Dopamine is the compound that fuels our drive and motivation. It increases attention, improves cognitive function, and stimulates our creativity. It makes us more social and extroverted and helps us form romantic and parental bonds. However, dopamine, when too high, can also have its drawbacks.
We provide a table of foods – LIGHT FOODS may help stop hair pulling and DARK FOODS may hinder it.
— Read on www.charizmatic.com/trichotillomania/trichotillomania-and-diet-the-john-kender-diet/
It’s been a while since I checked in and talked about my pulling. Perseverance though this uphill battle is not easy. Everyday I need to make a conscious effort to resist the urge to pull. Some days are good and I barely pull, while other days it seems I can’t stop. I still hope to be pull free one day, but accept where I am and see this as a process. It’s so engrained in my being that I don’t even know what life is like without pulling. I’ve had short remission periods, but never more than a few months.
I refuse to give up or become complacent. If I didn’t try I’d have way less hair so in a way I’m making progress. My recovery includes acceptance of my current situation and faith that it will change through awareness, commitment, helpful behaviors, following my rules (see below) a positive attitude, balance, mood stabilization, barriers, the John Kender diet, and supplements.
I had given up on the supplements because of some stomach issues which have resolved. I’m going to try my regimen of NAC, inositol, and the John kender diet again. I’ll also resume charting my pulling as that has always helped with my awareness. I’ll be checking in periodically with updates on my current supplements and pulling progress. I’ll use my daily score of 0-10 to rate my pulling. I’m going to post my supplement plan and rating system for anyone looking to follow it. These two tools have helped me most over my 25 years of battling trich.
The John Kender Diet
Basically , it’s a nutritional and skin care approach. First, try not eating sugar, caffeine, and chocolate. Have some dry red wine or uncaffinated tea instead. These should have an effect in about two or three days. Then, avoid peanuts, chickpeas beans, egg yolks, tuna, and waxes. These should have an effect in about 10 days. Take magnesium gluconate, and take borage oil. Use Shampoos with selenium (Selsun) or Nizoral. Keep a food diary to help you track your own particular triggers. Keep your hair and hands clean. Wash your lashes with baby shampoo hot compresses. Watch out for pet fur. Apply fresh cut ginger, or miconazole nitrate cream, or propylene glycol/aloe vera/rubbing alcohol, or eyewash/vinegar. Use Sea Breeze or Band-Aid Anti-Itch gel for emergency hot spot care.
I take NAC (N-acetylcysteine) 3- 600mg capsules of NAC (N-acetylcysteinen) in the morning and 3-600mg capsules in the evening, giving me a total of 3600mg of NAC. Doses between 1200-3600mg may be helpful according to this article.
It is generally agreed that a large dose is needed for inositol to be effective with trich. I worked my way up to 18g per day. I do this by mixing 3 teaspoons or 1 tablespoon of inositol in water 3 times a day. I have found the Jarrow brand powder dissolves best. It is available on amazon for a reasonable price. I mix it with warm water as it dissolves better that way. You can add it to fruit juice or other sweetened drinks. I simply mix the powder with ~3 oz.
#1 Where Bandaides or other barriers whenever possible, if not wearing them use fiddle toy /keep hands below neck and BE AWARE.
#2 Avoid mirrors. Don’ t stand close, do makeup quickly, avoid touch ups or unnecessary glances.
#3 Keep hands off of face. Don’t touch hair or eyes. Use only one finger or utensil if need to itch or touch eye/head and don’t linger. BE AWARE.
#4 Change activity when triggered before pulling begins.
#5 When stressed find way to take a break and relax (at least 1 minute deep breathing break).
Rating my Progress
Good Days 0-3
3 = 10-20
9=too many/couldn’t count
The changing seasons effect my moods in a noticeable pattern. Very often winter or even fall bring on depression which last though the spring. I slowly climb out of depression only to land in a hypomanic state, which often begins in the springs and worsens in the summer.
Once again, spring brought on a hypomanic episode that worsened in the summer. Stress, changing schedules, change in sunlight and activities all bring on these mood swings. I just read this blog about fighting summer mania. Here’s to a balanced life. Now I’m going to sleep because I know sleep and a consistent schedule are an important part of my self care. ☀️ 🏖🧜🏻♀️💦💛
While you can’t change the seasonal shift to longer days, you can make subtle lifestyle changes, such as regulating sleep, to sidestep summer mania.
