Category Archives: Expert Advice

Improving Dopamine Levels

What Is Dopamine?

Dopamine is the brain chemical that allows us to have feelings of bliss, pleasure, euphoria, drive, motivation, focus, and concentration. But let’s start at the beginning: Your brain actually communicates with itself. That is, you have an intricately linked system of nerve cells called neurons that “communicate” with each other via specialized receptor sites.

Dopamine is a chemical (neurotransmitter) that is used by the nerves to send “messages.” When a nerve releases dopamine, it crosses a very small gap called a synapse and then attaches to a dopamine receptor on the next nerve. Therefore, when dopamine levels are depleted in the brain, the nerve impulses, or “messages,” cannot be transmitted properly and can impair brain functions: behavior, mood, cognition, attention, learning, movement, and sleep.

How Do I Know Whether I Have Dopamine Deficiency?

When there is a dopamine deficiency, emotions cannot be correctly regulated. Mental impulses that mitigate intense feelings of sadness are inhibited; therefore, the most common low dopamine symptoms are the same signs associated with clinical depression (and more specifically, major depressive disorder):

14 Dopamine Deficiency Symptoms

1 Lack of interest in life

2 Decreased motivation

3 Procrastination

4 Inability to feel pleasure

5 Altered sleep patterns

6 Restless leg syndrome

7 Fatigue

8 Mood swings

9 Excessive feelings of hopelessness or guilt

10 Poor memory

11 Inability to focus/impaired concentration

12 Impulsive or self-destructive behaviors

13 Addictions to caffeine or other stimulants

14 Weight gain

Extreme dopamine deficiency, as in the case of Parkinson’s disease, causes a permanent and degenerative diminishing of motor skills, including muscle rigidity and tremors.

7 Ways to Treat Dopamine Deficiency

With that background in mind, consider the following dopamine-boosting tactics you can take to increase dopamine.

1. Decrease your sugar intake. Sugar alters brain chemistry by disrupting dopamine levels, which is one reason why people often experience a “sugar high” shortly after eating sweets. Just as alcohol and drugs can deplete dopamine levels, sugar does the same. In fact, sugar stimulates the exact same euphoric pathway targeted by alcohol and drug use–that is, the decreased dopamine levels lead to actual sugar addictions.

Whether initiated by alcohol, cocaine, or sugar, the compulsive behavior addiction is the same—an undeniable desire for dopamine. Limiting sugar intake will help fight this addictive dopamine depletion-sugar craving cycle. If you struggle with a sweet tooth, you can take chromium picolinate supplements to help decrease your sugar cravings.[1,2]

2. Take tyrosine. When your brain cells need to “manufacture” neurotransmitters for proper mood regulation, they use amino acids as the essential raw material. Amino acids are the building blocks of protein; there are 20 different amino acids that make up the protein our body needs.

The brain uses the amino acid l-phenylalanine as the source (precursor) for the production of dopamine. Phenylalanine is one of the “essential” amino acids; that is, the body cannot make it on its own so we have to get it from the foods we eat or from supplements. Once the body receives phenylalanine, it can convert it to tyrosine, which in turn is used to synthesize dopamine. So the way to increase central nervous system neurotransmitter levels is to provide proper amounts of the amino acid precursor.

Bananas, especially ripe bananas, are an exceptional food for regulating dopamine because they have a high concentration of tyrosine. Other foods that increase dopamine through the conversion of phenylalanine to tyrosine include almonds, apples, watermelons, cherries, yogurt, beans, eggs and meats.

It is important to note that dopamine foods alone generally do not have the therapeutic amino acid levels necessary to boost dopamine levels for someone experiencing major depressive disorder. To boost your levels of dopamine, dopamine rich foods may not be adequate. Tyrosine supplementation may help.

3. Decrease caffeine intake. Even though coffee gives you the energy boost you need, just like sugar, it only offers temporary relief and may actually be doing more harm than good. After experiencing the initial kick caffeine offers, dopamine levels in the body decrease. So, go for a cup of decaf or at least minimize consumption of coffee to counter dopamine deficiency.[5]

4. Set a routine schedule. One easy way to boost dopamine is to get in a healthy routine and stick to it. Your routine should include adequate time for work and rest. Ideally, your 24-hour day should include seven to eight hours of sleep per night in combination with periods of physical activity.

Under-sleeping and/or over-sleeping combined with lack of regular exercise can drain the brain of dopamine. Why? Proper sleep gives the brain time to recuperate from the day and recharge its stores of neurotransmitters.

5. Get consistent exercise. Regular physical activity increases blood circulation to influence the presence of many different hormones within the brain, affecting dopamine levels.

6. Decrease stress levels. High stress levels are also strongly correlated with dopamine deficiency. Stress can be caused by two sources: poor adrenal function and chronic daily life stressors. While we can’t always control our circumstances, there are “stress safeguards” you can utilize to help you deal with the day-in and day-out anxieties.

Remember, if stress is not handled properly, it can be devastating to your health. So, establish an ongoing plan that enables you to deal with stress effectively.

7. Correct a magnesium deficiency. Magnesium deficiency can cause decreased levels of dopamine, and natural health experts estimate over half of the US population to be deficient in this relaxation mineral. If you’ve been eating a diet heavy in junk foods or processed foods, you probably have a magnesium deficiency! Common symptoms include food cravings (salt or carbs), constipation, high blood pressure, rapid heartbeat or palpitations, muscle pains and spasms, fatigue, headaches, and depression symptoms such as mood swings, anxiety and irritability.

There are blood and urine tests that your doctor can perform to see if you have a magnesium deficiency. However, these tests may not always be accurate since most of the body’s magnesium stays in the cells, rather than in the bloodstream or the urine.

There is one lab test called a sublingual epithelial test that is more effective because it checks for magnesium in the cells, where most of it is present. To perform this test, your doctor will scrape under your tongue with a tongue depressor to obtain epithelial cells, which are then sent to a lab for analysis. Schedule this test with your doctor or start increasing your intake of magnesium.[6]

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Borderline Personality Disorder

Borderline personality disorder affects approximately two percent of adults. It can manifest as mood instability, difficulty with interpersonal relationships, and high rates of self-injury and suicidal behavior.

Definition

Borderline personality disorder (BPD) is a serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior. This instability often disrupts family and work life, long-term planning, and an individual’s sense of identity.

People with BPD, originally thought to be at the “border” of psychosis and neurosis, suffer from difficulties with emotion regulation. While less well known than schizophrenia or bipolar disorder, BPD affects two percent of adults. People with BPD exhibit high rates of self-injurious behavior, such as cutting and, in severe cases, significant rates of suicide attempts and completed suicide. Impairment from BPD and suicide risk are greatest in the young-adult years and tend to decrease with age. BPD is more common in females than in males, with 75 percent of cases diagnosed among women.

