What is Trichotillomania?

A great overview of trichotillomania provided by the Trichotillomania Learning Center (TLC)



What is Trichotillomania?

For an in-depth of overview of treatment guidelines and considerations for trichotillomania, download our free booklet, Experts Consensus Treatment Guidelines

Trichotillomania (trick-o-till-o-may-nee-uh) (TTM or “trich”), also known as Hair Pulling Disorder, is characterized by the repetitive pulling out of one’s hair. Trichotillomania is one of a group of behaviors known as Body-Focused Repetitive Behaviors (BFRBs), self-grooming behaviors in which individuals pull, pick, scrape, or bite their hair, skin, or nails, resulting in damage to the body.

Research indicates that about 1 or 2 in 50 people experience trichotillomania in their lifetime. It usually begins in late childhood/early puberty. In childhood, it occurs about equally in boys and girls. By adulthood, 80-90% of reported cases are women. Hair pulling varies greatly in its severity, location on the body, and response to treatment. Without treatment, trichotillomania tends to be a chronic condition; that may come and go throughout a lifetime.

Signs & Symptoms

Trichotillomania is currently classified as an “Obsessive Compulsive and Related Disorder” in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

The DSM-5 diagnostic criteria include:

Recurrent hair pulling, resulting in hair loss

Repeated attempts to decrease or stop the behavior

Clinically significant distress or impairment in social, occupational, or other area of functioning

Not due to substance abuse or a medical condition (e.g., dermatological condition)

Not better accounted for by another psychiatric disorder

Hair pulling may occur across a variety of settings and both sedentary and active activities. There are times when pulling occurs in a goal-directed manner and also in an automatic manner in which the individual is less aware. Many individuals report noticeable sensations before, during, and after pulling.  A wide range of emotions, spanning from boredom to anxiety, frustration, and depression can affect hair pulling, as can thoughts, beliefs, and values.

Although the severity of hair pulling varies widely, many people with trichotillomania have noticeable hair loss, which they attempt to camouflage. Thinning or bald spots on the head may be covered with hairstyles, scarves, wigs, or makeup. Those with missing eyelashes, eyebrows, or body hair, may attempt to camouflage with makeup, clothing, or other means of concealing affected areas.

Due to shame and embarrassment, individuals not only try to cover up the effects of trichotillomania, but may avoid activities and social situations which may lead them to feel vulnerable to being “discovered” (such as windy weather, going to the beach, swimming, doctor’s visits, hair salon appointments, childhood sleepovers, readying for bed in a lighted area, and intimacy).

Impact and Effects

For some people, trichotillomania is a mild problem, merely a frustration. But for many, shame and embarrassment about hair pulling causes painful isolation and results in a great deal of emotional distress, placing them at risk for a co-occurring psychiatric disorder, such as a mood or anxiety disorder. Hair pulling can lead to great tension and strained relationships with family members and friends. Family members may need professional help in coping with this problem.

Physical effects such as pruritus, tissue damage, infection, and repetitive motion injuries to the muscles or joints are not uncommon. Those who ingest the pulled hair or parts thereof may experience gastrointestinal distress or develop a trichobezoar (hairball in the intestines or stomach), which could lead to gastrointestinal blockage and require surgical removal. Although trichobezoars are rare, they are a serious risk for those who ingest hair.

Keep reading

What causes BFRBs?

How are body-focused repetitive behaviors treated?

Read our Experts Consensus Treatment Guidelines


WHO am I?

I am Mommy to four very special kids. They are 10, 6, 4, and 2. I have been married to my soul mate and father of my children for almost 11 years. I was an elementary teacher and am now a tutor for students with a wide range of needs. I love helping others and tutoring is one way I can do that. It is also the reason I started my blog.

I have lived with trichotillomania since age 6. In the past 24 years I have tried every treatment, strategy, medication, and therapy. I still pull, but I use strategies I know work for me. I do hope to overcome this demon, but its presence in my life will not keep me from loving myself and enjoying life. Everyone is fighting some battle or has hurts that we do not see. It is learning to live despite these trials that I find very important.

Personally, I seek recovery while still accepting the reality of trich. There is no right or wrong way to view or live with trich. I simply blog about my experience in hopes of helping others feel less alone.

ACT Therapy: Acceptance


ACCEPTANCE: allowing urges, emotions, thoughts and feelings to occur without attempts to control them.

Acceptance does NOT mean a hopeless acceptance of the fact you have TTM.

Why work on acceptance? He conducted an online study which showed that pullers who are less accepting of private events tend to have stronger urges to pull and more severe pulling. [I found the concept of “private events” confusing at first. From what I can tell, it’s anything that happens inside you that you experience privately. As he said: thoughts, feelings, emotions, urges].

People follow rules not experience. He cited a study where people played a slot machine that was rigged to never pay off for the player. The people who were told that the machine WOULD pay off eventually, played longer than the people who were not told anything. The point is, people follow rules over their experience.

Where this fits in with trich: the rule is, “if you feel bad, get rid of it.” This is what society teaches us. This works well in many situations (if the kids are too noisy, send them outside; if someone is tailgating you, change lanes, etc.).  But this does not work with private events such as feelings. Trying to just get rid of bad feelings, urges, etc. does not work long term. But we keep doing this anyway because that’s the rule we’ve been taught.

ACT breaks down rules by emphasizing experiential exercises over verbal rules. The idea is that the person accepts that while the rule they’ve been taught is “get rid of it”, their experience shows that this has not worked, and then they can learn a willingness to experience those private events. [Side note: the addiction book that I’ve found so helpful makes similar points: that our society teaches us that feeling bad is intolerable, to be avoided, and if you feel bad you must do something to stop feeling bad RIGHT AWAY. This is the kind of thinking that fosters addiction, and changing this way of thinking and being willing to FEEL bad is a major part of combating addiction.]

Steps to Acceptance

1. Creative Hopelessness

Focuses on getting the person to see that attempts to stop, alter or avoid private events such as thoughts, emotions or feelings have been unsuccessful. Pulling is often another way to avoid or control private events. He asked us to think about an uncomfortable private event that we’re dealing with right now. He asked how we tried to deal with it. The common answers people gave were: avoided thinking about it, distracting themselves from it, and denial. We confirmed that none of these things work long term in dealing with the private event. It comes back.

