Category Archives: Expert Advice

10 Ways to Keep from Feeling Overwhelmed

1. Let it go.

Whether it’s a critical remark from someone that is gnawing at your insides or an added task that you took upon yourself and now it’s causing you to feel overwhelmed, just let it go. There are few matters that are worth losing sleep over. And there are few things that can’t wait until  tomorrow. Or next week. Or even longer. Your health is more important than holding onto what is stressing you out.   

If you supervise others, practice the art of delegation and allow others to share the load. Know what you do best and hand off the rest to others who can do those jobs better than you. You are only one person. Cut the drama by cutting your schedule.  

2. Sleep on it.

Your mom might have told you years ago to “sleep on it” when you were faced with making a difficult decision. That’s great advice when it comes to not only important decision-making, but to anything that might overwhelm you, such as responding to an accusatory email or angry voice message, or committing to one more task that will leave you overextended. 

Studies show that the brain actually processes situations more thoroughly while you sleep. That means you wake up with a fresh – and often less emotional – perspective. Sleeping on it is the breather that will help you gain perspective and cool the heat of your emotions so you don’t overcommit to something spontaneously or out of guilt.

3. Commit to the three E’s.

I call them the Essential E’s: Eat right, exercise regularly, and embrace sleep. Fueling your body with protein and nutritious food, exercising to release those feel-good endorphins (as well as keep your heart healthier), and embracing opportunities to take a power nap or get a good seven-eight hours of sleep each night will keep you feeling fresh, rather than fatigued and overwhelmed. 

When you eat right, exercise regularly, and get enough sleep, you can be at the top of your game and cope so much better when the drama of life hits. When we are emotionally spent, it’s usually because we are physically and nutritionally spent as well. 

4. Stay out of it.

We often start feeling overwhelmed when we’ve extended ourselves a little too far when it comes to helping others. It’s called enabling – or “rescuing” – and women are great at it. But just because something happens in your sphere of influence doesn’t mean you are the one to run to the rescue and fix it. Just because you are made aware of something doesn’t mean God is assigning it to you. Much drama – and feelings of anxiety – can be avoided when you get in the habit of running your schedule past God first. It looks like this:

1) Stop

2) Seek God’s guidance

3) Stay out of it unless God gives you a clear indication to step into it. We often reverse that. We think I will do this unless God stops me. If you’re already overscheduled, think this way instead: The answer is no unless God says “go.”

5. Trust God to control what you can’t.

My friend, Donna, learned recently that the more she rests and trusts, the more God goes to bat for her. She had just learned of her mother’s sudden death in a car accident and felt the pull to leave her business to travel and be with her family and help make final arrangements. But although her heart was saying You need to go, her head was saying It’s a busy month, you can’t leave… you have to be here to keep things running smoothly. In the midst of the mental battle, she listened closely for God’s voice: Trust Me. Go do what you need to do. 

Donna left her business in the hands of capable people and trusted God with the rest. When she returned a month later, she discovered her business experienced its highest grossing month on record! Then when she stepped away from her business a second time – this time for two months after receiving a breast cancer diagnosis – her business experienced its best two months ever, financially. God was affirming to her, again, the principle that He can take care of more while we rest than we can while we stress!

6. Stop trying to please everyone.

I’m sure at one point you knew clearly who the priority people were in your life. But that can get fuzzy when we are trying to please too many people, which is often the case when we begin to feel overwhelmed. 

So stop being a people-pleaser and realize who matter the most in your life. Who are the people who will cry the most at your funeral? Put them first. Make everyone else take a number and wait in line. In short, that’s the simplest way to live without regrets. Priority people get the first and best of your time. Everyone else will simply have to learn to wait.

7. Pray it through.

When you start to feel overwhelmed, talk to God about it. Just giving Him your concerns will help usher peace into your life and give you a little more clarity. Philippians 4:6-7 says, “Don’t worry about anything; instead, pray about everything. Tell God what you need, and thank him for all he has done. Then you will experience God’s peace, which exceeds anything we can understand…” (NLT).  

You can experience that peace, not a feeling of being overwhelmed, when you pray about what is pressuring you. Praying is equivalent to taking an intermission. It quiets your soul, clears your mind, and teaches you to leave your concerns with God, who is better at taking care of them anyway. 

8. Get outdoors.

There is something therapeutic about getting outdoors, breathing the fresh air, and noticing the beauty of creation (even if it’s just some trees that line the sidewalk outside your office building). 

Getting out into nature reminds us that “the earth is the Lord’s, and everything in it” (Psalm 24:1) and it makes us realize that the petty things of this earth that overwhelm us don’t really matter in the scope of eternity.

