It’s Never too Late for Recovery

I’ve Had Trichotillomania So Long – Is It Too Late for A Cure?

At the Trichotillomania Relief Specialists, we hear a lot of concern from folks about just how “curable” their case of trichotillomania may or may not be.But it’s not always because of how much they pull, or how often.  Often, we find that the longer one has struggled with trichotillomania, the greater their concern – or outright pessimism – about even thepossibility of a cure.51-year-old Aubrey feared she might never find freedom from trichotillomania.But is this pessimism justified?  Is it really true that the longer you’ve suffered with trichotillomania, the harder it must be – and the longer it must take – to resolve?

As you might imagine, we have our opinion.  Let’s talk.

Coaching The Coach

Glei and I started work with 51-year-old Aubrey back in November of 2013.  Believe it or not, it took Aubrey a full year and a half (!) from our first contact to finally decide to take a chance by registering for our flagship 90-Day Distance Personal Breakthrough Coaching Program™.

A corporate coach herself, Aubrey was a very busy woman.  And as a breast cancer survivor, she had already proven herself to be one tough cookie – a woman who could conquer almost anything, once she’d set her mind to it.

But one thing she’d never been able to conquer was trichotillomania.  You see, Aubrey had been pulling her eyelashes for a long, long time.

46 years, to be exact.

Aubrey desperately wanted to be free of trichotillomania.  She told us it was the one thing she felt had been a skeleton in her closet for years…  She said she felt like a “fake” on stage at corporate events, teaching the power of positive talk and positive thinking – all the while, knowing full well she had been unable to personally live out her teachings in her own life.

She felt powerless to take control of this behavior.

So what took Aubrey so long to finally make the decision to move forward with us?

You can probably guess.  Despite our confidence in how we communicated to her what we thought we could do for her, it was the very understandable fear that even this wouldn’t work.

Because if this didn’t work, whatever would she do then?

And It’s Not Just Aubrey

Unfortunately, we know that Aubrey isn’t the only one in this kind of position – an older adult who worries that because of all the years in struggle with it, their case of trichotillomania is a case that’s now just too far gone.

Based on fears just like this, many older folks won’t even give themselves a chance to get better – they assume in advance that recovery at this late stage either isn’t possible – or even if it is, it has to be fraught with hard work and struggle.  Some people decide they simply don’t have the energy for that anymore.

But Wait!

And then we come along with the bold claim that it’s possible for anyone– regardless of age – to experience nearly immediate relief from trichotillomania, no matter how long they’ve had it, or how hard they’ve struggled with it over the years.

Admittedly, this claim raises some eyebrows.  But that’s only because of the limiting beliefs many people hold about what’s actually possible in terms of a “cure” for trichotillomania.

You see, beliefs are nothing more than a state of certainty about something.  They do not at all necessarily represent objective truth.

Too Good to Be True – Or Is It?

So how exactly is it possible that one can have been pulling seemingly uncontrollably for 20, 30, 40 years or more – and then be able to dispense with it almost overnight?

Put simply, it’s because the “past” is over with now – no matter how long a past we’re talking about.  All that’s “real” is the present – this specific moment in time.

The desire, urge or impetus to pull is a present-moment experience.   Any such urge you may have here in the present is not any stronger, or any more irresistible now just because you’ve been pulling for 40 years than it would be if you’d been pulling for just, say, 2 years.

And if here in the present you can find any way at all to stop pulling (especially simply!) then does it really matter how long you’d been pulling before that?

Back to Aubrey’s Story

As you might guess, Aubrey’s story has a happy ending.  With nothing more than a minor hiccup along the way, Aubrey reported she was now able to effectively exercise control of her eyelash-pulling activity.  Perhaps more importantly, the seemingly overwhelming urges she used to have to work so hard to resist were now gone.

You see, here at the TRS, we don’t believe in “white knuckle” change.  We believe it’s possible not only to take quick, relatively simple control of one’s hair-pulling activity, but to be able to do so in virtually struggle-free fashion.

We believe it because we’ve seen it; we’ve witnessed literally hundreds of clients live out this dream in their own lives.

Late in followup, with tears in her eyes, Aubrey related to Glei and I the story of how she had finally been able to look her partner in the eyes, finally permitting him to see the real “her” – the Aubrey free of her old false eyelashes – free to present herself as the real, true, authentic Aubrey.

She said it was a moment she will never forget.