2. Willingness

Focuses on getting the participant to be willing to experience negative or uncomfortable private events. If trying to control private events is the problem, willingness to experience uncomfortable feelings may be a solution.

– Willingness is not the same as “wanting”. He had a “Joe the Bum” metaphor (acknowledging that “bum” is not PC.) Say you are having a party that all your neighbors are invited to, and everyone is having a great time. Then Joe the Bum shows up. You don’t want him there, nobody likes him, he’s dirty, he’s smelly. But if you spend your time trying to physically keep him out, you won’t be enjoying your party. But if you are WILLING to accept that he’s there and not fight it, even though you don’t WANT him there, you can still enjoy your party.

– Willingness is all or nothing

3. Diffusion

He said that even if urges etc. are not originally language-based, they become so because WE are language-based. (There was a lot of clinical stuff he went over making this point.) We need to understand language for what it is, and that words are powerful only because we let them be. This step is about de-literalizing private events. We did two exercises to illustrate this.

First he asked us what we associate with the word “milk”. We said white, cold, frothy, things like that. Then he has us say, out loud,”milkmilkmilkmilkmilkmilkmilk. . .” over and over. (Try it, it’s physically not easy to keep this up!) Picture an entire room of us saying it over and over, and he had us keep it up for what seemed like forever. When he finally stopped us, he said, “I bet you’re not thinking of that white frothy stuff anymore.”

The idea is that “milk” made us think of the white frothy stuff, but only because of what WE associate with that word. By repeating the word over and over, we de-literalized it. It became just a word, the letters m-i-l-k. Similarly, an urge that’s felt as “I need to pull” can be de-literalized by repeating “I need to pull I need to pull I need to pull” until they are just words, not something that must be acted on. Those words don’t have power unless we give it to them.

The second exercise is to imagine you are watching a parade and a band is marching by. Imagine that your thoughts, whatever’s bothering you, are written up on cards that the band members are carrying. And just watch those “thoughts on cards” go past you.  Acknowledge them but separate yourself from them.

4. Understanding the Self

Who are “you?” Who is your “self?”

– Conceptualized Self: who do we say we are? What do we stand for? How do we see ourselves? (we typically think of this as our only self, and defend it)

– Knowing Self: the “self” that is experiencing events as they are occurring

– Observing Self: the “self” that has always been and always will be. He made an analogy to a chessboard: I am the board, not the game that is happening on it. Whatever happens on the board does not have to affect me.

5. Valuing

– You have the ability to choose your behavior. You must choose to move in your valued direction.

– What do you value? What do you want your life to stand for?

– Need to make psychological room for private events while you move your life in the valued direction.

[I think an example of what he means by the last item is: a valued direction for me, is not pulling. By trying to move my life in that valued direction, I will have uncomfortable private events and I need to accept this and be ready for this.

He also said:

-Committed Action Invites Obstacles (disguised as private events)

– The Journey in the Valued Direction involves fear and action. So I take it as, anything I do to move my life in a direction I value(trich-related or not) can bring up private events that will be uncomfortable. He is saying “choose to move in your valued direction” while experiencing these private events.]

**The idea is to combine acceptance techniques with other behavior therapy procedures. A clinical study showed this is effective, based on five different measures of pretreatment and post treatment hair pulling.

For more info, this book is very helpful:

Trichotillomania: An ACT-enhanced Behavior Therapy Approach Therapist Guide (Treatments That Work), March 31, 2008, by Douglas W Woods and Michael P Twohig

NAC for Trichotillomania

Research shows that nutritional supplements may help mental health including trichotillomania. Lately I have focused on inositol and NAC as I have heard about these supplements in many trichotillomania communities with varied success.

*Updated 3/17/18

I started taking NAC (N-acetylcysteine) about five years ago and have noticed a decrease in my urge to pull when I take it 5-6 days per week. I have gone though periods where I did not take it or did not take enough that I notice any benefit.

Currently, I take 2-600mg capsules in the morning and 2-600mg capsules in the evening, giving me a total of 2400mg of NAC. Doses between 1200-3600mg may be helpful according to this article,  N-Acetylcysteine, a Glutamate Modulator, in the Treatment of Trichotillomania

I recently added inositol to increase the benefits of NAC.  It is generally agreed that a large dose is needed for inositol to be effective with trich. I worked my way up to 18g per day. I do this by mixing 3 teaspoons or 1 tablespoon of inositol in water 3 times a day. I have found the Jarrow brand powder dissolves best. It is available on amazon for a reasonable price. I mix it with warm water as it dissolves better that way. You can add it to fruit juice or other sweetened drinks.  I simply mix the powder with ~3 oz. of warm water and drink it plain as it has a mild sweet taste that I actually like.


NAC and Trichotillomania

By Fred Penzel, Ph.D.

**Please note the following: This advice is purely informational, and not in any way meant to be a substitute for treatment by a licensed physician. Do not try this, or anything else, without first consulting your physician. If your M.D. has not heard about it, refer them to the following article and let them decide:

Jon E. Grant, JD, MD, MPH; Brian L. Odlaug, BA; Suck Won Kim, MD, N-Acetylcysteine, a Glutamate Modulator, in the Treatment of Trichotillomania: A Double-blind, Placebo-Controlled Study. Arch Gen Psychiatry/ VOL 66 (NO. 7), JULY 2009.


Over the years, it has become apparent that prescription medications, as remedies for trichotillomania (TTM), have proved to be somewhat of a disappointment. These meds have been employed since the early 1990’s, and although they may be seen to work occasionally for some individuals, research indicates that their overall effectiveness is not great for the majority of sufferers. When they do appear to work, it is most likely that they are actually helping with coexisting problems such as depression and anxiety that are impacting the pulling, but not directly causing it. The discovery of a new compound with a greater level of direct effectiveness would be considered a blessing to sufferers. If this compound were also an over-the-counter remedy, it would be even better.

This very thing was confirmed in 2009 with the publication of an article by Grant, Odlaug, and Kim in The Archives of General Psychiatry, titled “N-acetylcysteine, A Glutamate Modulator, In the Treatment of Trichotillomania.”This study, which lasted 12 weeks, investigated the use of the amino acid N-acetylcysteine (NAC) in 50 patients with TTM, and found that 56% of them were rated as improved or very much improved. A much smaller previous pilot study had also found positive results.