9. Reduce the clutter.

Do you realize that just by cleaning off your desk, getting rid of too many clothes in your closet, or clearing the kitchen counter can help you feel less overwhelmed? Everyone needs a clean, clear space to think, work and exist. Where is yours? 

When there is less clutter, there are less choices to make and less time spent trying to find things that get lost in the mess. How many times have you lost your keys right as you are trying to leave the house? Keeping all belongings in a designated space will prevent this issue, and save you the frustration of misplacing important items. Simplify your work or living space. It brings peace.

10. Go off the grid.

Slide 10 of 10

Imagine spending a whole day (or maybe even a week!) being inaccessible – no internet, no interruptions, no demands. Just you and the quiet. Most high-level business people need this at least one or two weeks a year in order to maintain their creativity, energy, and overall sanity. But you and I can try it in smaller chunks – like for an hour or two a day – if that’s what it takes to ease your anxiety. 

The world won’t stop if you do. You’ll just get the rest you need so you can perform better when you return to your desk, computer, or cellphone. Go off the grid by carving out time periods when you cannot be reached. Shut down your computer. Turn off your cellphone. Rediscover quiet and recollect your thoughts. 

We often believe that we must respond to every request, every email, and every text or voice message immediately. That not only leaves us feeling overwhelmed, but it trains others to expect us to be at their beck and call. Practice the art of being inaccessible (so you can quietly reflect) and trust God that when you take the time to rest He won’t punish you for it by making you miss important opportunities. 

By Cindi McMenamin

Cindi McMenamin is a national speaker who helps women strengthen their walk with God and their relationships. She is the author of 15 books, including the best-selling When Women Walk Alone (more than 125,000 copies sold), When You’re Running on Empty, and her newest book, Drama Free, upon which this article is based.  For more on her speaking ministry, books, or free articles to strengthen your soul, marriage, or parenting, see her website www.StrengthForTheSoul.com.

 

 

Narcissistic Personality Disorder vs. Autism Spectrum Disorder


A result of such a rendezvous would be the feeling that one was unworthy, invisible and, somehow, “less than “.This is exacerbated by the unexpected nature of the insult received. It would be safe, under these circumstances, to guess that one has been in contact with someone who is detached from the feelings that would be expected under normal circumstances.

It can be problematic to discern if one was slighted intentionally or accidentally. The issue of volition is what necessitates the effort to understand the difference between NPD and ASD. A narcissist is well aware of the offense that has been delivered. Someone on the autism spectrum doesn’t have a clue.

Someone with ASD may appear to be normal and may excel in certain of life’s tasks. What they lack is an understanding of anyone else’s emotions. As an example, if someone with ASD parented a child, he/she would not be able to figure out that when a baby cries it is in need. This ASD parent would believe that the child is crying just for the sake of crying.

An individual on the Spectrum suffers from what is called “mindblindness”. This is the inability to empathize. He/she does not understand that others do not see the world through his/her( the person on the Spectrum’s )own particular lens. So, when the baby is crying and the ASD parent feels well-fed and comfortable it is beyond the parent’s capacity to get it that the baby may be cold or hungry.

The narcissist understands the sensitivities of others all too well. The narcissist is a master manipulator who does not care when his/her actions are hurtful. In fact, the narcissist can, intentionally, be a dangerous enemy. Beneath the arrogance that is displayed when no one “important” is around, is an ego that has been depleted of feelings of safety and self-regard.
When it comes to intimate relationships the narcissist can launch an attack that is especially hurtful. The reason for this is that the narcissist is so vulnerable to feelings of shame that he/she may, literally, wish to destroy the person who tapped into that shame.

The individual with NPD uses his/her understanding of human nature (which, of course, is cynical) to curry favor on one side of the equation and to insult and depersonalize on the other. This person is a skilled seducer who becomes furious when his/her efforts fail to produce the desired outcome. Whoever becomes intimately involved with someone with NPD is certain to be bruised. Love and interest will be offered and withdrawn as the NPD strives to enhance his/her own life. There is no genuine concern for the welfare of others.

While the NPD uses his/her expertise deliberately, the ASP has no comprehension as to why others behave the way they do. While the ASP may appear to be arrogant and rude, he/she lacks any sense of self-awareness and cannot grasp the meaning of behaviors that he/she encounters every day.

What makes social interaction particularly difficult for the ASD is that he/she doesn’t know what he/she doesn’t know. Remember, an individual on the spectrum has no idea that another has a mind of his/her own. The ASD does not wish to inflict harm. It is helpful when offended by someone on the Spectrum, to remember that the intent was not to misuse. Rather, mindblindness kicked in and the individual with ASD has no idea that he/she may have left behind hurt feelings.