Moments like that are why Glei and I do this work. :-)

The Moral of The Story

It turns out that any concept you may have about having suffered with trichotillomania for an extended period of time – and especially to the extent you’ve been believing it means a big problem – in practice meansnothing – except to someone who believes it actually does means something (which by now, I think you know does not include us – and it’s a good thing it doesn’t!).

Here at the Trichotillomania Relief Specialists, when we get together with a client who’s been suffering with trichotillomania-related behaviors for 20, 30, 40 years or more, it means only one thing – that Glei and I are about to join you in having a whole lot of fun knocking this thing out far more quickly and easily than you probably imagine possible.

Question:  How long have you (or your loved one) been suffering with trichotillomania-related behaviors?  What kind of beliefs do you have about how easy – or difficult – a cure has to be, based on how long you’ve been struggling with it?  We encourage you to leave a comment or question below.

 

Source

I’ve Had Trichotillomania So Long – Is It Too Late for A Cure?

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BFRB (Body-Focused Repetitive Behavior)

BFRB for short, is an umbrella term for a group of repetitive self-grooming behaviours in which an individual damages* their appearance or causes physical injury through pulling, picking, biting or scraping of the hair, skin or nails. BFRBs are also considered impulse control disorders as part of the OCD Spectrum. Over time these conditions can cause very significant distress, which can affect work, social and daily activities.

BFRBs affect 2-5% of the Canadian population, or approximately 2 million adults and children.

 *These behaviours are NOT a form of self-harm.

Why are they not considered self-harm?

BFRBs are not considered self-harm because the intent of the behaviour is not to harm oneself, but rather to fix, correct or otherwise make better some aspect of physical appearance (for example, get rid of a blemish, or a hair that doesn’t seem to belong). BFRBs are also a coping mechanism for overwhelming emotions, but once again the intent is not to cause damage. When it comes to BFRBs, the physical damage done is just a by-product of the behaviour.


Common Types of BFRBs

 

Hair-Pulling Disorder (Trichotillomania/ Trich/ TTM) – The compulsive urge to pull out hair from various parts of the body resulting in noticeable hair loss. Areas where pulling usually occur include scalp, eyelashes, eyebrows, arms, legs, and pubic area.

Skin-Picking Disorder (Dermatillomania/Excoriation Disorder/ Derm) – The compulsive urge to pick at one’s skin resulting in noticeable damage (sores, scabs, infections). Common areas include: face, head, cuticles, back, arms and legs, hands and feet.

TrichophagiaCoinciding with Trichotillomania, Trichophagia is the compulsive urge to eat or ingest the hair that has been pulled. In extreme cases, this can lead to a hair ball called a trichobezoar, which can cause significant health problems. Removal of the hair ball is usually done through surgery.

Onychophagia – Compulsive nail/cuticle biting. The severity and extent of damage to the skin is variable, but can lead to infections, pain in the fingers and torn skin around the fingernails. Some signs include short nails, skin damage around nails, bleeding skin around nails, callouses.

Rhinotillexomania – Compulsive nose picking. Not to be confused with people picking thier nose from time to time for strictly hygienic purposes. Compulsive nose picking causes a greater risk of infection/damage to the lining of the nose.

Other BFRBs include:

  • Trichotemnomania (compulsive hair cutting/shaving)
  • Dermatophagia (compulsive skin biting ie. around nails, lips & inside of cheeks)
  • Scab Eating Disorder (comparable to the way someone with trichotillomania may digest the hair after pulling it out)

Who is affected and when does it typically develop?

Most BFRBs begin in early puberty/adolescence and many continue into adulthood. In childhood both males and females are affected equally, but in adulthood more females are seemingly affected. Anyone can be affected by a BFRB.

Why do I pull or pick?

Research indicates these behaviours are possibly related to genetics/ environmental causes, but there is no concrete answer yet as to why people begin these behaviours. The symptoms are not personality traits or something that a person can just “snap out of” or stop.

I think my child has a BFRB, what should I do?

First and foremost, be there to support your child and NEVER punish them for the behaviour. Although it may seem like a good deterrent, BFRBs are a group of disorders, not just bad behaviour that can be solved by punishment. Keep in mind that your child very likely doesn’t want to pick or pull, and is probably ashamed of the behaviour. They probably want to stop just as badly as you want them to.

Knowledge is power! Educate yourself about BFRBs and if you take your child to the doctor for the behaviour(s), bring some printed materials/ information along with you. It will take some effort, but find what’s best for your child as they deal with their BFRB(s).