So what is this compound? NAC is a both a pharmaceutical drug and a nutritional supplement used primarily to treat Cystic Fibrosis, and also to treat individuals suffering from acetaminophen overdoses. In the former case, it thins mucus, making it easier for patients to cough it up, and in the latter case, has liver detoxifying effects. It has also been said to aid in the treatment of cocaine addiction. Some practitioners out there are also exploring the use of NAC in the treatment of OCD, although whether it is effective or not, is still unproven.

What exactly is NAC? NAC is a natural sulfur-containing amino acid that is a breakdown product of the amino acid L-cysteine, and is in turn broken down by the body and converted to a powerful antioxidant known as glutathione.Antioxidants can repair oxidative stress in the body. Oxidative stress occurs when cell metabolism produces an increased level of oxidants known as free radicals that tip the balance between themselves and antioxidants in the body.These free radicals can cause the breakdown of cells, damaging proteins, genes, and cell membranes. Substances known as antioxidants act by neutralizing free radicals, and some are produced naturally by the body. Some have theorized that hair-pulling may be the result of the effects of oxidative stress within the brain, and that NAC can help reverse this.

NAC is also what is known as a chelating agent. That is, it hastens the excretion of heavy metals such as lead, mercury and arsenic from the body by binding to them. While this is of course, a positive benefit of taking it, it also causes the body to excrete copper, zinc and other essential minerals when used over time. Some research says this effect may be minimal, but others have suggested that it is necessary to take supplements containing copper, zinc, and other vital minerals when using NAC. Until this is settled, it is advisable to take a daily multivitamin plus minerals along with the NAC. It is often recommended to take extra vitamin C, itself an antioxidant, along with NAC, as it can also assist in raising glutathione levels. The amount of vitamin C one should take has been said to be in the range of 500 mg. per day.

As far as taking NAC itself for a BFRB, we have been using the following approach:

1. Start by taking one, 600 mg. capsule of NAC daily for the first two weeks along with a daily multivitamin plus minerals, in addition to 500 mg. of vitamin C. You will most likely not see any changes on this dosage.

2. If the NAC appears to be well tolerated, increase it to 1, 600 mg. capsule, 2x per day. Again, wait two to three weeks to see if there is any reduction in pulling activity.

3. If there are no changes, or only minimal changes in pulling, increase to 1 capsule, 3x per day, and again wait two to three weeks to see if there is any noticeable result.

4. If there is only little or no change, you can then increase to 4, 600 mg. capsules per day, and wait another two to three weeks. Take 2 capsules for one of the three daily doses, to make a daily total of four.

5. If there is still little or no change, you can increase up to what is the maximum of 5, 600 mg. capsules per day. A total of 3,000 mg. is the maximum you should take as a daily dose. Take 2 capsules for two of the three daily doses, to make a daily total of five.

6. If after 4 weeks at the maximum dosage there is still no result, then it is likely that it is not working, and can then be discontinued.

As with all medications and supplements, there are no sure things. It is ultimately all trial-and-error. We hope that NAC will help, but just keep in mind that it will not necessarily work for everyone. Remember that it was shown to be effective for about 56 percent of the subjects in the original research study.

NOTE: There are some very important precautions that should be observed when taking NAC.

1. It should be noted that there are some individuals who suffer from cystinuria, a genetic disorder that causes cysteine to build up in their urine. If levels of cysteine molecules become high enough, they clump together to form kidney stones. It is therefore recommended that those with this problem not take NAC.


2. In addition, NAC supplementation might increase the side effects associated with nitroglycerin and isosorbide, two medications commonly used to treat angina.


3. Using NAC at the same time as the hypertension drugs ACE-inhibitors might cause blood pressure to drop too low. It might also excessively strengthen the actions of immunosuppressant drugs.


How N-Acetylcysteine (N-A-C) Cured My Depression and Anxiety

The maternal side of my family contains a history of severe mental illness. My maternal grandmother suffered from schizophrenia and died in a mental ward. My mother has been institutionalized repeatedly, suffering from a decades long battle with bipolar disorder.

My younger brother is a legitimate sociopath. He is not merely “dark triad.” He has actual antisocial personality disorder. He has no feelings of empathy or kindness or decency. Lacking the vision to rob banks or become a drug kingpin, he is currently free after spending 10 years in prison for shooting his one-armed drug dealer.

In other words, there’s some funny business in my DNA.

I used to get depressed and feel anxious. I never had full-on panic attacks, but I would have severe anxiety that would leave my brain spinning. My skin would break out in rashes.

I conquered this anxiety through two means, as anxiety and other mental illnesses have two components – physical and psychological.

The psychological components of anxiety come from society and the brain washing. That is where state controlreframing techniques, and other Mindset Training comes into play.

The physical components of anxiety and depression come from a variety of sources – poor nutrition, lack of sunlight, excessive oxidative stress, high cortisol, and heavy metal poisoning.


N-Acetylcysteine (N-A-C) has been clinically proven to help treat symptoms of anxiety and depression.

N-Acetylcysteine is a powerful nootropic with still many unstudied benefits. N-A-C has been used by visionary doctors to help treat intractable depression and anxiety.

Why haven’t you heard about the magical effects of N-A-C? Simple. Go on Amazon and see how much a bottle of N-A-C costs.

My mom was on a $1,500 a month cocktail of drugs. No one would listen when I suggested they buy a $15 bottle of N-A-C. But the science is there.

See, N-acetyl cysteine for depressive symptoms in bipolar disorder–a double-blind randomized placebo-controlled trial(“NAC appears a safe and effective augmentation strategy for depressive symptoms in bipolar disorder.”) (PubMed.)

See also, N-acetyl cysteine as a glutathione precursor for schizophrenia–a double-blind, randomized, placebo-controlled trial. (“These data suggest that adjunctive NAC has potential as a safe and moderately effective augmentation strategy for chronic schizophrenia.”) (PubMed.)

N-A-C depression anxiety

Why does N-A-C help treat depression?

Acetylcysteine is a glutathione precursor. That is, acetylcysteine is converted into glutathione.

Glutathione is an antioxidant that used by your liver to detox your body. Emergency rooms give high doses of NAC to patients that have overdosed with Tylenol.


  • The Wahls Protocol: How I Beat Progressive MS Using Paleo Principles and Functional Medicine (Amazon).
  • Smash Chronic Fatigue: A Concise, Science-Based Guide to Help Your Body Heal, and Banish Fatigue Forever (Amazon).