For someone on the Spectrum, friendships are about shared interests not about emotional connection. Emotions are inexplicable to the ASD individual. The vocabulary is extremely limited and very basic. For many, their interests are confined to a particular subject and are intense. The ASD will happily perseverate on a topic of interest.

Another aspect of spending time with someone on the Spectrum is that he/she has no understanding of symbolism and metaphor. It has been reported that a mother told her child, who was on the Spectrum, that she did not believe what he was telling her. She illustrated this by saying, “You can tell me this until the cows come home and I still won’t believe you.” Her son’s reply: “ I don’t care about cows”.

An individual on the Spectrum cannot draw inferences or make predictions about the outcome. Therefore, this individual may be quite unprepared for the negative feedback or consequences of his/her behavior.

While there have been many theories as to the cause of ASD, the answer remains elusive. Some have theorized that children on the Spectrum have at least one parent who has NPD. There is no evidence that supports this premise.

There is evidence, however that the offspring of those with either NPD or ASD bear a number of traits in common. Because these children have been raised by parents who are incapable of empathy, they often grow up believing that they are inherently damaged and that, somehow, it is their own fault. There is a term for those who hold these damaging and intractable beliefs: Ongoing Traumatic Relationship Syndrome — OTRS. The lack of parental validation can cut deeply into a youngster’s soul and may prove to be incurable even with ongoing psychotherapy. The child of a parent on the Syndrome is frequently ashamed of the parent, which reinforces the child’s personal shame.

The person with ASD is frequently a victim. The individual with NPD is likely to be a victimizer. It is fortunate when there is a so-called “normal” individual who can look out for the welfare of the person on the Spectrum. Those with ASD are sitting ducks for exploitation.

The narcissist does not care about the damage left behind. The person on the Spectrum does not understand that the damage has occurred. An important piece of knowledge to hold on to when one encounters a personal interaction that is breathtakingly obnoxious. It is wise to protect oneself from the narcissist. It is equally judicious, as well as kind, to allow an individual on the Spectrum some latitude. Intent makes all the difference



Asperger’s vs Narcissism. (n.d.). Retrieved July 18, 2017, from refulgentcoleman.blogspot.com Heitler, S., Ph.D. (2014, June 11). Do You Think of Narcissism as an Autism Spectrum

Heitler, S., Ph.D. (2014, June 11). Do You Think of Narcissism as an Autism Spectrum Disorder? Retrieved July 11, 2017, from psychology today.com

Koenraadt, M. (2016, May 18). Raised By Emotionally Immature Parents. Retrieved July 11, 2017, from koenraddt.info

Marshack, K. (16, January 18). Narcissistic Personality Disorder and Asperger Syndrome — Can You Tell The Difference? Retrieved July 11, 2017, from kmarshack.com

Rodman, S. (2016, August 28). Aspberger’s: When Narcissism Just Doesn’t Explain Your Partner’s Inability to Empathize. Retrieved July 11, 2017, from drpsychmom.com

About the Author

Ruth GordonRuth Gordon, MA/MSW/LCSW

I bring with me +30 years of experience as a clinician. My Masters degrees are from: Assumption College, Worcester, MA, Master of Arts in Psychology & Counseling/ and Boston University School of Social Work, Boston, MA, an MSW in Clinical Social Work. This is the 11th year I have written a monthly newsletter that is sent to approximately 500 individuals. The archive can be found on my website, http://www.foreverfabulousyou.com.

Office Location:
The OC Building, 11983 Tamiami Trail, N., Naples, FL 34110
Naples, Florida
34110
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Phone: 239 293-4314
Contact Ruth Gordon

Ruth Gordon has a clinical practice in Naples, FL

Professional Website: www.foreverfabulousyou.com

Anxiety Disorders Typically Caused by Exposure to Narcissistic Abuse

Anxiety Disorders Typically Caused by Exposure to Narcissistic Abuse

By admin

Overt abuse techniques commonly used on preferred scapegoat targets by Cluster B people tend to cause physical health issues for victims of people who are socially aggressive, violent, and foster a complex atmosphere of Ambient Abuse in any social environment they have the opportunity to influence.

The most common targets for social abuse are highly sensitive and emotionally intelligent people who are by nature prone to behaving like humanists. People who are of lesser social means (meaning less socially powerful or influential) are also likely targets, too.

If you live in a home where abuse is prevalent, expect your health to decline and your self-conception to suffer. Being told all the time YOU are the problem for reacting to abuse in ways that are actually emotionally intelligent and PHYSICALLY appropriate tends to cause victim self-identity to suffer.