Photo: Merlas/Getty Images
By Brittany Sibley
The days are longer and the sun is shining the brightest in a while. For a person diagnosed with Bipolar I in 2006, the mere transition to long, luminous days and shorter nights causes more anxiety and nervousness than usual.
The change of seasons has caused me plenty of manic episodes in the past. I have since learned seven solid solutions and tips to help combat the symptoms of seasonal changes. These tips help in staying clear of an inpatient hospital visit during what most consider the best months of the year. I hope they are as effective for you as they have been for me.
It has been essential for me to always get enough rest. However, with Daylight Saving Time and longer, shinier days, an additional burst in energy is never too far away. Although it almost always feels wonderful, and causes you to want to get more done, stay out longer, possibly accomplish a few more things in 24 hours…DON’T!
While the feeling of more energy is real and feels great, falling away from your regular sleep regimen is never a good idea, especially when the season of mania approaches. In fact, one should definitely keep the regular sleeping hours and if anything changes, let the hours increase, and not the opposite.
2. Eat Healthy
Eating healthy and making healthy eating decisions regularly is something I still struggle with. Yet I have experienced the benefits of eating salad instead of a deep dish pizza several times. You are what you eat! Eating more veggies, fruit, and lean meats instead of processed foods regularly, and especially during manic season, makes a difference. You will feel a difference in your skin, your mood, and even your waistline.
3. Take Deep Breaths
Taking deep breaths when stressed, tired, upset, angry, unfocused or even irritated helps. Try deeply inhaling through your nose and exhaling through your mouth in sets of 3. This is also a good tool because it requires nothing but reminding yourself to do so in times of sudden distress.
Take time out of your day, (first thing in the morning works best for me), and remind yourself of who you are besides your diagnoses.
Remember that you are loved and worthy of all the great things that day has in store for you.
Since I am a Christian, it helps me to remind myself that I am never alone because the Holy Spirit, who my Savior promised to send when he left, is with me no matter how lonely I may feel.
5. Take Breaks
The sudden burst of energy one may experience from the sunnier days and more exposure to the sun in general can trigger the want to complete more tasks—and this can be alright, as long as you remember to take breaks.
It helps to remember that this new energy feels good, but is coming from an unbalanced source.
Doing too much in 24 hours with little time to break or rest can cause the onset of a manic episode.
6. Watch Alcohol Intake
5 years ago in 2013, I had an inpatient hospital visit that can be directly attributed to the large intake of hard alcohol consumed two nights before. I simply drank way too much that night.
With spring and summer come more festivals, barbecues, beaches, and let’s admit it—booze.
Monitoring alcohol intake during these seasons is a must! If you still are not sure when you have had enough, take it slow. Yes it can be a bit lame being the responsible one at the party, but I promise, your freedom will thank you later.
7. Cover Bedroom Windows Heavily
The day before Daylight Saving Time, try covering your bedroom window with a dark-colored blanket. The blanket will work as a shield to the bright rays of sun in the morning.
Although longer, sunnier days are always welcome, adjusting to the initial change while having a mental health condition can be traumatic.
The dark blanket helps ensure your sleeping pattern is not interrupted so blatantly. It also allows your body to tell you when it has had enough sleep.
I hope these seven tips are as helpful for you as they have been for me over the past several springs and summers.
Let’s do our best to have a safe, healthy and stable summer while enjoying the sunnier days and moonlit nights. Remember, mental health is just as important as physical health. Until next time…Happy Summer!
Dopamine is the compound that fuels our drive and motivation. It increases attention, improves cognitive function, and stimulates our creativity. It makes us more social and extroverted and helps us form romantic and parental bonds. However, dopamine, when too high, can also have its drawbacks.
- A Summary of What Dopamine Does
- How to Increase Dopamine
- The Dopamine Diet: An Ideal Diet to Increase Dopamine
- Lifestyle to Increase Dopamine
- Food to Increase Dopamine
- Supplements That Increase Dopamine
- 10) Tyrosine
- 11) Green Tea
- 12) Caffeine
- 13) Pregnenolone
- 14) Magnesium
- 15) St. John’s wort
- 16) Gingko
- 17) Curcumin
- 18) Butyrate
- 19) Folate
- 20) Huperzine A
- 21) SAM-e
- 22) Shilajit
- 23) Uridine
- 24) Fish Oil
- 25) Ginseng
- 26) Danshen
- 27) Resveratrol
- 28) Oregano
- 29) Carvacrol
- 30) Clary sage
- 31) Bacopa
- 32) Mucuna pruriens
- 33) Catuaba
- 34) Rosemary
- 35) Kava
- 36) Lactobacillus plantarum
- 35) Fresh Cut Grass/Essential Oils
- 36-41) Flowering Quince, Psoralea coryfolia, Mycoleptodonoides aitchisonii, Blue trumpet vine, Prickly nightshade, Gardenia jasminoides
- Hormones that Increase Dopamine:
- Dopamine Drugs/Agonists
- Decreasing Dopamine
- Are You Struggling With Chronic Health Issues?