Could mental illness be caused by toxins that your liver is unable to clear from your body, due to a glutathione deficiency?

That is not so far fetched, and in fact the cutting-edge of mental health research is on the role toxins and oxidative stress play in mental illness.

See, The efficacy of adjunctive N-acetylcysteine in major depressive disorder: a double-blind, randomized, placebo-controlled trial (“These data implicate the pathways influenced by NAC in depression pathogenesis, principally oxidative and inflammatory stress and glutamate, although definitive confirmation remains necessary.”) (PubMed.)

See also, The Glutathione System: A New Drug Target in Neuroimmune Disorders (“Glutathione depletion and concomitant increase in oxidative and neurological stress and mitochondrial dysfunctions play a role in the pathophysiology of diverse neuroimmune disorders, including depression, myalgic encephalomyelitis/chronic fatigue syndrome and Parkinson’s disease, suggesting that depleted GSH is an integral part of these diseases.” (PudMed.)

Do you know what else boosts glutathione?

Carrot orange pomegranate juice

How much N-A-C should you take?

That would be medical advice, which I don’t give. However, participants in the studies usually used between 1 and 2 grams daily.

Why take N-A-C instead of glutathione?

If N-A-C is a precursor, wouldn’t it make more sense to take glutathione directly? That seems intuitively correct. There is some evidence to suggest that N-A-C is more bioavailable than glutathione.

I personally use N-A-C because that was the compound studied. How much glutathione would one need to take to get the same benefits that one can obtain from 1 to 2 grams of N-A-C? As I don’t know, I went with N-A-C.

You are of course free to try both for yourself to see what works best.

What brand of N-A-C is best?

As the supplement industry is unregulated, I generally prefer to use use two brands of supplements – Life Extension Foundation and Jarrow.

I personally use Jarrow’s form of N-A-C Sustain, which is time released. (Amazon).

For more information on oxidative stress, nutrition, and various maladies, watch this video.

Minding Your Mitochondria

John Kender Diet: ‘Bad’Foods Trigger Urge to Pull

The John Kender diet has been designed based on input from trichsters who have charted what foods increase the urge to pull.


I figure who better to explain the John Kender diet then John Kender himself..so here he gives an excellent overview of his findings.  Michael Grant also presents his extensive knowledge on good and bad skin products that affect trichotillomania, much like good foods.

Here’s some info about hair pulling, particularly about nutrition, skin care, and yeast. This compilation was originally created in July 1997, and should be accompanied by an updated article, “A Theory of Trichotillomania”, written in August 2008, which focuses more on the possible chemicals involved. Please write me if you have not received it.

As of July 2012, more than 600 people (including more than 100 children or adolescents) have been reported to me via email as obtaining from “good” to”total” relief, from at least one week to over eight years, using some or all of these techniques. I have used them since July 1992, and (except for experiments with new things and an occasional deliberate dietary lapse) I have been pull-free for that time. I have also received several reports that skin-picking and even nail-biting are also responsive to these methods, and that five dogs have stopped their compulsive paw-licking similarly.

Thank you,

John Kender


(Submitted to the TLC newsletter “InTouch” in August 1999, so references to dates and times have to be adjusted somewhat.)

by John R. Kender and Michael J. Grant

In this letter, we outline some observations about several simple at-home procedures that have proven to be helpful to many pullers. These procedures involve various foods and skin care practices. We guess that for many people, hairpulling is aggravated by a particular biological cause that these practices help to address. At the end of this letter, we list postal and email addresses where you can get more detailed information about our ideas and methods.

1) Who We Are and What We Have Done

Let’s first introduce ourselves. One of us, John, is a university professor who pulled eyebrows for 30 years, but is currently enjoying a more than seven year remission which he attributes to dietary control. For the past four years, John has run the TTM remailer program, a private internet email exchange about trich, which has about 400 subscribers and participants. John has spoken at two TLC retreats about his experiments with nutrition and its effect on trich.

The other of us, Mike, is the father of a hairpuller. He and his daughter, Terri, have experimented with several skin and hair treatment approaches to hairpulling. Mike started and is an active contributor to an email support group for PoPs (Parents of Pullers) on the internet. Mike has attended several TLC retreats, at which he has demonstrated on multiple volunteers his various scalp care procedures, which use only non-prescription preparations.

The two of us, in our combined 12 years of experimentation, have observed that for many people some of the trich experience is directly affected by diet and by skin condition. By continuing to use the internet to gather the experiences of other hairpullers, and by combining these with our own experimentation, we have become convinced that for many people it is possible to achieve significant amounts of relief and control by taking some straight forward measures with regard to nutrition and skin care procedures.

Although our observations have not yet been medically verified and our guesses as to their biological roots remain unproven, in the past four years we have gathered reports of significant improvement from an encouragingly large number of people.

We aren’t selling anything–there is really nothing to sell–and we realize that what we have noted does not work for all forms of trich. But we offer them to the readers of InTouch, who can try them for themselves as they see fit. Please be aware that we are not medical doctors and that anyone considering these approaches should check with their doctor first.

We will describe first some nutritional means, then some skin and hair care means, and then suggest a possible explanation for why these two seemingly unrelated approaches may both be ways of attacking a common biological cause. If anyone then wishes further information, we list where we can be reached.

2) Nutrition and TTM (John writes)

Seven years ago, by keeping careful records of what I ate, I noticed that certain foods tended to increase my urges to pull. By avoiding those foods, I began what is now a seven year remission: no urges, and no hairpulling. Numerous experiments, some even with my dog who had a problem with compulsive paw licking, confirmed that some foods were “bad”, meaning that they increased hairpulling urges and sometimes increased an itchy “this hair is out of place”feeling. I wrote in a previous issue of InTouch four years ago about some of these experiments.

Since then, based in part on written and email reports from other pullers, the list of “good” and “bad” foods and of other food-related techniques has been refined, and there is now a better understanding of the strengths and weaknesses of this approach. As of the Summer of 1999, over 100 people, including about a dozen children and adolescents, and several dogs, have reported or have been reported as obtaining from “good” to “total” relief, for a week to years, using some or all of these techniques. More than two dozen of these pullers report from two months to three years’ worth of benefit. At the same time, the number of people reporting increased urges and hairpulling after eating “bad” foods has been so numerous (on the order of several hundred) that I have stopped keeping track of them, even electronically. On the other hand, we have received a few reports of earnest attempts at dietary control measures that have failed, most of them appearing to be from lash pullers.