If you feel like you are unsure whether you over-react to abuse or you are justified in being upset when you are lied to, conned by a love fraud, are cheated on, are beaten or sexually assaulted, threatened with murder, etcetera… your mind and body are already experiencing symptoms of extreme C-PTSD.

Chances are you are likely to be developing a  form of Stockholm Syndrome based on trauma bonding with your Abuser.  When and if a trauma bond forms, the biology of the human form does a couple of things.

First of all — if you are healthy and sane, you will tend to trust your own eyes and ears as well as sanity. If you catch a partner cheating, for instance, but they blame YOU? Or an Enabler tries to convince you that your abuser loves you in their own way? Or they tell you that physical assault is for your own good?

Seriously — if you believe them you are already likely to be living with adrenal fatigue and heightened forms of pervasive social anxiety soon.

The following list of anxiety disorder types was compiled by the Mayo Clinic. The healthcare organization describes many of the most common conditions as follows

• Agoraphobia (ag-uh-ruh-FOE-be-uh) is a type of anxiety disorder in which you fear and often avoid places or situations that might cause you to panic and make you feel trapped, helpless or embarrassed.

• Anxiety disorder due to a medical condition includes symptoms of intense anxiety or panic that are directly caused by a physical health problem.

• Generalized anxiety disorder includes persistent and excessive anxiety and worry about activities or events — even ordinary, routine issues. The worry is out of proportion to the actual circumstance, is difficult to control and affects how you feel physically. It often occurs along with other anxiety disorders or depression.

• Panic disorder involves repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes (panic attacks). You may have feelings of impending doom, shortness of breath, chest pain, or a rapid, fluttering or pounding heart (heart palpitations). These panic attacks may lead to worrying about them happening again or avoiding situations in which they’ve occurred.

• Selective mutism is a consistent failure of children to speak in certain situations, such as school, even when they can speak in other situations, such as at home with close family members. This can interfere with school, work and social functioning.

• Separation anxiety disorder is a childhood disorder characterized by anxiety that’s excessive for the child’s developmental level and related to separation from parents or others who have parental roles.

• Social anxiety disorder (social phobia) involves high levels of anxiety, fear and avoidance of social situations due to feelings of embarrassment, self-consciousness and concern about being judged or viewed negatively by others.

• Specific phobias are characterized by major anxiety when you’re exposed to a specific object or situation and a desire to avoid it. Phobias provoke panic attacks in some people.

• Substance-induced anxiety disorder is characterized by symptoms of intense anxiety or panic that are a direct result of abusing drugs, taking medications, being exposed to a toxic substance or withdrawal from drugs.

• Other specified anxiety disorder and unspecified anxiety disorder are terms for anxiety or phobias that don’t meet the exact criteria for any other anxiety disorders but are significant enough to be distressing and disruptive.

Folks who actively abuse and enable other abusers love telling their abuse victims that they are somehow socially, emotionally, and intellectually deficient. They are huge fans of abusing the crap out of their target, then when caught or confronted about their behavior choices they love nothing more than playing the victim.

The more extreme the personality disorder the more likely social predators are to enjoy harming or humiliating and dominating other people.

Not only do they expect their willing Narcissistic Supply Sources to consistently play SUB-servant, they wholeheartedly expect and demand total obedience from any preferred scapegoat they like to claim ownership of and to toy with psychologically and emotionally on a regular basis.

People who get trapped* in the CYCLE OF NARCISSISTIC ABUSE tend to know something is not right with the claims the Cluster B person makes, but unless they are well educated about things like how to spot the warning signs of a Cluster B pack or egocentric Abuser, love fraud tactics, and are made aware of verbal abuse and mind control tactics, predators make incredible logical fallacy statements and appeals to emotion that sound — at least plausible — to an unaware listener.

If a target makes the mistake of reverse projecting and presumes that all human beings — INCLUDING CLUSTER B PEOPLE AND VERTICAL THINKERS — have the same core values as roughly 75-80% of the global human population, that is the instant chaos manufactures or pot stirrers have the ability to start mind assaulting trouble.

People who are exposed to physical abuse, sexual assault, verbal assaults of a poignant or pervasive nature, financial abuse, social persecution, and the word choices of dehumanizers seeking to sadistically or callously persecute tend to develop extreme social anxiety, pervasive stress related illnesses, and extreme confusion over knowing they are good folks in their heart and mind but hear constant ad hominem attacks against themselves by bullies and manipulators all the time.

