The Problem with Perfectionism

Although there is no scientific evidence that Trichotillomania is associated with any particular personality, perfectionism appears to be extremely common and often provides a real roadblock to recovery in a number of different ways. One common problem is the false belief that in order to stop pulling, all urges to pull must cease. It is highly unlikely that urges to pull will ever completely vanish. While one can attempt to decrease urges to a manageable amount (such as through medication or naturally over time with relative abstinence from pulling), the main goal is to manage the urges in a different manner than before. It is sometimes a giant leap in recovery when the hair puller realizes that they don’t have to pull whenever they have the urge.

Another threat to recovery comes when the puller experiences success with not pulling, then has a setback. The perfectionist in them says it is all-or-nothing, so they might as well give up. Virtually everyone successful in recovery from hair pulling has times, perhaps during periods of great stress or illness, some degree of relapse. It is hard for many not to feel that they are starting over again. One hour of pulling can mean the total loss of hard-earned lashes or brows-a bad week may result in a large bare area on one’s scalp.

The amount of hair one has at any given moment is not synonymous with the degree of recovery. It is important to realize that all that has been learned about how to stop pulling is not lost in that hour or week. Each setback is simply a new challenge to be figured out. Recognizing through trial and error that, for instance, premenstrual times are uniquely difficult or that studying for final exams inevitably leads to total loss of control allows one to build upon or add to the techniques learned or medications taken.

Yet another roadblock may come when hair starts to grow back. It is bound to be uneven, asymmetrical, stubbly, gray, or in some other way bothersome to the puller. These hairs are, after all, for many, what triggers the pulling in the first place. The urges then become stronger than ever and the tendency to feel or look at these “wrong” hairs has to be avoided in favor of changing the cognition that drives them in the first place. A number of techniques individualized for each puller can be used at that time. For instance, a person who craves symmetry may need to practice asymmetry in a number of areas to eventually tolerate asymmetry of hair (especially of eyebrows in many cases.)

Rather than hiding all imperfections as the hair puller generally spends much time doing, practicing appearing deliberately imperfect, and experiencing the real lack of importance this has in life, can be a helpful step. This needs to be done in hierarchical stages with the imperfections least important to the puller shown first and the hardest revelations put at the top end of the list.

Recovery, then, is a complicated process fraught with barriers-hidden or overt, real or imagined. Overall, it requires giving you time, effort, assistance, and forbearance. What does the recovered hair puller look like? A woman or man with imperfect hair, urges to pull, possibly occasional bouts of pulling, who has healthy relationships and a positive self-image and identity as a whole, worthwhile human being.

Full Article: Barriers to Recovery from Hair Pulling By Carol Novak

Carol Novak, M.D., is the founder of the Pioneer Clinic, specializing in the treatment of Trichotillomania and Obsessive-Compulsive Disorder. She has treated approximately two hundred hair pullers.

Keep On Keepin’ On

I’m feeling good with two completely pull free days under my belt and 16 PF days on my scalp.  The urge to pull from my scalp has not returned.  This is a miracle after 10 years without a break from the gnawing irritation.

I am continuing the NAC at 3600mg.  I am lowering my inositol to 12g (from 18g) per day, as I am increasing my l-methionine.  The John Kender diet has also proven to be very helpful.  The days I did pull from my eyes, I saw a direct correlation to sugar the day before.

I have learned that my urge goes way up after caffeine, sugar, egg yolks, and peanut butter. I am still learning what I can eat and what triggers urges.  Keeping the food journal has been tedious, but enlightening.  It has also been hard to cut out caffeine and limit my sugar.