According to several polls we have taken on the TTM remailer list, we have gathered the following information. About one-half of pullers who responded to the polls do experience strong hairpulling reactions to one or more of sugar, caffeine, cola and/or chocolate, egg yolks, legumes (peanuts, mostly), or fatty fish (tuna, mostly). First preceded by an growing internal feeling of agitation, the hairpulling urges begin increasing a few hours after eating sugar or caffeine, or about one to two days after eating the others. The increased urges usually peak after about twice that amount of time. Often these urges, particularly the ones due to egg yolk and legumes, take as much as a week to fully subside down to their usual level. Although stress aggravates such food-related pulling, it is not necessary for it: after “bad” foods, people report they pull regardless of their mental state.

The polls have indicated, however, that scalp and/or body pullers seem to differ somewhat from lash and/or brow pullers. Scalp and/or body pullers seem to be food-sensitive to the extent that their hairpulling is worse during Premenstrual Syndrome (“PMS”)–which tends to be experienced as increased depression–and to the extent that they “trance out” while hairpulling. Lash and/or brow pullers, however, seem less food-sensitive and more business-like in their hairpulling. Their PMS tends to be experienced as irritation, and their hairpulling is more focused; further, their hairpulling may be more related to the eating and drinking of vitamin-D enriched dairy products. But both kinds of pullers in general tend to be far more likely than average to have allergies, to have sweet tooths, and to have an unexpectedly extensive experience of being around furry pets. Most surprisingly, the polls indicate that pullers tend to have an unusually high number of “trichy” dogs and cats.

If people are interested in seeing if their hairpulling is food-related, there is a simple test: they should simply eat as many peanut M&Ms or Reese’s peanut butter cups as they can stand at one sitting (sugar! chocolate! legumes!),washing them down with Coca-Cola (cola! caffeine! more sugar! or aspartame, which is just as bad!). Alternatively, especially for children, it could be peanut butter and jelly sandwiches with chocolate milk. If in two days there is a noticeable increase in hairpulling urges, then they could consider abstaining from “bad” foods. Unfortunately, it appears to take from 30 to 40 days to purge the gut and skin of their bad effects fully, and it also seems to take several attempts and about a year of trying for most pullers to get there. People report that avoiding sugar and caffeine, which act more quickly, is the most rewarding way to start.

The “bad” food list given above reflects the worst experiences of many people, but it is not complete. The full list is available on written request (it’s too long to explain here). It includes, among other things, concentrated natural sugars, tomato seeds, soy products, yams, MSG, and ibuprofen. However, there are a few “good” foods, which partially counteract the “bad” ones. They include garlic, most acidic fruits, dry red wine, unsweetened yogurt, and a chemical family called gluconates.

Additionally, certain hair care products and certain skin creams carry chemicals that appear to be similar to those involved with the “bad” foods. In particular, food-sensitive pullers report that hair conditioners with stearyl alcohol or other fatty alcohols should be avoided. Similarly, there have been reported a few “good” food-related chemicals that can be applied to the skin and hair to stop them from itching, among them alpha hydroxy acids (“AHA”s, sometimes called “fruit acids”), and a home-made hair rinse made from a mixture of acetic and boric acids (essentially, dilute vinegar and eyewash). We have a theory as to what may hold these unusual collections of “good” and “bad” foods and chemicals together, which we will briefly explain below.

3) Skin and Hair Care and TTM (Mike writes)

My continuing interest in the relationship of certain types of scalp conditions and TTM has been an outgrowth of my daughter Terri’s experience which began more than five years ago. At the time Terri was diagnosed withTTM, she had already been under a dermatologist’s care. She had what was thought to be spontaneous hair loss due to alopecia areata, as well as due to an inflammatory condition of the scalp that had progressed to the point of forming sores which she would want to pick at due to their intense itching. The condition of Terri’s scalp was thought to be a medical consequence of her primary impulse control disorder.

In the years that have followed, through Terri’s experience as well as my own participation with children and adults in the TTM community, I discovered a group of hairpullers who share the same scalp symptoms. Further, observing these scalp conditions over time, I have noticed that in many instances the scalp conditions preceded, not followed, the hairpulling. The pulling appeared to be triggered by the inflammatory process, much like the scratching behavior most of us have in response to conditions such as mosquito bite,poison ivy, or athlete’s foot. I speculated that it might be possible in some instances to reduce or eliminate the hairpulling behavior simply by alleviating the inflammatory trigger.

The opportunity came when Terri consented to have her head shaved for medical reasons to help resolve her on-going scalp problems. Her urge to pull seemed to disappear literally overnight, an observation agreed with by the medical professionals attending her. The conventional explanation was that this had removed a significant trigger and prevented the self-reinforcement of pulling behavior. But the conventional explanation did not explain the suddenness with which the urge seem to be extinguished, nor the experimental result that the relief only came when the scalp was wet-shaved with a blade, and not with a surgical clipper which cut the hair to virtually the same length. At the same time, the razor shave was observed to relieve the inflammation, whereas the clipper shave noticeably exacerbated the redness and itching.

After reading an abstract John posted to the remailer describing a protocol for treating a particular inflammatory process possibly related to a biological cause, I noted that there were some similarities between the article’s treatment and what Terri was receiving in the head shave. The article’s treatment soaked the scalp with a soapy lather beneath hot water-saturated towels. This was exactly the preparation done prior to using the razor. As an experiment, we did the soak but didn’t use the razor. Terri experienced nearly the same degree of relief as if her head had been actually shaved, and it alleviated the inflammation of her scalp as well. This strongly suggested it was not the cutting of the hair that provided the relief–the clipper did that without good effect–but rather it was the preparation regimen itself. We also noted with some interest that letting her scalp get some sun also helped; in fact, an accidental sunburn gave about four days free of itching.

On the possibility we were dealing with a dermatological disorder, a receptive dermatologist prescribed the antifungal shampoo Nizoral, then available only by prescription. And based on the article, we substituted Cuticura soap, which is similar to the liquid barber’s soap we were using, but which also contains an antiseptic. Over time, we found that the optimal regimen was to alternate the Cuticura with the Nizoral shampoo on a daily basis. It appears that the two are good compliments to one another. Cuticura is anti-bacterial, Nizoral is anti-fungal. Cuticura is a soap which is milder but leaves a residue which can build up. Nizoral is a detergent which removes the residue and prevents the build-up.