People with borderline personality disorder often need extensive mental health services and account for 20 percent of psychiatric hospitalizations. Yet, with help, many improve over time and are eventually able to lead productive lives.

Symptoms

A person with borderline personality disorder may experience intense bouts of anger, depression, or anxiety that may last only hours or, at most, a few days. These may be associated with episodes of impulsive aggression, self-injury, and drug or alcohol abuse. Distortions in thoughts and sense of self can lead to frequent changes in long-term goals, career plans, jobs, friendships, identity, and values.

Sometimes people with BPD view themselves as fundamentally bad or unworthy. They may feel bored, empty, or unfairly misunderstood or mistreated, and they have little idea who they are. Such symptoms are most acute when people with BPD feel isolated or lacking in social support, and they may result in frantic efforts to avoid being alone.

People with BPD often have highly unstable patterns of social relationships. While they can develop intense but stormy attachments, their attitudes toward family, friends, and loved ones may suddenly shift from idealization (great admiration and love) to devaluation (intense anger and dislike). Thus, they may form an immediate attachment and idealize another person, but when a slight separation or conflict occurs, switch unexpectedly to the other extreme and angrily accuse the other person of not caring for them at all.

Most people can tolerate the ambivalence of experiencing two contradictory states at one time. People with BPD, however, must shift back and forth between good and bad states. If they are in a bad state, for example, they have no awareness of the good state.

Individuals with BPD are highly sensitive to rejection, reacting with anger and distress to mild separations. Even a vacation, a business trip, or a sudden change in plans can spur negative thoughts. These fears of abandonment seem to be related to difficulties feeling emotionally connected to important persons when they are physically absent, leaving the individual with BPD feeling lost and perhaps worthless. Suicide threats and attempts may occur along with anger at perceived abandonment and disappointments.

People with BPD exhibit other impulsive behaviors, such as excessive spending, binge eating, and risky sex. BPD often occurs with other psychiatric problems, particularly bipolar disorder, depression, anxiety disorders, substance abuse, and other personality disorders.

Causes

Although the cause of borderline personality disorder is unknown, both environmental and genetic factors are thought to play a role in predisposing people to BPD symptoms and traits. BPD is approximately five times more common among people with close biological relatives with BPD.

Studies show that many individuals with BPD report a history of abuse, neglect, or separation as young children. Forty to 71 percent of BPD patients report having been sexually abused, usually by a noncaregiver.

Researchers believe that BPD results from a combination of individual vulnerability to environmental stress, neglect, or abuse as young children and a series of events that trigger the onset of the disorder as young adults. Adults with BPD are also considerably more likely to be the victims of violence, including rape and other crimes. These incidents may result from harmful environments as well as the victims’ impulsivity and poor judgment in choosing partners and lifestyles.

Neuroscience is revealing brain mechanisms underlying the impulsivity, mood instability, aggression, anger, and negative emotion seen in BPD. Studies suggest that people predisposed to impulsive aggression have impaired regulation of the neural circuits that modulate emotion. The brain’s amygdala, a small almond-shaped structure, is an important component of the circuit that regulates negative emotion. In response to signals from other brain centers indicating a perceived threat, it marshals fear and arousal, which may be more pronounced under the influence of stress or drugs like alcohol. Areas in the front of the brain (prefrontal area) act to dampen the activity of this circuit. Recent brain-imaging studies show that individual differences in the ability to activate regions of the prefrontal cerebral cortex thought to be involved in inhibitory activity predict the ability to suppress negative emotion.

Serotonin, norepinephrine, and acetylcholine are among the chemical messengers in these circuits that play a role in the regulation of emotions, including sadness, anger, anxiety, and irritability. Drugs that enhance brain serotonin function may improve emotional symptoms in BPD. Likewise, mood-stabilizing drugs that are known to enhance the activity of GABA, the brain’s major inhibitory neurotransmitter, may help people who experience BPD-like mood swings. Such brain-based vulnerabilities can be managed with help from behavioral interventions and medications, much as people manage susceptibility to diabetes or high blood pressure.

Treatments

The recommended treatment for borderline personality disorder includes psychotherapy, medications, and group, peer, and family support. Group and individual psychotherapy have been shown to be effective forms of treatment for many patients. Psychotherapy is the first line treatment for BPD, and several forms of therapy, such as dialectical behavioral therapy (DBT), mentalization based therapy (MBT), cognitive behavioral therapy (CBT), and psychodynamic psychotherapy, have been studied and proven to be effective ways to alleviate symptoms.

Pharmacological treatments are often prescribed based on specific target symptoms shown by the individual patient. Antidepressant drugs and mood stabilizers may be helpful for depressed and/or labile mood. Antipsychotic drugs may also be used when there are distortions in thinking.

References

• National Institute of Mental Health

• American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Revised.

• American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

• US Department of Health and Human Services

• National Alliance on Mental Illness

Last reviewed 03/06/2018

19 Signs You Grew Up With Borderline Personality Disorder

Sarah Schuster

Borderline personality disorder (BPD) is a highly stigmatized and misunderstood mental illness that affects about 14 million Americans, or 5.9 percent of adults in the U.S. But because the symptoms usually first occur while a person is a teenager or in their early 20s, it’s too easy to dismiss those early signs as “bad behavior” or “teenage angst,” when in actuality the person is really struggling.

To find out some ways people knew (in hindsight) they had borderline personality disorder, we asked people who live with it in our community to share what it was like to grow up with undiagnosed, or maybe not-yet-developed, borderline personality disorder.

Here’s what they had to say:

1. “Ever since I can remember, even as far back as first grade, I have always been extremely sensitive to everything. I remember I would always feel different and really alone… Looking back, it really set in around age 14. That’s when the anger started coming out, the abuse of drugs and alcohol, the impulsivity, very rocky relationships — basically all the symptoms of BPD. I’m 20 years old now and I have gotten some aspects under control, but it’s still a battle I fight every day.” — Julia F.

2. “The impulsiveness, reckless behavior and trouble maintaining healthy relationships. The black-and-white thinking, self-harming behaviors… pushing and pulling people in and out of my life.” — Melissa R.

3. “I always thought I just felt everything a lot more than other people. I would get super excited about things other kids didn’t seem to care about. I can remember jumping up and down because my team scored a point and looking around wondering why no one else was as excited as me. I was told over and over to calm down, be quiet and even when I expressed outrage over an injustice, I was told there is nothing I can do.” — Melanie M.

4. “A friend of mine, who I thought was my BFF, wanted to sit next to another girl in class next. When she told me that, I threw myself on the ground and cried my heart out as I thought she hated me. In that moment I hated her with my very soul. I was crying for days because of that.” — Lenka W.

