to go to my head and pull! R: No they don’t! I can keep my hands busy with trich toys such as a koosh ball, silly putty, stress ball, grabbing both hands, holding any thing or doing some thing to keep my hands busy in a positive way instead of pulling, such as rug hooking or other crafts and hobbies.
27. T: Every thing that I do must be perfect, if it is not, then I get stressed out and want to pull out my hair. R: Every thing that I do does not have to be perfect! No one else is perfect and I don’t expect them to be, so why should I expect perfection from myself? I can lighten up and enjoy life!
28. T: If I stop pulling, who am I? R: I am still a person who has trich, only I am in recovery.
29. T: If I stop pulling, will I do some thing else that is equally destructive? R: I won’t replace my trich with another bad habit, if I realize that this is possible. I will work at replacing my trich with good behaviors and habits.
30. T: When I am on the phone I have to pull. R: I don’t have to stay on the phone with a person that is stressing me out. I can end the conversation and therefore end my need to pull. I can also play with the cord instead of pulling, when I have to be in this stressful situation and continue talking to this person.
31. T: I am a compulsive hair puller. R: I am so much more than a person that pulls out their hair. I am some one who enjoys hobbies, sports, leisure, relaxation, work and fun! I can choose what will define me and hair pulling is not what I want to be known for.
32. T: If I pull out my hair, I’m not worthy of love. R: Yes I am! I am worthy of love whether I pull out my hair or not. Hair pulling is not all that I am. I am worthy of love from others and from myself!
33. T: What is the point of trying to quit, when I will just start again? R: I know that everything takes time to learn and I will learn to not pull out my hair. I may have setbacks, but with each successful attempt at not pulling, I get closer to quitting pulling forever!
34. T: Trich is bad! R: Trich is good. When my hand goes to my hair, I know that some thing is not right with in me. I am either bored, tired, stressed, have dirty hair, am procrastinating, am depressed, etc. and I need to do some thing about it. Trich the is first to know, long before I know these things consciously.
35. T: I have an urge to pull, therefore I must pull! R: The urge to pull will pass if I do nothing at all. I will not die from this urge. It’s ok to get urges, but I don’t have to act on them. I can take a deep breath and relax.
36. T: I’ll never be able to stop pulling! I hate myself! R: I can learn to stop pulling by learning all that I can about trich and how it affects me. I can learn what my triggers are and what to do when I get them. I can learn that beating myself up for pulling and hating myself because of my pulling only makes my pulling worse. I can learn to use positive self-talk to help decrease the urge to pull. I can learn to love myself even if I continue to pull out my hair. I am worthwhile for who I am, not for how much hair I have.
37. T: I often pull with out realizing it and zone for a long time before I am aware of my pulling. How can I help myself if I don’t know I’m pulling? R: Awareness takes time and practice. In time, I will become aware of where my hands are and stop them before they start pulling. I will give myself the time and patience to learn the new behavior of awareness.
38. T: I’m the only one that does this. R: Nope. Millions of people pull out their hair, some where between 2 and 5% of the population pulls their hair. This covers all walks of life.
39. T: Slips are bad. R: Slips are a way of learning. I ask myself why I was pulling and then try to do something different next time to either avoid that situation or to change my response to that trigger, one that is positive and not negative like pulling.
40. T: Quitting pulling is too hard. R: Quitting pulling is not too hard if I take it in small steps, have patience with my recovery and give my recovery the time that it needs to succeed.
“Inaction breeds doubt and fear. Action breeds confidence and courage. If you want to conquer fear, do not sit home and think about it. Go out and get busy.” ~ Dale Carnegie…
Good morning everybody… To me, faith is a mindset. It is the substance of things we hope for yet evidence of things not seen. Doubt, on the other hand, is just another form of fear. As a child, I deeply trusted my faith. I was young, life hadn’t had the opportunity to beat me down yet. This was before I started listening to my ego more than my heart and fear started pushing God out. So, when my faith and trust in God began to re-enter my life, I started feeling like a child again with absolute faith. I began to realize that every experience, especially the difficult ones, are here to teach me about my own truth and help me to awaken. But, if I remained frozen in doubt, I would never learn that lesson. So, follow your dream, take that chance. God will be with you every step of the way. Have a great Thursday! Good bless you in all endeavours.
“…we covered low self-esteem by hiding behind phony images that we hoped would fool people. The masks have to go.”
Basic Text, p. 33
Over-sensitivity, insecurity, and lack of identity are often associated with active addiction. Many of us carry these with us into recovery; our fears of inadequacy, rejection, and lack of direction do not disappear overnight. Many of us have images, false personalities we have constructed either to protect ourselves or please others. Some of us use masks because we’re not sure who we really are. Sometimes we think that these images, built to protect us while using, might also protect us in recovery.
We use false fronts to hide our true personality, to disguise our lack of self-esteem. These masks hide us from others and also from our own true selves. By living a lie, we are saying that we cannot live with the truth about ourselves. The more we hide our real selves, the more we damage our self-esteem.
One of the miracles of recovery is the recognition of ourselves, complete with assets and liabilities. Self-esteem begins with this recognition. Despite our fear of becoming vulnerable, we need to be willing to let go of our disguises. We need to be free of our masks and free to trust ourselves.
Just for today: I will let go of my masks and allow my self- esteem to grow.