Some other preparations we tried were pure aloe vera gel, benzoyl peroxide, and camphor. Terri’s barber suggested the aloe vera gel as a skin conditioner to soothe and protect her scalp after shaving. She also tried a lanolin-based product, but that resulted in intense itching within 30 minutes of being applied to Terri’s scalp, whereas the aloe vera gel seemed to help reduce what itching there was. The benzoyl peroxide worked well for an intense itching area where there was inflammation and a distinct raised area on the skin, but it was very drying to the scalp and it bleached the emerging hair. (Along the way, I discovered that benzoyl peroxide also stopped, within a week, one of my own year-long bouts with skin picking.) But with further experimentation we found that camphor spirit topically applied would alleviate itching for several hours without adverse effects. Camphor is also contained in Sea Breeze astringent, which we found useful and mild enough for general routine application.

What I believe to be a significant discovery happened while Terri was having her head shaved on a regular basis. To alleviate the “shine” which my daughter did not like, the barber applied to her scalp a mineral clay masque, made principally from bentonite, to help absorb the excess oils. As the water evaporated from the clay, contrasting dark areas would appear in proportion to the amount of oil that had been absorbed. (We later found a formal clinical study in which bentonite clay was also used to collect skin oils from patients.) An astonishing phenomenon slowly began to appear. Terri only pulls from highly selective areas that have an intense itch-like sensation. After shaving her head with the straight razor, these areas could no longer be distinguished from the rest of her head. But the contrasting dark areas of the clay masque exactly outlined those “hot spot” areas which were otherwise indistinguishable on her scalp–even when they were examined by an experienced dermatologist under magnification. I believe this to be a physical demonstration of the correlation between hot spots and excess sebum, present even six months after the cessation of all pulling.

In an attempt to replicate the observations I made with Terri, as well as to do a preliminary investigation of a possible biological cause, I made up kits with various over-the-counter preparations and skin care products for some of my email TTM friends. Included were the Cuticura soap, as well as several other types of soaps we had used. Also included were a triple antibiotic, a mild steroid anti-inflammatory (hydrocortisone), an antihistamine (diphenhydramine), as well as an anti-yeast product (miconazole nitrate). Only general cautions were provided, together with the instructions to try all the products and decide which ones worked the best. At least half of those who received the kits were not associated with John’s remailer, and had not heard of any possible search for a biological connection with TTM.

The antiseptic Cuticura was by far the preferred cleansing agent over very similar soaps without the antiseptic. Sea Breeze astringent for general overall application, and camphor spirit for intense hot spots, were also widely reported as being helpful. The antibiotic ointment seemed to have no effect, nor did the antihistamine ointment, but the surprisingly effective agent, widely and independently reported to alleviate the itch and pulling urge, was the antifungal miconazole nitrate 2% cream.

At this point, I can recommend a specific program for shampooing, massaging, and treating the hair, skin, and scalp. The full program is available on written request (it’s too long to explain here). We have a theory as to what may hold these unusual collections of “good” and “bad” skin treatments together, and what may relate them to the “good” and “bad” foods and chemicals, which we will briefly explain below.

I have had the privilege of demonstrating these techniques at the last two TLC Retreats, and I would like to thank those individuals who participated. They helped to advance our understanding and to make this letter possible. I would also like to thank Jo Ann, our family barber, and most of all, my daughter Terri, for her patience, understanding, and courage.

4) A Possible Theory of Some TTM (both of us)

Putting all these observations together, we guess that some people pull because of a local skin irritation caused by chemicals released into skin grease by a skin micro-organism. Specifically, we guess that some (about 60% of) hairpulling is aggravated or caused by a local allergic reaction to the enzymes and/or fatty alcohols produced by a normally innocuous skin yeast, Malassezia. Nearly everyone has this skin yeast, particularly in hair follicles of the lashes, brows, and scalp. But what may make pullers different is that their immune system reacts more strongly to its presence. From this perspective, hairpulling is like sneezing: the body is attempting to rid itself of an allergy-causing irritant.

What ties the “bad” things together is that the “bad” foods are all scientifically known to encourage the growth of this yeast, and the “bad” chemicals are scientifically known to cause allergic reactions. Oppositely, the “good” things are known to kill or inhibit either the yeast, the yeast enzymes, or the yeast-produced chemicals in various ways.

There are more details to this theory, which are available on written request. For example, common sugar is a powerful yeast food, for all yeasts (including the different yeast which is known to cause vaginal yeast infections), but fructose, a somewhat different sugar which does not seem to bother pullers, is not a good yeast food at all. Foods rich in sterols, whether they are the cholesterols in animal foods such as egg yolks, vitamin D-related sterols in milk or tuna, or the phytosterols in plant foods such legumes, are believed by researchers to be growth signals to the specific skin yeast we suspect. Similarly, there are links between the other foods and chemicals to this yeast’s life cycle and health. One of us, Mike, has even grown a colony of Malassezia, and has found that its most preferred food is the oil from freshly ground peanuts.

Further, the irritancy of conditioners containing fatty alcohols, the “hot spots” of pulling, the slow migration of hot spots over the skin, their localized overproduction of skin grease, the relief people experience from the grease-removing clay masks, the effectiveness of anti-bacterial and anti-fungal shampoos, and the soothing action of the extended grease- expressing hot-towel scalp massages: these all appear consistent with the idea of a localized allergic response to an infecting organism. Seen this way, the

hot towels, high pH soaps, and blade shaving may be removing both the organism and the grease it feeds on, something an electric razor misses. Even the gradual recurrence of the itch after four days or so fits with what is known about the time necessary for yeast growth. Further, the propylene glycol base for the helpful aloe vera gel is a known yeast killer (as is sunlight and as is benzoyl peroxide), whereas the troublesome lanolin is a complex of growth-stimulating sterols and irritating fatty alcohols.