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Take a look at these helpful websites and organizations

5. “It was like no matter how good things were, I could always find a negative in everything… [it was like the] wall that was up was always getter higher could never reach it.” — Stephen J.

6. “Extreme sensitivity. I would idealize people, then push them away. I had the biggest fear of abandonment. Anger would consume me, and I felt I could not get rid of it unless I self-harmed. Then, I would feel horribly guilty and ashamed about it. I remember scratching at my face and hair as early as 4, I think.” — Amy W.

7. “Going from being best friends with someone to hating their guts, and then going back to being best friends after a while… My self-harm as a teenager… having only two to three close friends growing up. I found it very hard to make and keep friends. I was very emotionally sensitive and would get hurt easily. All these things I can see now as signs of my BPD.” — Michelle M.

8. “I was only diagnosed a year ago, but looking back it all makes sense. As far back as I can remember, I was extremely sensitive, had highly fluctuating moods including intense anger and I would self-harm. I would freak out over any sudden changes in plans, and I was terrified of abandonment. It wasn’t until years later I realized it was something much more than just depression and anxiety.” — Kelsey M.

9. “Making impulsive, life-changing decisions without thinking through the consequences, moving from city to city and job to job thinking my problems would go away if I moved to another city. I now have a very unstable work history and am finding it very difficult to find employment.” — Pam M.

10. “Dissociation. Feeling like you’re out of your body — like it’s not even yours, is the most terrifying feelings ever, and was the main symptom/sign that I had something different from depression. Nobody ever really talks about dissociation, and I have no idea why, it horrified me more than anxiety attacks ever did. It’s like this huge seemingly endless brain fog. You can’t think, you can’t talk, you just can’t function. You feel completely numb from the inside and out. To me it gets so bad it feels like I don’t ‘exist,’ and it’s terrifying. Especially when you think you’re the only one who felt this way (which was the case for me for months).” — Alexis W.

11. “I felt like I’d always be alone, like I was not worthy of having friends. I’m in a better place now and have been in treatment for five months.” — Isobel T.

12. “Being extremely sensitive, wanting to be everybody’s best friend, being insanely hard on myself, thinking everyone was talking about me behind my back, loving people way too much, being co-dependent, thinking in absolutes, being very black and white, constant fear of abandonment.” — Marissa L.

13. “My whole life I have been extremely sensitive. If an adult so much as raised their voice a little, I would burst into tears. I also once I hit puberty could never seem to have a steady relationship with peers. My friendships were always very up and down and one-sided especially as I became a teenager. I never had a self-esteem and I started cutting when I was 13. I was misdiagnosed with depression and anxiety first. I always wondered why I was so different, why weren’t other kids like me? Now it makes perfect sense.” — Jessie B.

14. “Black/white thinking. Am I a good/bad person? I love/hate you. Don’t ever leave me/I want be on my own. With everyone of these issues it is extreme and intense, there is no middle ground, no balance or stability.” — Roma S.

15. “It was a constant up and down. I didn’t have steady friendships. I felt insecure and had a low self-esteem. Oftentimes social interactions induced intense emotions that completely overwhelmed me and made me feel isolated and invisible. I felt anchor-less and didn’t know where I belonged or if I would ever find someone who would love and understand me. I was so afraid of my friends leaving me that I tried everything to make them love me. I started self-harming at 14, desperately trying to keep me grounded and gaining recognition.” — Mona B.

16. “As far back as I can remember as a little kid I’d deliberately push people away to test their limits and kind of prove to myself that I wasn’t a lovable person. As a teenager it mainly showed in my complete inability to handle breakups and extreme impulsivity, self-harm, constant suicidal thoughts, etc. This was all shrugged off by everyone around me as ‘being a teenager’ and ‘attention seeking.’ As a result I struggled for years without treatment. I’m still in shock that I survived that to be honest.” — Lucy R.

17. “I have had a serious problem with overspending money and self-harm. I would get so emotional at things that were not even real (fictional things or playful things) and the constant changes of my moods were hard for me to handle. Now I have been diagnosed with BPD and as I look back I see that I’ve had this for quite some time. It feels good to have a name for it now.” — Mackenzi D.

18. “I felt alone, unwanted and so different.” — Seth B.

19. “Definitely getting overemotional at almost everything. Sensitivity to violence, I couldn’t even handle violent TV shows like CSI. Even reading books would put immediately in a mood related to the book — it would make me happy or sad depending on how it ended. I was and still am more sensitive in my interactions with people. I would get easily upset even if they didn’t mean to upset me. I thought for years that something was wrong with who I am. That everything about me was wrong and it was all my fault. Even at age 9 I was self-harming. I hated myself and had no self-confidence. I was dual diagnosed with borderline and bipolar at age 19, and everything finally made sense. All the things I thought were wrong with myself actually had a name. Not that that made it any easier to accept. I’m now 24, and I’m finally starting to accept this is just how I was made. And it’s not my fault.” — Meghan W.

*Some answers have been edited for length or clarity.

If you or someone you know needs help, visit our suicide prevention resources page.

If you need support right now, call the National Suicide Prevention Lifeline at 1-800-273-8255 or text “START” to 741-741.

Are You Vitamin L (Love) Deficient? 10 Steps to Solve It

Are You Vitamin L (Love) Deficient? 10 Steps to Solve It

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Sadly, illnesses caused by low or absent levels of essential nutrients, minerals and vitamin are pervasive in the world in which we live. Such deficiencies more negatively impact children than adults, as a child’s future physiological and neurological health requires a steady stream of what their body and brains need most. Anemia, tooth decay and Rickets are just a few of the medical problems connected to childhood mineral and vitamin deficiency. To illustrate this dilemma, anemia, which is caused by an iron deficiency, impacts two billion people worldwide, while 70% of American children aren’t getting enough vitamin D (CNN 2015).

Vitamin L — Vitamin Love
An “emotional vitamin” is a metaphor for interpersonal and emotional “sustenance” that is given to children by their parents in order to promote healthy psychological and social development. The most important of all the metaphorical emotional vitamins is “vitamin L” or “vitamin love.” Just like actual vitamins, say C or D, vitamin love is critically important to a child’s developmental needs. Or, in other words, if parents or caretakers do not provide sufficient, consistent and predictable levels of emotional nurturing, mental health problems in adulthood will surely occur. There is no way around this stark but important fact.