Trichotillomania Research, Clinical Research into BFRBs

 

BFRBs are categorized under Obsessive Compulsive related Disorders in DSM-V. BFRB for short, is an umbrella term for a group of repetitive self-grooming behaviours in which an individual damages* their appearance or causes physical injury through pulling, picking, biting or scraping of the hair, skin or nails. BFRBs are also considered impulse control disorders as part of the OCD Spectrum. Over time these conditions can cause very significant distress, which can affect work, social and daily activities.

Many people find NAC helpful to reduce their BFRBs. Ideally a full nutritional program should be utilized.  This would begin with a food journal to analyze the effects of various foods and supplements.  Looking at the rate of urge and pulling days and weeks after particular foods will help you see patterns of increased pulling following consumption of certain ‘bad’ or ‘triggering’ foods.

The John Kender Diet is a helpful launching point for this analyses.  Although that diet plan sets a good foundations, each trichter is unique and his or her food triggers may vary.  In addition, various supplements may help some trichters, while not helping others.  Most commonly, NAC and inositol have shown a correlation with reduced urges and hair pulling.  Also there is a milder correlation between Luvox and some other prescription medications.  Personally, I have found Zoloft and Anafranil helpful with my pulling.  The Zoloft mildly decreases my urge to pull. Moreover, it reduces my overall anxiety, which is a major contributing factor to my pulling.

Laboratory mice are helping researchers from Stanford University School of Medicine who have developed the study of specific nutritional supplements to prevent skin picking and hair pulling. The mice have been supplemented with NAC and glutathione, leading to decreased BFRBs.

NAC is necessary for the natural formation of glutathione. Glutathione is one of the methods used by the brain to regulate cortisol. Cortisol is often described as a stress hormone, but its role in life is far more complex. Cortisol wakes people up in the morning and lowers to allow for sleep at night. Many people with trichotillomania experience a reversed effect, feeling extremely low in energy on waking and only beginning to wake up by the time most people go to bed. Another effect of cortisol is to lower histamine levels, thereby reducing inflammation both in the body and brain.

The role of enhanced emotion in trichotillomania is evident in certain brain areas, and the reward centre of the brain reveals a connection with dopamine. An MRI-based human study by Grachev investigated only twenty right-handed females aged 28-30, ten were trichsters while ten were not. Two areas of the neocortex were significantly reduced in volume, but there was no overall loss of volume, indicating that the tricster brains may have developed differently, possibly in a compensatory manner. Additional studies have also revealed increased grey matter in the amygdale hippocampus area of the brain, which plays a vast role in emotional processing (Aldridge et al, 1993).

Increased cortical thickness has also recently been revealed in people with trichotillomania and their close relatives, possibly causing response inhibition. (Odlaug et al, 2014)

References

Aldridge JW,. Berridge KC, Herman M, Zimmer L, Research report neuronal coding, Psychological Sciences, 4 (1993).

Christenson GA, Popkin MK, Mackenzie TB & Realmuto GM, Lithium treatment of chronic hairpulling, Journal of Clinical Psychiatry, 52 (1991).

Grachev ID, MRI-based morphometric topographic parcellation of human neocortex in trichotillomania, Psychiatry and Clinical Neuroscience, 51(1997).

Odlaug BL, Chamberlain SR, Derbyshire KL, Leppink EW, Grant JE, Impaired response inhibition and excess cortical thickness as candidate endophenotypes for trichotillomania, Journal of Psychiatric Research, 59 (2014).

If you are interested in carrying out a research project and would like any help or involvement from us; please contact us. We are always happy to help improve knowledge of trichotillomania in any way we can.

John Kender Diet: Good and Bad Foods

LIGHT FOODS help stop hair pulling DARK FOODS DAMAGE
Oranges Sugars :
plus the sweetener aspartame found in Diet Coke etc.
Apples Glucose
Fructose Egg Yolk
Red wine Caffeine
Lemons Chocolate
Cherries Popcorn and corn
Beef Tomato seeds
Garlic Nuts, especially peanuts
Onions Monosodium Glutamate
Kiwi Alfafa sprouts
limes Apartate/asparagine
Ripening bananas crustaceans (lobster, prawns, crab)
Decaffeinated tea Soy products of any kind
ginger root Legumes
papaya Butterfat
guava fatty fish, e.g. tuna, herring
Kefir with yoghurt sardines, salmon, mackerel
Pineapple Most shellfish : Mussels Shrimp, Prawns, Lobster & Crab
mustard Nitrites
cabbage Peas
unsweetened live yoghurt Beans of any sort
Brussel Sprouts hair roots!!!!!!!!!!!!!!!!!!