We think the theory helps explain why hairpulling is worse premenstrually: the increased progesterone, a sterol, is a known yeast growth stimulant. And why hairpulling usually doesn’t hurt and is often done in a trance: this skin yeast is known scientifically to make a chemical called hexanol that has anesthetic properties. (And besides, people with other skin yeast infections scratch like crazy, sometimes drawing blood, but finding it pleasant.) And why hairpulling usually starts in early adolescence: this is when the sebaceous glands start to produce the grease this yeast needs. And why hairpulling is chronic: this yeast, in general, is hard to control, and other disorders related to it are chronic; in any case, most allergies are unfortunately chronic, too.

We think the theory may help explain the “fat roots” that hairpullers seem to go hunting for: skin micro-organisms are able to turn soft grease into a harder wax-like plug that is easy for exploring fingers to recognize. (We have found that non-pullers get them, too, but it doesn’t seem to drive them nuts.) We think the theory may help explain why such very large doses of serotonin-specific reuptake inhibitors (“SSRI”s, like Prozac) are found to be necessary for TTM: it may be that the SSRIs act like chemotherapy, stressing the human body, but fatally overloading critical yeast digestive processes (technically, the “cytochrome P450 enzymes”, which the human body also uses to dispose of SSRIs). We even speculate that hairpulling and furry pets seem to go together because, perhaps, the microorganisms involved can be shared between people and dogs and cats; some people have in fact have found some relief from lash pulling by simply making sure to regularly wash their hands and eyelids.

5) For Further Information

If you have access to the Internet, a good place to explore these food and skin care observations is by joining the TTM remailer (send email to jrk@cs.columbia.edu), or by viewing Amanda’s website (at jly2.com/ttm). The authors can be reached at jrk@cs.columbia.edu or TTMParents@aol.com.

6) An Important Final Disclaimer

Please note that the two of us are simply reporting what we have observed and thought. We are not offering medical advice. We cannot guarantee results, or even the safety of any these procedures. It is important that you check with your doctor first before you experiment. And, please, let us know of your results, so that we can keep all these things safe, and share them with other hairpullers.


Don’t you give up on a miracle
You’ve got to speak to the impossible,  oh
You’ve got to pray till you break through breaks through the ceiling keep on believing



Have you stopped reaching?
No longer seeking greater things
Have you forgotten you have a Father listening? oh
He tells the sun when to rise
Gives the wind it’s breath
Swings a door wide open and moves in a moment you least expect

Don’t you give up on a miracle
You’ve got to speak to the impossible, oh
You’ve got to pray till you break through breaks through the ceiling keep on believing

Don’t you give up
Don’t you give up on a miracle
How many chances?
How many answers pass us by?
You know it takes faith to step on the waves when you’re terrified
So when you’re packed in a corner (corner)
And can’t wait any longer
Don’t you give up on a miracle
You’ve got to speak to the impossible, oh
You’ve got to pray till you break through breaks through the ceiling keep on believing
Don’t you give up
Don’t you give up on a miracle
Feels like the presents the words you’ve spoken
They go unnoticed like drops in the ocean
Just beyond the veil of your vision
Your mountains are moving, moving on
Remember the works his hand has done
Where you once were and how far you’ve come, oh

Don’t you give up on a miracle
You’ve got to speak to the impossible, oh
You’ve got to pray till you break through breaks through the ceiling keep on believing
Don’t you give up on a miracle (don’t you give up)
You’ve got to speak to the impossible, oh (you’ve got to speak, keep on believing)
Pray till you break through breaks through the ceiling keep on believing
Don’t you give up
Don’t you give up on a miracle
Pray till you break through breaks through the ceiling keep on believing
Songwriters: Jason Walker / Chad Mattson / Tedd Andrew Tjornhom / Jon Lowry
Miracle lyrics © Warner/Chappell Music, Inc, Capitol Christian Music Group

Seeds of Faith


If you have faith the size of a mustard seed it will be multiplied exponentially.

Some seeds when planted produce a hundred fold. Do not compromise when it appears God is not working the miracle for which you have prayed and believed. Just because you don’t see it doesn’t mean God isn’t working in you. As a seed grows underground we do not at first see the work that has started, but in due time there is a harvest.

If God met all of your expectations, He would never be able to exceed them.

Never stop believing for a miracle.

LifeChruch Sermon Series: Exponential

Seed of Faith

Key Scriptures

Some time later, the LORD spoke to Abram in a vision and said to him, “Do not be afraid, Abram, for I will protect you, and your reward will be great.” But Abram replied, “O Sovereign LORD, what good are all your blessings when I don’t even have a son?” …

Genesis 15:1-2 NLT

Then the LORD took Abram outside and said to him, “Look up into the sky and count the stars if you can. That’s how many descendants you will have!”

Genesis 15:5 NLT

If you belong to Christ, then you are Abraham’s seed …

Galatians 3:29 NIV

Let us not become weary in doing good, for at the proper time we will reap a harvest if we do not give up.

Galatians 6:9 NIV

Start talking. Find a conversation starter for your group.

• When you were a kid, what did you want to be when you grew up?

• Do you have any dreams for your life or family that feel impossible? Will you share them?

Start thinking. Ask a thoughtful question.

• What do you think causes people to settle for less than God’s best for their life?

• Read Galatians 6:9. What are some good things that are easy to grow weary of?

Start sharing. Choose questions that create openness.

• Have you ever been disappointed by unmet expectations for your life? What happened?

• Share a story when you couldn’t see it in the moment, but at the right time, God completely exceeded your expectations.

• What seed are you waiting to see the results of? What new seed is God leading you to plant in faith?

Start praying. Be bold, and pray with power.

God, You are so incredibly good and faithful. Your ability to multiply our smallest efforts is immeasurable. We can barely begin to comprehend the width and depth of Your love and plans for us. We trust You. Give us faith to plant the seeds You want us to plant. Amen!

Start doing. Commit to a step and live it out this week.

• Write down or list out loud a few of the big blessings in your life. Then, write next to them the initial seeds that over time multiplied into these blessings. Finally, thank God for what He’s done.

• Write down, or list out loud a few of the big, maybe unbelieveable dreams you have for your future. Then, write next to them the seeds you can plant in faith. Finally, commit your seeds of faith to God.

• Find a Bible Plan to start with your friends: www.life.church/plans


Gently breathe in God’s spirit, that spirit which, if not barred out by selfishness, will enable you to do good works. This means rather that God will be enabled to do good works through you. You can become a channel for God’s spirit to flow through you and into the lives of others. The works that you can do will only be limited by your spiritual development. Let your spirit be in harmony with God’s spirit and there is no limit to what you can do in the realm of human relationships.