If you are being harassed, bullied, messed with at work, are being picked on by family members who display Cluster B behaviors, an ex has done some crappy thing like tried to smear campaign, or worse…

Or you are feeling the literal weight of an angry and hostile narcissistic led faction world…

You are not alone in suspecting being around mean people can damage your health. Verbal assault can lead directly to neurological damage to the part of the brain that houses complex emotional reasoning centers and the body fatigues and organ function is medically depleted by the fear-induced surge of toxic adrenal chemicals.

Seriously.

Life-threatening illness tends to develop in humans who feel TRAPPED by an Abuser (unable to flee) or who are held hostage by toxic thinkers seeking to silence and oppress their scapegoats, targets, and control the fear-based psychology of their toys as well as any collateral damage victims.

[Abusers tend to rage at anyone who offers one of their preferred scapegoat targets humanitarian aid or social support. Doing so tends to produce the effect of socially isolating their targeted victim while humiliating and truly frightening them further when and if people passively choose to stay out of it or to enable, leaving the target even more vulnerable to further pervasive overt (as well as extreme covert) situational abuse. ]

The more healthcare workers start to realize if a patient presents with stress illness and psychiatric symptoms that the patient is more than likely showing physical signs of complex psychological and emotional duress more than likely being caused by ongoing exposure to Narcissistic Abuse or an Ambient Abuse promoting environment, the sooner human beings of neurotypical nature are likely to be able to end the healthcare crisis beginning to plague most modern nations.

SOURCE: http://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/dxc-20168124

16 Signs You’re Nearing Burnout

16 signs you’re nearing burnout

Alisa, November 29, 2016, Mindfulness and Cognitive Science, Neurobiology and Behavior, Self Care, 6

Does it sometimes feel like you have to hit bottom before you can really change? You can see the warning signs…the negative effects of overcommitting yourself are probably pretty predictable. But how do you take action now? (As opposed to when your body forces you to or when the next break gets here).

Burnout often happens in a cyclical fashion. With unsustainable habits it’s always just a matter of time before your tank dwindles down to empty again. But it’s difficult to make changes to those habits when it feels like you have to choose between having fun and sustainable energy.

Hold up, do we really have to choose between FUN and WELL? Screw that. I think the choice lies elsewhere, in fact, I demand it lie elsewhere. We just might have to dig a little bit to find it.

Recognizing the patterns

The cool thing about habits is that they can be easy to spot. Trigger >> routine >> reward. It’s always the same pattern. And your patterns, though unique to you, are also easy to spot. You just have to be looking. I’ve compiled a list of common signs of burnout. These physical, mental, emotional, relational behaviors signal you’re reaching the breaking point where your system (being your life) can no longer withstand the stress of the environment. You’re a bridge just waiting to collapse.

Signs you’re approaching burnout (based on research + personal experience):

1 Trouble sleeping / falling asleep

2 Tension in back + shoulders

3 Headaches

4 Hard time waking up in the morning (even after a full night’s sleep)

5 Lack of interest in normal activities

6 Low energy

7 Trouble focusing / easily distracted

8 Trouble regulating behavior (outbursts, losing chunks of time to scrolling social media, unable to stop eating or turn off the tv)

9 Reversion to “default” behaviors (previous transformations start to unravel)

10 Easily overwhelmed

11 Down / depressed mood

12 Easily frustrated

13 Prone to ruminating on interactions with others

14 Crying more than usual

15 Trouble identifying “why” you feel sad, angry, tired, etc.

16 Pulling away from friends / family

And I’m certain I’ve missed some.

Now if you’re experiencing these “symptoms”, there is no need to panic. This is a diagnosis or anything like that. My hope is that by looking at this list you will see that some of the things you do that are just a “normal part of life” are actually signs that you aren’t handling the stress you’re under well.

See, it’s not a choice between “fun” and “well” – it’s the decision to raise the bar on what fun really is.

Take action

Don’t let this be something that becomes “oh that’s interesting” and on you go. Choose right now to set a higher standard for the “fun” you let in your life.

The greater the responsibility you have to perform at your best, the more resolute you must be in your standard for wellness. From your nutrition to your free time, the stuff you do needs to set you up for better performance. Your classroom, your clients, your patients – they need you operating at your capability. Which means they need you well, not the bare minimum of “functional.”

1 Take time to write down your personal signs of declining wellness and what you currently do to cope with it — scrolling, tv, declining invites, dessert, hyper-cleaning or organizing, etc

2 Choose one of your go-to habits for coping with stress and get curious about it. Every time you see yourself doing it or feeling the compulsion, ask yourself why that might be happening and observe does this actually make me feel how I want to feel? Am I really getting what I’m looking for?

3 Develop a routine or ritual to go through when it’s been a long day – something that will help you feel the way you really want to feel. Read more about this step here.

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]

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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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

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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.

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