On a global basis, vitamin L deficiency is as real and pervasive as other serious real vitamin deficiencies. As with complications from iron or a vitamin D deficiency, vitamin L deficiency manifests itself in adulthood when it is too late to correct the problem. Rickets, for example, if untreated in childhood, will result in permanent bone or skeletal malformation. Similarly, when vitamin L is lacking or absent in childhood, harmful psychological, social and even physiological consequences are likely to occur, some of which may be difficult to treat in adulthood. According to my book, “The Human Magnet Syndrome“ (2013), when unconditional love/nurturing is absent in infancy and early childhood, adult mental health and interpersonal disorders will probably occur, i.e., codependency and pathological narcissism (Rosenberg, 2013).

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A glaring example of a vitamin L deficiency was observed in Romanian children who were raised in stark and emotionally depriving orphanages. According to numerous studies (Tottenham, 2013), many Romanian orphans suffered adult brain dysfunction and mental health disorders due to a lack of nurturing, attention and stimulation in the infant and toddler years. The dire consequences of such deprivation included neurological or brain dysfunction, a dramatic reduction in brain size and language, intellectual and cognitive impairment. In addition, higher incidents of conduct disorder and Antisocial Personality Disorder were also demonstrated.

Erik Erikson Knew about Vitamin L Deficiency
Erik Erikson, a world renowned developmental psychologist and personality theorist, created a psychological and social (psychosocial) developmental theory that was based upon eight distinct developmental stages, each with two possible outcomes — success or failure. He theorized that if a child was to mature into a psychologically healthy adult, they would have to been cared for and emotionally nurtured in a manner that facilitated an active and passive completion of each stage.

Healthy parent-child attachment is absolutely essential for successful completion of the first five of Erikson’s stages. Without it, the child will remain frozen in a specific stage, which will deprive them of the skill development necessary to proceed with the following psychosocial stages. Erikson and the legions of followers of his theory maintain that children who are frozen within a stage are psychosocially underdeveloped in adulthood. In other words, these children will likely develop mental health and interpersonal problems in adulthood. Vitamin L is, therefore, the key developmental constituent that facilitates healthy childhood psychosocial development.

A little like the unfolding of a rose bud, each petal opens up at a certain time, in a certain order, which nature, through its genetics, has determined. If we interfere in the natural order of development by pulling a petal forward prematurely or out of order, we ruin the development of the entire flower. (G. Boeree, 2006)

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Vitamin L Deficiency and Attachment Trauma
Vitamin L Deficiency Disorder is a metaphorical disorder caused by a lack of emotional, physical and environmental nurturing during critical developmental stages of childhood, especially during the first four years of life. Because of the fragile nature of an infant’s/child’s rapidly developing brain, any developmental disruption or harm to it will result in a lifelong template for pathological thoughts, feelings, behavior and/or a variety of mental health disorders.

There is no doubt that Vitamin L and parent-child attachment are intricately connected — both are necessary for adult mental and relational health.

“Attachment, the emotional bond formed between an infant and its primary caretaker, profoundly influences both the structure and function of the developing infant’s brain. Failed attachment, whether caused by abuse, neglect or emotional unavailability on the part of the caretaker, can negatively impact brain structure and function, causing developmental or relational trauma. Early-life trauma affects future self-esteem, social awareness, ability to learn and physical health (Trauma, Attachment, and Stress Disorders, 2015).”

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Sustained neglect, deprivation or abuse of a child by a pathologically narcissistic caregiver detrimentally affects the parent-child attachment process. In other words, Vitamin L Deficiency Disorder or attachment trauma is caused by the lack of or impaired attachment between a child and his parents. Such trauma is often perpetrated unconsciously and reflexively by a pathologically narcissistic parent (Rosenberg, 2013). These parents are often oblivious to the harm they caused because of a lack of insight and empathy for others, especially for their children. Moreover, they often parent their child in the same manner in which they were raised by their own narcissistic parent. Just as Erik Erikson theorized, such trauma (developmental breakdown) sets the child up for adult mental health and relational problems.

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Attachment trauma and vitamin L deficiency is difficult to identify in adulthood as it is the basis for adult personal and relational problems, not the actual problem. Because some forms of maltreatment or neglect do not always result in vitamin love deficiency or attachment trauma, it is necessary to consider the amorphous nature of the problem. Although neglect, deprivation and/or abuse sets the stage for attachment trauma, such maltreatment doesn’t always cause it. A child’s unique personality type, psychological strengths or weakness, level of resiliency and other biological and personality attributes will either deepen or mitigate (buffer) the effects of attachment trauma.

Only with an understanding of Vitamin L Deficiency Disorder can one proceed with the appropriate treatment of it. It is this author’s opinion that vitamin love deficiency can be successfully treated with trauma-based psychotherapy treatment strategies.

The following are 10 recommendations to solve or heal Vitamin L Deficiency:

Ten Steps to Reverse Vitamin L Deficiency
1. Seek psychotherapy that can address and resolve attachment trauma.
2. Seek help with your codependency or narcissism, which is a secondary effect of of the deeper attachment trauma wounds.
3. Create clear boundaries and expectations with those who seek to deprive you of vitamin L.
4. When possible, eliminate or pull back from relationships that do not have vitamin L reciprocity.
5. Create support systems when disengaging or setting boundaries with those who won’t give you vitamin L
6. Get daily doses of Vitamin L by surrounding yourself with loved ones who take part in empowering, affirming and personally connective relationships.
7. Seek healthy relationships where there is a fair distribution of love, respect and caring
8. Seek support and guidance though 12-Step groups, namely Codependency Anonymous (CODA) or Adult Children of Alcoholics (ACA).
9. Prepare for pathological levels of loneliness, a major withdrawal symptom of codependency (Rosenberg, 2015).
10. Stop the generational pattern of Vitamin L Deficiency Disorder. Love, respect and care for your child in a way that your parents did not do for you.

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What is Trichotillomania?

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

http://www.bfrb.org/learn-about-bfrbs/trichotillomania

 

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

ACT Therapy: Acceptance

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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 trichotillomania.

ACT is an acceptance-based, behaviorally oriented therapy.  It was first proposed by Hayes et. al. (1999), but I believe Dr. Woods is the first to study treating ttm with ACT.

ACT Therapy � TLC Retreat Notes
Credit Sue Price notes – TLC Conference Session

TLC Retreat Session September 2002
Acceptance and Commitment Therapy
Douglas Woods, Ph.D.

Why work on acceptance? Dr.Woods 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

A Beginner’s Guide to Treating Trichotillomania

Clinical Psychologist

I often tell my colleagues that trichotillomania (hair pulling disorder) represents the wild west of psychological disorders. Unfortunately, it remains one of the least researched and most misunderstood disorders in the DSM. Additionally, there is a lot of pseudoscience, snake oil, and plain old quackery on the internet about the best way to treat it.