My sugar ‘withdrawal’ is starting to wear off and I’m not craving it so much.  The first two weeks were really tough.  I hoping that it will get even better, as I still day dream about chocolate and soda. It is so worth it though!  I’ve dreamed of a full head of hair and long lashes for twenty years. 🙂

A Changed Perspective

A Changed Perspective

recovery is a process

small steps

improvement not perfection

prepare for slips

don’t be discouraged

look for good days

strategies that work

rules to follow

make a plan

celebrate small victories

watch the numbers

go down

focus on the big picture

not the slips

stay strong

for the fight

is long and

requires perseverance

be your own advocate

when treatments fail

move on to

your next step

there is hope

and this will end

if you keep fighting

~August 2014

Poem

My Addiction-Explained

another day

I look in the mirror

still the same

no more hair than yesterday

block out the pain

as I watch myself

put on the makeup

under which I try to hide

the disguise can’t erase

the shame and embarrassment

this self-torture

brings upon me

I try to control my hands

that ravage destruction

on the few fragile lashes

that dare attempt to grow

in a war with myself

two pieces forever fight

no rest, no hope

in my self-made pain

I am a prisoner trapped within

I try to get free but

have no control as I am

pulled back by an invisible force

remission never lasts

always fall back

an endless cycle of

devastating hair pulling

twelve years

I have struggled

to overcome this addiction

much more than a bad habit

my compassionate compulsion

inviting misery and good pain

lies all lies I tell myself because

I cannot control this obsession

continuous treatment

therapy, doctors, MRIs

more medication than

I ever knew existed

nothing ever seems to help

no matter how hard I try

still I cannot break free

from this part of my life

haunted by alienation

like I’m some kind of freak

no one seems to understand

people say “just stop”

search for answers

strength, a way to

overcome this monster

that I hate

to the outsider

it seems so simple, but

it’s a complex disorder

called trichotillomania

~2006

Poem

Addiction

something living inside me

continually grows

What can I do-

control seems unobtainable

it eats away at my life

I watch myself destroy all hope

hate this ugly part of me

wish I had never known it

I feel so alone

even though millions suffer

because society continues to neglect

allowing silence to prevail

I just want to be free

from my self-made pain

losing more than I gain

each time I give in

haunted by the mirror

my own worst enemy

falling deeper

surrounded by darkness

freedom is the light

I can see, but cannot reach

feeling lost as I wonder

Will I ever break this addiction

~2004

How I cured my own chronic hair pulling, Trichotillomania, OCD

Probiotics are helpful in the treatment of trichotillomania. I take a probiotic each day and eat a cup of plain greek yogurt.

how_i_cured_my_hair_pulling

Hey everyone,

I am not selling anything here!  Not selling any books, not selling any products, nor services. Not selling anything at all. I started this free WordPress.com blog simply to tell others out there who may be suffering with chronic hair pulling, aka Trichotillomania, how I cured myself of this obsessive compulsive disorder, once and for all.    I am posting this account of what happened to me simply because I am so overwhelmed that this approach worked for me and I want to help other sufferers, to see if it works for them.

First off, I am not a doctor.  I am not a psychiatrist nor a psychologist.  I am not a nurse.  I am not a paramedic.  In fact, I am not a medical professional of any kind, and have had absolutely no medical training, ever.

Nothing written in this blog is intended as medical advice or any kind…

View original post 1,315 more words

Halfway

I am halfway to my first goal.  My goal to have one month with more good days than bad days in regards to my hair pulling.  This goal, which first sounded impossible, now seems doable, easy even.  Next month, I will have to raise the bar.

I have gone 15 days without pulling from my scalp and of those 15 day I have had only 3 ‘bad’ days of pulling my lashes and/or eyebrows.  Now when I look back at those ‘bad’ days I don’t see them as failures, just reminders of why I need to stay strong, aware, and focused on my recovery.  I know that I need to follow the rules I have given myself and use the strategies I know that help.

I cannot become complacent with good enough progress, this has been my downfall in the past.  It is these hiccups along the way, that keep me focused and determined.  Over time, I know they will be less and less, but I do see the purpose and I will not loose hope or become discouraged.  Rather I choose to look at these slips as days to refocus my energy and remind myself why I am working so hard.  I know I will break free, but it will be a process.

Good Day

I’m feeling good about my progress.  I haven’t been ‘perfect’, but I’ve done well and been realistic with my expectations.  My plan will see me through in the long run.  I’m not going to beat myself up over ever slip, just focus on the numbers.  I want to see them going down each month.  This is my first month charting, but I know if I were to rate the last few months everyday would have been between a 7 and a 10.  Since setting my goal and starting charting with the 0-10 system 11 days ago, I still have not pulled from my scalp.  Yay!!  I have had seven 0’s, two 1’s, and two 4’s.