John Kender Diet: ‘Bad’Foods Trigger 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

TRICH, FOOD, AND SKIN CARE

(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.

At Your Feet

At Your Feet

I lay each day

Down at your feet

Each breathe I breathe

I give to you

I want what you want

And nothing more

Lead me

To follow in your ways

Take my suffering

And make me new

Use me for Your purpose

Your perfect plan

I am yours

I want to serve you

All the days of my life

I am yours

I trust in you Lord

To use all things for good

Take this suffering

and use me for Your glory

The Bipolar Coaster

i_m__fine__by_banditmaster721-d9ij7hv

My bipolar roller coaster in a nutshell …. I’m just holding on tight, enjoying the ride, and doing my best to level out. I am way better than a few years ago, but I still have ups and downs. My super talkative, productive hypomanic self is coming out right now. I know it freaks out a lot of people who know me and think I am not acting like myself. I am thankful I am in touch with reality and have realized what is happening. It is a welcome change from the overwhelmingly gloomy and exhausting postpartum depression I have been in for the last 10 months. To anyone with a mental illness, I empathize with your struggle. Although each of us suffers in our own way, we have similar feelings.

The Bipolar Disorder Definition of “I’m Fine”

Gabe Howard

Social etiquette is an important thing for society, and that includes such things as asking, “How are you?” when we greet others. As a person with disorder, I dont’t have any special exemption from answering that question in any way other than, “Fine”.

There are three main moods that most people with bipolar will experience at any given time: bipolar mania, baseline, and depression.  As we all know, “fine” can mean different things, based on our moods. Here are my truthful answers based on each of those moods.

Bipolar Mania: How Are You?  

When I am manic (not very happy, not excited, not hypomanic), there is only one truly honest answer to the question: “I am a god from the planet Awesome. I’m better than you. And I can shoot happiness from my eyes into your soul.”

Then, over the next five minutes, in dramatic and rapid fashion, I will tell you my amazing plans. I’ll tell you how to fix everything wrong with the world, and what incredible, exceptional, and amazing rock-star caliber thing I am getting ready to do. At some point, I will forget what I’m talking about and rush off to do said rock-star caliber thing and — who knows? — I may actually succeed.

I will make no sense, but trust me when I say you’ll love it – and me – right up until it goes horribly wrong. That generally happens around the next morning, long after everyone has gone home.

Bipolar Depression: How Are You?

The more depressed I am, the less likely you are to get any answer at all, both because I simply won’t have the energy and because I’ll be holed up alone somewhere away from your ability to ask. But, if we did come into contact and I did have the energy to answer, I would tell you I feel nothing.

Describing “nothing” is difficult and confusing. There is no analogy that is truly fitting. It can’t be described as the absence of something, much in the same way describing darkness as the lack of light doesn’t really help someone understand.

Specifically, I say: “I have no energy. I have no desires. If I were to die right here, right now, I wouldn’t care, mainly because I lack the motivation to care one way or the other. I feel nothing for myself. I feel empty, as does the world around me. I feel abandoned, alone, and broken. I have no belief in future happiness, nor any recollection of happy times in the past. And all this seems perfectly normal to me.”

Bipolar Baseline: How Are You?

Depression and mania are symptoms that anyone with bipolar disorder has experienced to some extent. However, living in recovery, which is the goal, means I spend most of my time in the middle. My moods still exist on a spectrum, but the spectrum is a lot narrower. My depression is manageable and I’m able to continue moving forward, even if at a slower pace.

I am still excitable, but mania is almost completely wiped out. I function, day to day, pretty much the same as everyone else, just with a chronic health condition to manage. This takes work, but life for most people takes effort. This is just my lot.

So when someone asks how I am, you might be surprised to know that the answer, nine times out of ten, is “traumatized.” My exact answer would be:

“I’m scared, worried, and I know that I’m going to get sick again and be left alone or be a burden to my loved ones. The emptiness I’ve felt, the suicidal feelings, the loss, the abandonment, and the failure are still living inside me. Since the illness is still with me – albeit controlled – the potential for it to come back and torture me again is very real. And that terrifies me.”

The reality is that my daily life is hard because I have to move forward with the trauma of my past weighing me down. I am scared of ending up back where I started. I’m scared of losing everything. I’m scared of hurting myself or others emotionally. I’m scared of making my granny cry again.

So that’s why I answer, “Fine.” It’s the easy answer. But never has a little word carried so much hidden meaning.

Please Note: Gabe is writing a book about a regular guy living with bipolar and needs your support. Pre-orders available and much more. Check it out by clicking here.

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