In this article, I will highlight what we do know about scientifically supported treatments for trichotillomania. As a disclaimer, this is only an introduction to treating trichotillomania and is not intended to formally train clinicians. Lastly, I will not be reviewing medical treatments for trichotillomania (you can learn more about those here).

Historical Treatments

hands.jpg

Photo by Gregory Parker

The first scientifically based treatment for trichotillomania was Habit Reversal Training (HRT) (Azrin, Nunn, & Frantz, 1980; Duke, Keeley, Geffken, & Storch, 2010). During HRT, individuals become more aware of their hair pulling behavior and practice interrupting the behavior by engaging in incompatible behaviors. For example, people who use their hands to pull from their scalp might practice reaching down towards one’s knees. While HRT has been effective in the treatment of tics and Tourette’s Disorder, it doesn’t work for everyone who has trichotillomania and also has a high rate of relapse. Why? As I described in a previous article, trichotillomania is a very heterogeneous disorder and affects each person differently. A “one size fits all” treatment just won’t work for trichotillomania.

Modern Treatments

Recently, researchers have developed more comprehensive approaches to treating trichotillomania. Dr. Charles Mansueto pioneered the Comprehensive Behavioral Model (ComB) for trichotillomania (Mansueto, Stemberger, Thomas, & Golomb, 1997). In ComB, clinicians first understand the function of hair pulling. Does it relieve stress? Does it end boredom? Does it reduce anger and frustration? Next, clinicians identify the main types of hair pulling. Some individuals pull for sensory stimulation (trying to find the hair that feels just right), others due to specific thoughts (I have to get rid of all the grey hairs), etc. Lastly, clinicians create treatments that address all aspects of trichotillomania including emotional regulation (learning more adaptive ways of dealing with stress, anger, boredom), physical habits (using HRT and objects to stop motor behavior), and environmental interventions (covering mirrors, getting rid of tweezers).

While research is underway to evaluate Mansueto’s ComB model, other researchers have found support for this approach to treating trichotillomania. In a recent pilot study, Dr. Nancy Keuthen and her colleagues found that Dialectical Behavior Therapy (DBT) was effective at reducing trichotillomania symptoms for at least 3 months (Keuthen et al., 2010). DBT is a form of cognitive behavior therapy that focuses on learning new ways of regulating one’s emotions. Additionally, in a review of all published scientific treatment studies on trichotillomania, Dr. Michael Walther and his colleagues concluded that behavior therapy (HRT), emotional regulation, and acceptance together represent the most promising treatment for trichotillomania (Walther, Ricketts, Conelea, & Woods, 2010). Furthermore, Dr. Martin Franklin and his colleagues have demonstrated that this comprehensive approach to behavior therapy not only works for adults, but it can help children as young as 7 (Franklin, Edson, & Freeman, 2010).

So what does this all mean? To the best of our scientific knowledge, effective trichotillomania treatment includes three things:

  1. An increased awareness of when, where, and why hair pulling occurs.
  2. An effort to control or change hair pulling behavior.
  3. Emotional regulation training to find alternative ways of dealing with negative feelings.

Here’s how I use these scientific findings to treat trichotillomania.

Increasing Awareness

Photo by Wim Mulder

Before creating a treatment plan, I collaborate with my clients to understand the unique patterns of their hair pulling. This usually includes a 1-2 week record of all hair pulling episodes. I ask each client to record the following information after each hair pulling episode:

  • What part of the body was the hair pulled from?
  • Where was the person when they pulled their hair?
  • What time was it when the person pulled their hair?
  • Was an instrument (e.g. tweezers) used to help pull hair?
  • What was the person doing while they pulled their hair?
  • What was the person feeling before, during, and after the hair pulling?
  • What was the person thinking before, during, and after the hair pulling?
  • Was anyone else present during the hair pulling?
  • What did the person do with their hair after they pulled it? (Sidenote: You’ll want to look out for individuals who swallow their hair, this could lead to a potentially lethal condition known as a trichobezoar and will need immediate medical attention).

Changing Hair Pulling Behavior & Emotional Regulation

Photo by Aimee Quiggle

A key component of Dr. Manysueto’s ComB model is the SCAMP Intervention. SCAMP stands for Sensory, Cognitive, Affective, Motor, and Place. Once my client and I have a firm understanding of the hair pulling behavior, I use the SCAMP Intervention to create a customized treatment plan.

Sensory: For individuals who seek sensory activation on their scalp, we might use brushes, combs, pens, massages, or ice to ease sensations. For hands, individuals can get manicures, use lotions, or file their nails. For the face, bath oils, baths, facial scrubs, or a loofah could be used.

Cognitive: Often specific thoughts can lead to hair pulling. Common thoughts include, “My hair has to look perfect”, “I need to get rid of that blemish”, “I’ll just pull a little”, “I’ve already pulled once, so why try holding back?” Here, individuals practice thinking in more realistic way (e.g. “It’s okay to be imperfect”, “The best way to fix it is to let it heal”, and “A slip-up is not a failure, any progress is helpful”).

Affective: When specific emotions lead one to pull their hair, the best way to address this problem is learn more effective ways of regulating your nervous system. To become more relaxed, individuals can use diaphragmatic (belly) breathing, progressive muscle relaxation, practice meditation, listen to white noise, use a heating pad, drink a warm beverage, take a slow relaxing walk, use an eye/face gel mask, or take a long bath. To address intensity and pain, individuals can stick their fingers in frozen ice cream, put their face in a bowl of ice water, suck on a lemon, snap a rubber band on your wrist, take a cold shower, go for a fast run, or chew a large wad of gum. To deal with boredom, individuals can learn about a topic of interest on the internet, write in a journal, draw, play a musical instrument, read a book, paint, take photographs, do a crossword puzzle, and garden.

Motor: In addition to HRT, physical barriers can often help reduce hair pulling. For example, rubber fingers, band-aids, sleep masks, head wraps, glasses, hats, gloves, thumb braces, and tape can all be used to create barriers to hair pulling. Also, changing the condition of your hair and hands can help (e.g. wetting hair, placing Vaseline on your eyelids/brows, wearing false nails, using hand lotion). Objects such as loud bracelets, elbow braces, and perfume can increase awareness of hair pulling. Fiddling toys can sometimes provide alternatives to hair pulling (e.g. koosh balls, silly putty, clay, knitting). For oral rituals, chewing gum, eating sunflower seeds, chewing raw pasta, chewing a toothpick, and eating gummy bears can help.

Place: Comprehensive interventions should also target the environment in which hair pulling takes place. Individuals can try changing light levels, covering mirrors, getting rid of tweezers (or placing them in the freezer), using sticky notes, keeping certain doors open (to decrease privacy), rearranging furniture, and sitting in different positions.