I have to look at the numbers to feel good about my progress. If I look in the mirror, I can’t tell, my hair still looks about the same.  I’m not focusing on how it looks, I’m thinking about how I’m doing and how I’m thinking.  I have a positive attitude, which is a game changer.  Yes, I pulled 2 eyebrows out today, BUT then I stopped myself even though the urge was strong. I am choosing to focus on the fact that I stopped and not that it wasn’t a perfect day or a ‘pull free’ day.  I don’t want to get stuck up in being pull free.  Its more important to improve, do my best, and love myself even when I have a bad 10 day…we all fall down, but it’s how we get back up that defines us.

As a teacher, I am a little obsessed with rubrics…so to help myself with Claudia’s rating system I made myself a rubric.  It’s not an exact science and I think over time I will get a feel for where I fall.  For now, I needed some guidance on specific things to look at when rating my pulling.  I also made up 5 ground rules for myself.  If I pull as a result of breaking these ground rules, then I will get a worse score.  I will probably tweak this as I go along.

 

Score

#Pulled

Rules Broken

Time Spent Pulling

Areas pulled From

0

0

0

0

0

1

1-3

   

1

2

4-10

1

<5min

 

3

<20

   

2

4

20-30

2

<15min

 

5

30-40

     

6

40-60

3

<30min

3

7

60-80

     

8

80-100

4

~1 Hour

 

9

100+

     

10

Way too many to count

5

Hours

 

 

Rules:

#1 Where Bandaides or other barriers whenever possible, if not wearing them use fiddle toy /keep hands below neck and BE AWARE.

#2 Avoid mirrors. Don’ t stand close, do makeup quickly, avoid touch ups or unnecessary glances.

#3 Keep hands off of face. Don’t touch hair or eyes. Use only one finger or utensil if need to itch or touch eye/head and don’t linger. BE AWARE.

#4 Change activity when triggered before pulling begins.

#5 When stressed find way to take a break and relax (at least 1 minute deep breathing break).

 

Are you in love?

Well said, I am also “in love with the Lover of my soul”. I couldn’t imagine going through this life without knowing God’s love and grace. It is a personal, unconditional, and evey present love. God is love and when I feel this and see it’s power in my life I can’t help, but be overcome by the awesomeness of it all. Jesus loves me so much He would’ve done it all just for me. Francis Chan’s writes about this in his book Crazy Love.

Kidd Clan Chronicles

love

I’m in love. News to you? Shouldn’t be. See, I’m in love with God. And because I’m in love with God, everyone everywhere who knows me should be aware of that. It’s kind of mandatory that I shout from the rooftops my love for Him. One should never question whether a Christian is a Christian. The love we have for our Jesus should ooze from our pores. It should flow into every conversation we have. It should consume our every waking thought. That love we have for Him should overtake our lives in such a way that no one could ever question our allegiance.

Does all this sound a little crazy? Perhaps a bit radical? It is! The love I have for my Savior is crazy and radical. Wanna know why? Because His love for me is crazy and radical. His love for me is immense. His love for me…

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l-methionine

In Walsh’s Commentary on Nutritional Treatment of Mental Disorders he gives a thorough explanation of methylation and it correlation to mental health. He is also the first scientist I have heard who specifically discusses trichotillomania in relationship to undermethylation. For this reason, I am very interested in finding out more about his work. In the following excerpt from his work, I have highlighted the information I found post pertinent.  Walsh describes a treatment plan using 3-4 grams of inositol in combination with 2,000-3,000 mg of I-methionine.

Methylation

Effective “markers” for methylation are (1) whole blood histamine (ref. levels 40-70 mcg/dL), available from Quest and LabCorp; (2) Absolute Basophils (ref. levels 30-50), available from Direct Healthcare, Inc in the Chicago area.