Prayer for the Day

I pray that I may become a channel for God’s spirit. I pray that God’s spirit may flow through me into the lives of others.

Relax, “Let Go & Let God”, Everything Will Work Out for Your

God has a purpose for your pain, a reason for your struggle and a reward for your Faithfulness. Don’t give up! God’s word teaches us to Cast our care upon the Lord. “Casting all your care upon him; for he careth for you.” [1 Peter 5:7]

I realize that learning to “let go” and “let God” is not as easy as it sounds, however, the bible reassures us to …”Cast your cares on the Lord and he will sustain you; he will never let the righteous fall.” [Psalm 55:22]


Let’s consider Job’s trials. Job said: “Though he slay me, yet will I trust in him: but I will maintain mine own ways before him.” [Job 13:15]


I pose this question to you: If you’re in constant turmoil and worrying, why do you pray? Is it just something you do because it’s tradition, or, do you truly seek God for peace and understanding?

1). Forming a “real” relationship with God provides a sense of security, revelation knowledge and mostly, “a peace that surpasseth all understanding.”

2.)The Bible says to, “Delight yourself in the Lord and He will give you the desires of your heart.” [Psalm 37:4] What we should understand mostly from this passage is the fact that there is a process of learning just how to “delight yourself in God.”


As you study God’s Word, you will learn to “Let Go & Let God!” Pray and sincerely ask the Holy Spirit to order your footsteps as you prepare to study God’s Word daily.

“For I know the thoughts that I think toward you, saith the LORD, thoughts of peace, and not of evil, to give you an expected end.” [Jeremiah 29:11]


I love Worn by 10th Avenue North


I’m tired

I’m worn

My heart is heavy

From the work it takes to keep on breathing

I’ve made mistakes

I’ve let my hope fail

My soul feels crushed

By the weight of this world

And I know that you can give me rest

So I cry out with all that I have left

Let me see redemption win

Let me know the struggle ends

That you can mend a heart that’s frail and torn

I want to know a song can rise

From the ashes of a broken life

And all that’s dead inside can be reborn

‘Cause I’m worn

I know I need

To lift my eyes up

But I’m too weak

Life just won’t let up

And I know that You can give me rest

So I cry out with all that I have left

Let me see redemption win

Let me know the struggle ends

That you can mend a heart that’s frail and torn

I want to know a song can rise

From the ashes of a broken life

And all that’s dead inside can be reborn

Cause I’m worn

And my prayers are wearing thin

I’m worn even before the day begins

I’m worn I’ve lost my will to fight

I’m worn so heaven so come and flood my eyes

Let me see redemption win

Let me know the struggle ends

That you can mend a heart that’s frail and torn

I want to know a song can rise

From the ashes of a broken life

And all that’s dead inside can be reborn

Yes all that’s dead inside will be reborn

Though I’m worn

Yeah I’m worn

Songwriters: Jason Ingram / Jeff Owen / Mike Donehey

Worn lyrics © Sony/ATV Music Publishing LLC

Scary Times


A sudden urgency to read my bible woke me from a deep sleep at 1:00 AM. This is a unique experience. When I turned on the audio of my youversion bible app to continue my daily reading plan,  it went to chapter 17 of the book of Revelation.

I didn’t notice it wasn’t on my plan until it went into chapter 19 of Revelation. Confused, I realized I was reading yet another chapter from Revelation when my daily reading had not yet started this chapter and I ‘d not read from this book this year.  I looked and somehow was not in my normal reading plan. At this point I checked my app and bible plan. I should have been reading Numbers 1, Mark 11, Psalm 46, and Proverbs 10:23. I have no idea how I ended up in the book of Revelation.

Perplexed and drawn to the eerily familiar chapter, I continued. Reflecting on my reading and experience I am baffled. I have never experienced something quite like this and believe God pointed me to this reading. I don’t know exactly why, but I trust Him above all else. I thought I should share in hopes that it makes more sense to someone.



Thank You God for These Hands

Thank you God for these able hands that shoveled many feet of snow. My poor van was almost lost for good, but with help from my wonderful husband we saved her.


Now I rest. I’m thankful for this ‘Mommy break’. I gave myself a manicure. I am happy even though they are short. I broke four nails in the process of shoveling and putting outside clothes on and off four kids about a hundred times.

A little me time and pampering goes a long way. It was a much needed 30 minute break while my three big kids played outside and baby Rachel napped. Thank you God for moments of rest and peace. #simplepleasures #girlygirl




Have you stopped reaching?

No longer seeking greater things

Have you forgotten you have a Father listening? oh

He tells the sun when to rise

Gives the wind it’s breath

Swings a door wide open and moves in a moment you least expect

Don’t you give up on a miracle

You’ve got to speak to the impossible, oh

You’ve got to pray till you break through breaks through the ceiling keep on believing

Don’t you give up

Don’t you give up on a miracle

How many chances?

How many answers pass us by?

You know it takes faith to step on the waves when you’re terrified

So when you’re packed in a corner (corner)

And can’t wait any longer

Don’t you give up on a miracle

You’ve got to speak to the impossible, oh

You’ve got to pray till you break through breaks through the ceiling keep on believing

Don’t you give up

Don’t you give up on a miracle

Feels like the presents the words you’ve spoken

They go unnoticed like drops in the ocean

Just beyond the veil of your vision

Your mountains are moving, moving on

Remember the works his hand has done

Where you once were and how far you’ve come, oh

Don’t you give up on a miracle

You’ve got to speak to the impossible, oh

You’ve got to pray till you break through breaks through the ceiling keep on believing

Don’t you give up on a miracle (don’t you give up)

You’ve got to speak to the impossible, oh (you’ve got to speak, keep on believing)

Pray till you break through breaks through the ceiling keep on believing

Don’t you give up

Don’t you give up on a miracle

Pray till you break through breaks through the ceiling keep on believing

Songwriters: Jason Walker / Chad Mattson / Tedd Andrew Tjornhom / Jon Lowry

Miracle lyrics © Warner/Chappell Music, Inc, Capitol Christian Music Group


I blog about my personal struggle with trichotillomania and bipolar disorder. I also discuss helpful strategies, reflections, and treatments.

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Trichotillomania Weblog

Personal stories from those with experience of trichotillomania - pulling out hair.

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