Monitoring Progress and Revising Treatment

As a client and clinician begin treatment, it’s important to keep a daily log of the hair pulling episodes and the attempted interventions. Some interventions will work right away, others will need to be fine tuned, and some will lose their effectiveness over time. The client and clinician must work together, constantly monitoring and reevaluating the treatment until a plan is developed that fits the needs of the client. This process could take weeks or months. Additionally, since trichotillomania changes as we age, treatments that worked at one phase of life may not work in another.

Advice for Treatment Seekers and Treatment Providers

As you can tell, treating trichotillomania is a complex and long process. It takes a lot of time, courage, and motivation on the part of the individual and a lot of training and experience on the part of the clinician. If you are someone who is suffering from trichotillomania, make sure that your clinician is using scientifically supported treatments. Ask them about the type of treatment they are using. If you don’t hear anything about increasing awareness, changing behaviors, or emotional regulation, their treatment may not be based on science. If they start using personal testimonials and wild theories to backup their treatment, or say their treatment cannot be evaluated by science, run away – they’re probably selling you snake oil.

I recommend using the Trichotillomania Learning Center’s list of health care providers to find individuals trained in scientifically supported treatments. If you are a health care provider wanting to learn more about these treatments, I highly recommend attending a Trichotillomania Learning Center Professional Training Institute and browsing through their clinical resources.

References:

Azrin, N. H., Nunn, R. G., & Frantz, S. E. (1980). Treatment of hair-pulling (trichotillomania): A comparative study of habit reversal and negative practice training. Journal of Behavior Therapy and Experimental Psychiatry, 11, 13-20.

Duke, D., Keeley, M., Geffken, G., & Storch, E. (2010). Trichotillomania: a current review. Clinical Psychology Review, 30, 181-193.

Franklin, M. E., Edson, A. L., & Freeman, J. B. (2010). Behavior therapy for pediatric trichotillomania: Exploring the effects of age on treatment outcome. Child and Adolescent Psychiatry and Mental Health, 4, 18.

Keuthen, N. J., Rothbaum, B. O., Welch, S. S., Taylor, C., Falkenstein, M., Heekin, M., Jordan, C. A., et al. (2010). Pilot trial of dialectical behavior therapy-enhanced habit reversal for trichotillomania. Depression and Anxiety, 27(10), 953-959.

Mansueto, C. S., Townsley-Stemberger, R. M., McCombs-Thomas, A., & Goldfinger-Golomb, R. (1997). Trichotillomania: A comprehensive behavioral model. Clinical Psychology Review, 17, 567-577.

Walther, M. R., Ricketts, E. J., Conelea, C. A., & Woods, D. W. (2010). Recent Advances in the Understanding and Treatment of Trichotillomania. Journal of Cognitive Psychotherapy, 24(1), 46-64.

Newer:Update From the Fall 2010 APAGS Committee MeetingOlder:Ask Congress to Strengthen the Graduate Psychology Education Program

Peace

Reflections on Skin Picking and Hair Pulling - OCD Center of Los Angeles

Reflections on
Skin Picking and Hair Pulling

__________________________

Peace is not something you wish for; it’s something you make, something you do, something you are.

~ Robert Fulghum

__________________________

Peace

It’s quite natural to crave a feeling of peace. This is true whether you are experiencing a significant mental health issue, coping with a personal crisis such as a divorce or the death of loved one, or just trying to effectively manage the vicissitudes of every day life.

If you suffer with Skin Picking Disorder or Trichotillomania, peace is likely something you have been “wishing” for throughout your struggle. Of course, it would be wonderful if a feeling of peace would descend upon us just by wishing for it. But in reality, peace requires action. If you are committed to finding peace, you must wholeheartedly agree to do the work involved in attaining it.

In many ways, peace is a function of conscious acceptance in that it requires us to choose to accept reality as it is, rather than as we would like it to be. Of course, this may not be easy – sometimes the urge to pick or pull may be so powerful that it feels almost impossible to peacefully accept. Some with Skin Picking Disorder or Trichotillomania describe their urges as being like a loud sound that simply can’t be ignored – as if someone has turned the volume of the urge up so high that it is the only thing they can pay attention to.

In order to move through and past this extremely distracting urge, the first thing you must do is to fully accept its existence. If you spend your time attempting to control or avoid your picking and pulling urges, all you are doing is spending time engaging with something you cannot control.

Once you have accepted the presence of your loud and annoying urges to pick or pull, you can choose to engage in other activities. When you do this, you will notice the volume of your urges decreases because they are no longer front and center. They will still be there, but they will not be all-consuming. By choosing the action of doing something other than engaging with the urge, you take an enormous step forward in your recovery.

Choosing to act differently in response to your urges may at first feel quite difficult. But keep in mind that peace is not just wishing or hoping – peace is “something you do”. It is something that requires repeated practice. And with effort and commitment, it eventually becomes “something you are”.

__________________________

1) In what ways are you accepting, or not accepting, of your unwanted urges to pick or pull?

2) What actions might you take to further develop a peaceful, accepting relationship with your urges?

3) What are some activities that you find peaceful, and how can you implement them in your daily life?

__________________________

Weekly Tip: This week, try to be mindful of your thoughts, feelings, and actions at those times when you are able to accept and move through an urge without giving in to it. Notice if there is a sense of peace after you accept an urge rather than trying to control it. Practice this approach in order to develop a consistent, new pattern of responding to your urges with acceptance, action…and peace.

__________________________

For a free subscription to “Reflections”, please click here.

The OCD Center of Los Angeles is a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of OCD, Skin Picking Disorder, Trichotillomania, and related conditions. We offer the following services:

  • Individual Therapy
  • Low-Fee Group Therapy
  • Online Therapy
  • Phone Therapy
  • Home Visits
  • Intensive Outpatient Program
We treat adults, adolescents, and children, and offer services six days a week, including evenings and Saturdays. For more information, please contact one of our client coordinators at (310) 824-5200 (ext. 4), or click here to email us.
__________________________

OCD Center of Los Angeles
http://ocdla.com

(310) 824-5200

Written by
Kelley Franke, MA
and Tom Corboy, MFT

© 2016 OCD Center of Los Angeles

We will never share, rent or sell your personal information to third parties.

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Inositol

Studies show that Inositol helps many Trichotillomania suffers. I find that it reduces the urge to pull, which helps with my focused pulling. The Inositol also increases my awareness, which decreases my unfocused pulling.