Elevated histamine and/or elevated basophils indicate undermethylation. Review of symptoms and medical history can bolster the diagnosis. For example, most undermethylated persons exhibit seasonal allergies, perfectionism, strong wills, slenderness, OCD tendencies, high libido, etc. Overmethylated persons generally exhibit anxiety, absence of seasonal allergies, presence of food/chemical sensitivities, dry eyes, low perspiration, artistic/music interests/abilities, intolerance to Prozac and other SSRI’s, etc.

Conditions associated with undermethylation: Anorexia, Bulemia, shopping/gambling disorders, depression, schizo-affective disorder, delusions, oppositional-defiant disorder, OCD.

Conditions associated with overmethylation: Anxiety/Panic disorders, anxious depression, hyperactivity, learning disabilities, low motivation, “space cadet” syndrome, paranoid schizophrenia, hallucinations. (Oct 3, 2003)

One-carbon (methyl) groups are involved in numerous important biochemical reactions in the body, including genetic expression, neurotransmitter synthesis and metabolism, etc. Methylation (more properly, the methyl/folate ratio) is a major factor in the rate-limiting step (the tetrahydrobiopterin reaction) in the synthesis of serotonin, dopamine, and norepinephrine in the brain. Undermethylated persons tend to be depleted in these 3 neurotransmitters, and the opposite is true for overmethylation.

The SAM cycle in which dietary methionine is converted to SAMe (the primary CH3 donor in the body), and then to homocysteine, is a dominant cascade of reactions in methylation and also is very important in production of glutathione, cysteine, and other aspects of sulfur chemistry.

Most persons with depression, oppositional defiant disorder, OCD, bipolar disorder, or schizophrenia exhibit a genetic abnormality in methylation….. which appears to be central to their illness. Carl Pfeiffer, MD, PhD of Princeton, NJ was a pioneer in this field. (Oct 3, 2003)

About 25 years ago, Dr. Carl Pfeiffer (Princeton, NJ) identified the condition he called “histapenia” or histamine deficiency. After studying the metabolism of more than 20,000 schizophrenics he learned that this  “low histamine” syndrome was common in anxiety, panic disorders, and classical paranoid schizophrenia. His enormous biochemistry database revealed that most histapenics suffered from (1) copper overload and (2) deficiency of folic acid and/or B-12. More importantly, he found that aggressive therapy using folic acid, B-12, and B-3 usually produced dramatic improvements in these persons. Pfeiffer thought the improvements were largely due to elevating histamine levels in the body & brain.

Subsequent research has indicated that the improvements are due to normalizing the methyl/folate ratio. This ratio is important in the BH4 rate-controlling step in catecholamine synthesis (dopamine & norepinephrine). Also, methyl/folate abnormalities can impact genetic expression of many biochemicals. At any rate, too much methyl results in overproduction of DA and NE, and vice versa.

Also, a serious overload of homocysteine (homocysteinuria) can result in symptoms quite identical to paranoid schizophrenia. Folic Acid & B-12 serve to lower HCy levels.

One thing that is absolutely certain is that methionine and/or SAMe usually harm low-histamine (overmethylated persons)….. but are wonderful for high-histamine (undermethylated) persons. The reverse in true for histadelic (undermethylated) persons, who thrive on methionine, SAMe, Ca and Mg….. but get much worse if they take folates & B-12 which can increase methyl trapping.

I guess the bottom line is that undermethylated persons generally exhibit very elevated folate levels…. and these persons get worse if additional folate is given.

This is a fairly complex subject, and some of my medical staff are still struggling with the concept. However, they have the solace of knowing the clinical impact of methylation or folate therapy on persons with specific methylation/histamine disorders.