Leading Trichotillomania specialist Dr. Penzel’s wrote, Inositol and OCD. He recommends the following regimen to begin Inositol: 

(1 teaspoon=2 grams, and be sure to use a measuring spoon) for an adult:

Week 1 – 1 teaspoon/2x per day
Week 2 – 1 teaspoon/3x per day
Week 3 – 1.5 teaspoons/3x per day
Week 4 – 2 teaspoons/3x per day
Week 5 – 2.5 teaspoons/3x per day
Week 6 – 3 teaspoons/3x per day

Following this regimen, I worked my way up and now take 18g each day. I do this by mixing 3 teaspoons (1 tablespoon) of inositol in water 3 times a day. I have found the Jarrow brand powder (shown above) to dissolve well. It is available on amazon for reasonable price. I mix it with warm water as it dissolves better that way. You can add it to fruit juice or other sweetened drink. I simply mix the powder with ~3oz of warm water and drink plain as it has a mild sweet taste that I actually like. In addition to Inositol, l I take 1800mg of  NAC, which I started several months before the Inositol. I did not see much progress with that alone, therefore I added the Inositol. If you are considering both supplements, choose one to start with, otherwise you will not know which is helping and or causing side effects.

I have taken Inositol on and off for 2 years. When I first started the recommended regimen over 6 weeks, I noticed many GI side effects. When I unexpectedly became pregnant a couple months later, I had to lower my dose because it increased my nausea. That did not help so I discontinued the Inositol until my morning sickness passed. Reassured by my OB that Inositol is safe while pregnant and breastfeeding, I slowly reintroduced the Inositol. I only took 1-2 because it aggravated epigastric pain I had while pregnant. The lower dose helped a bit, but not nearly as well as the recommended 3 TBSP. Now that I am back to 3 TBSP per day (which I take in one large dose at night to help my insomnia), I am definitely feeling the benefits. It decreases my urges and makes me more aware of pulling.

Here’s more details information I copied from the article about Inositol use for trich sufferers, written by trich specialist Fred Penzel:

“Obviously, before you run out and try anything new, you should always consult your physician. If your physician recommends trying this, you might also want to mention the following information to him or her:

  1. It cannot be taken together with Lithium, as it seems to block its action.
  2. The chief side effects of inositol are gas and diarrhea. Some people get this for the first few days and then it clears up. Many of those taking it never have this side effect, and some only get it when they take more than a particular amount.
  3. I have heard reports that caffeine lowers inositol levels in the body, so if you are a heavy coffee drinker, you might consider cutting down or eliminating this from your diet. Actually, stimulants such as caffeine can sometimes contribute to anxiety, jitteriness, etc.
  4. It should be purchased in powdered form, and taken dissolved in water or fruit juice. It has a sweet taste, and is chemically related to sugar. If it is allowed to stand for about 10 minutes after mixing it, it seems to dissolve better. Vigorous mixing for a few minutes also helps. If it still doesn’t dissolve well (not all brands do), stir it up and drink it quickly before it settles. The use of powder is recommended, as the larger doses required could require taking as many as 36, 500 mg. capsules per day.
  5. Inositol is a water-soluble vitamin, so although the doses appear to be large, it will not build up to toxic levels in the body. Whatever the body doesn’t use is excreted. The average person normally takes in about 1 gram of inositol each day via the food they eat. There are no reports of any harm associated with the long-term use of inositol. Some of our patients have been taking it as long as eight years now, with no problems.6. It can be built up according to the following schedule (1 teaspoon=2 grams, and be

sure to use a measuring spoon) for an adult:

  • Week 1 – 1 teaspoon/2x per day
  • Week 2 – 1 teaspoon/3x per day
  • Week 3 – 1.5 teaspoons/3x per day
  • Week 4 – 2 teaspoons/3x per day
  • Week 5 – 2.5 teaspoons/3x per day
  • Week 6 – 3 teaspoons/3x per day

A child can be built up to 3 teaspoons per day over the same six-week period. Dosages for adolescents can be adjusted according to weight. In either case, it is best to allow side effects to be the guide. If they begin to occur, it is not considered wise to increase the dosage unless they subside.

Once a person has reached either the maximum dosage, or the greatest amount they are able to tolerate, it is best to try staying six weeks at that level to see if there is any noticeable improvement. If there is none by the end of that time, it should probably be discontinued. As with any treatment, those who are absolutely positive that it will help are only setting themselves up, and may wind up more than disappointed. Everything works for someone, but nothing works for everyone.”

Habits

habits-wordle1

__________________________

Chains of habit are too light to be felt until they are too heavy to be broken.

~ Warren Buffett

__________________________

Habits

We all have habits. In fact, many habits, such as putting on your seatbelt or brushing your teeth, are beneficial. But those suffering with Skin Picking Disorder and Trichotillomania have habits that are anything but beneficial.

All habits – good or bad – include three components:

  • A cue, which triggers the habitual behavior to start.
  • The behavior itself, such as picking or pulling.
  • A reward, which “reinforces” the behavior, thus leading you to repeat it in the future.

This is called a “habit loop” and it is a crucial principle in understanding these conditions.

Habit Reversal Training (HRT) is one of the most important strategies used in changing your behavior and breaking habit loops. The first step in HRT, as discussed here in previous installments, is building awareness of your picking and pulling. Once a trigger is identified, it can act as a warning sign that you are about to engage in a destructive behavior.

Using HRT, you learn to instead use a competing response to the trigger, rather than picking or pulling. This competing response should ideally be something that actively engages your hands, and which can be done easily in most situations. The immediate goal is to make picking or pulling more difficult, or even burdensome. Some examples of competing responses include squeezing a stress ball, knitting, writing, or painting. Basically, anything that keeps your hands away from your skin and hair!

By introducing this alternative behavior as a replacement for your habitual behavior, you interrupt the reinforcement, start the process of breaking the habit loop, and begin developing a new, non-damaging habit in its place. Additionally, some people use habit blockers such as gloves, to act as a further impediment to their picking and pulling.

It may take some time to find what works for you, and some things might work better than others depending on the given situation. As a result, you may at first find it difficult to consistently implement HRT, and may grow frustrated with yourself. But with repeated practice, you can learn to replace a destructive habit with one that is neutral or even positive. While HRT is seldom a solution in itself, it is a critical component of a long-term process of challenging these destructive, habitual behaviors.

__________________________

1) Create a list of the situations that often trigger you to pick or pull.

2) Create a list of different competing responses you might use this week when you feel the urge to pick or pull. (Hint: The TLC Foundation for BFRBs website at www.bfrb.org sells many inexpensive “fidgets” that can keep your hands busy.)

3) Keep a log of which competing responses work and don’t work for you this week, and try to come up with alternatives for those times that the competing behavior you try is not helpful.

__________________________

Weekly Tip: Remember that when you first start using competing responses, you might feel frustrated because you are using it so often, or because HRT is simply not working in that moment. This is a normal reaction, and it is important to keep trying new ways to break the habit loop. You might find that you will have to try several replacement behaviors, or to repeat the replacement behaviors numerous times before you start to experience success in breaking your habit loop.

__________________________

OCD Center of Los Angeles
http://ocdla.com

(310) 824-5200

Written by
Kelley Franke, BA and Tom Corboy, MFT

© 2016 OCD Center of Los Angeles

Treating the Whole Person: Part 2

Treating the Whole Person: A Personal User’s Guide, Part Two

Renae M. Reinardy, PsyD.,LP
Lakeside Center for Behavioral Change, PC
Fargo, ND

Reprinted from InTouch Issue 64, Winter 2012
© The TLC Foundation for Body-Focused Repetitive Behaviors. 2016. All Rights Reserved

As we bring in the New Year many people have the goal of making a significant change in their life. If you struggle with a body focused repetitive behavior (BFRB), that goal might be increased control over picking or pulling. In Part One of the Personal User’s Guide, we discussed how building a healthy foundation through nutrition, exercise and sleep are important to good health and decreased urges. We also looked at the balance of how we live our life in comparison to how we would like to spend our time and energy. Spirituality was also briefly discussed as a tool to improve our experience. Any one of these areas could be the focus for changes in the coming year. Do not overwhelm yourself, narrow your goals to what makes sense to you. The purpose of the Personal User’s Guide is to serve as a self-guiding compass. It is not a final destination, but a process of change.

Here are some other things to consider in planning your route in your personal change process. And, please pull out your notes from Part One.

My Mind

We are all actors in our internal soap operas. Our thoughts are incredibly powerful, yet we tend to just accept our internal script without much editing. Cognitive behavioral therapists encourage the process of cognitive restructuring. This involves identifying, challenging and replacing thoughts that are not true or helpful to us. It is good to look inside of your mind to make any helpful editorial changes to your internal script about BFRBs. Thoughts can involve perceptions of self control, permission-giving thoughts, perfectionism, and/or social judgments to name a few. Just like a soap opera, there tends to be many areas of dialog that can use some editing to more accurately reflect reality.

Identify: What is a thought that often comes up about your picking or pulling? How much do you believe it?
  • Is this thought true?
  • Is it helpful?
  • Is there another way of thinking about it that would be p helpful?Edited thought: What is my new self-care script about picking or pulling that is more positive, realistic, or takes a problem solving approach?

The script that we rehearse is the life that we choose to live. In addition to identifying, challenging and replacing toxic thoughts, it is also good to practice mindfulness. Mindfulness involves awareness of ourselves and how our mind functions. It is turning off autopilot. There is quite a bit of information out there on the benefits of mindfulness training. I would encourage you to practice a mindfulness activity daily. One thing at a time, being aware of ourselves and our activity in that moment. This also helps to improve awareness of BFRBs and can be a good substitute if your picking or pulling puts you into a “trance-like” state.

My Emotional Triggers

Emotional triggers are very common in picking and pulling behavior. It is good to understand what emotions your BFRBs are trying to regulate. Do you pull when you are bored? Tired? Frustrated? Unsure? Angry? Excited? Intolerant of less than perfect skin or hair?

Most common emotional triggers:

  • What sparks your emotions?
  • What do you do to cope with emotions?
  • What can you do to cope with emotions?

Once you are aware of your emotional triggers, you can start to learn and practice some adaptive emotional coping skills. For example, if you notice strong picking or pulling urges when you are frustrated, it may be helpful to learn a relaxation exercise such as controlled breathing or progressive muscle relaxation. Most cognitive behavioral therapists can help you identify which skills would be best for you to regulate trigger emotions.

Other Triggers

This article has already discussed some of the cognitive (thought-related) and emotional triggers of BFRBs, but it is important to look at other factors that may also influence your behavior. It is common for people to have certain locations that become conditioned as situational triggers (i.e., pulling in the car, picking when washing your face before bed, etc.). Sensory triggers are the fascinating experiences that people have when they pick or pull. It can be a tpingly scalp, the coarse feeling of a hair, a bump on the skin, or the pop of a blemish. There can be much satisfaction in these sensory cues, so it is important to understand if they are a factor for you, and what substitutes can be used to satisfy these sensory experiences.

Situational triggers:

Sensory triggers:

Other triggers:

My Strategies

In this section, take a few minutes to focus on one or two strategies/goals in each area. If it is overwhelming, break it down and focus on one area at a time. Once that becomes more of a habit add another to your daily routine. Remember to be flexible; there are often twists and turns in any journey.
There are a number of strategies that can be used; it may be helpful to review some of the resources on the “Resource Library” tab on The TLC Foundation for Body-Focused Repetitive Behaviors’ website,www.bfrb.org, for some additional inspiration.

My Body: Diet, Exercise, Sleep

How will you meet physical needs to promote overall well-being?
Example: Decrease soda consumption to 2 cans per week

My Life:

How will you create a better match between the “ideal” and the “real?”
Example: Check work email no more than 2x per week at home

My Spirit:

What steps will you take to connect to something outside of yourself?
Example: Practice walking meditation twice per week

My Mind:

How will you edit your internal script?
Example: Challenge permission-giving thoughts like, “I will start tomorrow” with “Trich is getting restless, now is the time to use a strategy before I even start pulling”

My Emotions:

What are some different ways you can cope with emotions
Example: Practice breathing exercise when mind is racing before bed

My Other Triggers: Sensory, Situational, Habits

Example: Meet sensory needs by using fiddle toy while on computer

Example: Modify situation trigger by practicing quick in and out of bathroom without lingering

Example: Make picking or pulling more difficult by wearing a rubber fingertip

As you practice these new patterns you will find that they will become stronger and the BFRBs will decrease in the frequency and intensity of urges. It is important to remember that it is still a part of you, but it can go into “hibernation.” Monitor how you are doing and evaluate which strategies work best for you in getting and keeping your picking or pulling under control by giving your body and mind what it needs in other ways.

My Story
What is the direction you have decided to take on this journey?

 

 

Many good wishes on your path.

Dr. Renae Reinardy is the founder of the Lakeside Center for Behavioral Change in Fargo, ND. Prior to opening her own practice, Dr. Reinardy worked as a psychologist at the Behavior Therapy Center of Greater Washington in Silver Spring, Maryland. Dr. Reinardy specializes in the treatment of hair pulling and skin picking disorders, obsessive compulsive disorder, compulsive hoarding, and related conditions. She has been an adjunct professor at the doctoral level and has presented numerous times at national conferences and at local meetings and trainings, including The TLC Foundation for Body-Focused Repetitive Behaviors’ Annual Conferences and Retreats. Dr. Reinardy has been interviewed on Good Morning America, the Joy Behar Show, Dateline NBC, and A&E’s Hoarders. For more information, visit www.lakesidecenter.org.