It’s certainly true that whole blood histamine is compromised by AH treatments (including antigens and many psychiatric medications). We’ve gotten quite proficient in taking these factors into account. Fortunately, the ABC test doesn’t suffer from this disadvantage. Also, the syndromes of over-methylation and under-methylation are well defined…. and a medical history & review of symptoms greatly aids the diagnosis. (Oct 6, 2003)

The generalization that perfume and other chemical sensitivities are associated with overmethylation, low blood histamine, and elevated norepinephaine… is exactly that…a general rule with many exceptions.  However, the correlation seems to be above 90 percent in the case of perfume sensitivity.  Whenever a patient enters our clinic wearing a mask to filter out inhalant chemicals, we immediately suspect the overmethylation syndrome.  The chemical testing usually confirms this diagnosis, but there definitely are a few persons who have severe perfume sensitivity for other reasons.  We’ve evaluated about 19,000 persons, including about 1500 with anxiety disorder or panic disorder.  Hundreds of these patients reported sensitivity to perfumes.  Nearly 90 percent of the perfume-sensitive group were overmethylated, and reported multiple chemical and food sensitivities. usually in the absence of seasonal inhalant allergies.  Perfume sensitivity is a classic symptom of these high nonepinephaine persons, who usually respond beautifully to folate/B-12 therapy [1 Dec -03]

Inositol is especially helpful for undermethylated persons (for example most persons with OCD), but can cause negative side effects in those who are overmethylated. Since Inositol is one of the primary second messengers in neurotransmission, it’s surprising is isn’t more commonly used. It’s especially useful in reducing anxiety and enhancing sleep.

To enhance sleep for a 160 lb person, we usually recommend 650 mg tablets, 1-3 as needed for sleep. Persons who have difficulty falling asleep should take it 30-60 minutes before sleep. Persons whose main problem is waking up in the middle of the night should take it at bedtime.

We’ve often given as much as 3-4 grams/day to undermethylated persons who respond beautifully to Inositol, and these persons take it morning, noon, and evening.

I once gave an invited presentation at a symposium at an APS annual meeting… in which data on megadoses (15-30 g) of Inositol were reported by another speaker. The volume of Inositol used seemed extreme to me, and would present daunting compliance problems. I believe such huge doses of Inositol are unnecessary, if methionine, calcium, B-6, and other nutrients to combat undermethylation are used. However, massive doses of Inositol might be needed if one tries to combat OCD with Inositol alone. 

Regardless of the form of inositol, its use should be started as a trial, with close monitoring of patient. We’ve found that persons who achieve improved sleep after inositol are excellent candidates for taking it throughout the day also. I recommend you be alert for adverse side effects, especially with persons with severe anxiety or panic symptoms

Trichotillomania has been associated with OCD and undermethylation. If you can confirm the presence of undermethylation, the patient should benefit from (1) aggressive doses of l-methionine, calcium, magnesium, along with augmenting nutrients zinc, B-6, Inositol, Vitamin A & C and (2) strict avoidance of folic acid, choline, DMAE, and copper supplements

Aggressive methylation therapy can be very successful, but usually involves a very slow response. Typically, treatment with methionine, calcium, magnesium, B-6, etc requires about 2 months before the patient before any progress is evident — and 6-12 months are required for all of the benefits to be attained. Please note that whole blood histamine is a marker for innate methylation tendency, but is not an indicator of wellness or the degree to which undermethylation has been overcome. Undermethylated patients can become quite well without their histamine lab results changing at all.

One way to speed up the process of recovery is to use SAMe supplements in the beginning. Undermethylated patients usually report nice progress after the first week or two. SAMe is quite expensive, and can be gradually replaced by methionine after a couple of months.

Nearly all severely undermethylated persons have low serotonin levels and present with a history of depression, internal anxiety, and OCD. Many have a history of perfectionism and high accomplishment in the early years.  Unfortunately this population also has a tendency for non-compliance with any treatment.

The late and great Carl Pfeiffer would occasionally resort to use of the anti-histamines Benedryl or Dilantin in high-histamine persons who were slow to respond. Avoidance of folate supplements is essential for most undermethylated persons, an exception being autism.

Some practitioners like to tinker with the SAM cycle to promote conversion of homocysteine to methionine, but this can deplete the cystathione pathway and result in deficiencies of glutathione, cysteine, etc. Some persons have a genetic enzyme weakness which can disrupt the SAM cycle

Undermethylated adults typically require 2,000 – 3,000 mg/day of methionine for several months to see good results. Also, augmenting nutrients such as calcium, magnesium, B-6, and zinc are essential.