Cutting-Edge Solutions For a Better Life
— Read on www.selfhacked.com/blog/ways-to-increase-and-decrease-dopamine
Thank you God for these able hands that shoveled many feet of snow. My poor van was almost lost for good, but with help from my wonderful husband we saved her.
Now I rest. I’m thankful for this ‘Mommy break’. I gave myself a manicure. I am happy even though they are short. I broke four nails in the process of shoveling and putting outside clothes on and off four kids about a hundred times.
A little me time and pampering goes a long way. It was a much needed 30 minute break while my three big kids played outside and baby Rachel napped. Thank you God for moments of rest and peace. #simplepleasures #girlygirl
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.
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
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.
– 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:
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).
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.
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:
- An increased awareness of when, where, and why hair pulling occurs.
- An effort to control or change hair pulling behavior.
- Emotional regulation training to find alternative ways of dealing with negative feelings.
Here’s how I use these scientific findings to treat trichotillomania.
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.
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.
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:
- It cannot be taken together with Lithium, as it seems to block its action.
- 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.
- 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.
- 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.
- 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.”
Treating the Whole Person:
A Personal User’s Guide
By Renae M. Reinardy, PsyD., LP
There are many different ways for us to understand our experiences in life. I have not found it helpful for clients to be overly harsh or punishing in their efforts to produce the changes they want to make. Rather, it is good practice to take a comprehensive, wise and compassionate approach toward getting unstuck on the path to change. Everyone’s path is different, so I want to offer a few tips that might help you to write your own Personal User’s Guide. This includes taking care of your mind, body and spirit in a comprehensive manner, which I will briefly outline in this article. Please have a pen and paper handy for taking notes as we go along.
Before reading on, take a few minutes to write down what your pulling or picking means to you. Questions to help you start include: How did this journey start, what directions has it taken you in, what have you gained and what do you feel like you have lost, what works, what doesn’t, when did the behavior start, and what function does it serve?
The way that I conceptualize BFRBs is that they are like a friend who is trying really hard to make a person feel better, but they do not offer the best advice. Pulling and picking are often ways for one’s body to sort out sensory, emotional, cognitive, spiritual, and physical deregulation. This friend may offer some quick relief or distraction from these experiences, but often there are no lasting gains. Rather, it can lead to a vicious cycle of behavior which can feel out of control.
Somewhere along the way, many people lose track of what they need and have stopped listening to their inner core. Instead, they tried to quiet it with distracting and impermanent forms of relief or pleasure. Let’s look at a few components of the Personal User’s Guide to see if it is helpful in hearing one’s self better.
One of the first things that I work on with my clients is the “pillars of health”. This is learning how to take care of one’s body through proper nutrition, sleep, exercise and general self-care. Again, if a person has any deregulation in their body, there is a good chance that the BFRBs will pick up on that imbalance and try to fix the problem. Let’s try in a new way, by looking at what might be contributing to the problem in the first place. Please ask yourself to honestly answer the following questions:
Nutrition: What do I eat?
List some typical items you consume on a daily basis for the following meals:
Exercise: How and when do you exercise?
Sleep: What time do you wrap up your day?
How long does it take to fall asleep?
Do you wake up at night?
What time do I wake up in the morning?
Well, how does it look?
If you are like most of us, at least some improvement can be made in how we care for our bodies. Perhaps there are one or two things from the lists above you’ve always wanted to change, or believe if you COULD change, it would help with your BFRB management. Can you identify one small difference you could make to begin?
Over the past few years, there has been more research to support the role of nutrition in BFRBs, including sugar intake, and dietary supplements. Some people have had great success with the supplements N-acetylcysteine (NAC) and/orInositol (B- vitamin) decreasing urges to pick or pull. Work with your healthcare provider to determine if these might be appropriate for you. I have also found that my clients experience great benefit when sugar intake is reduced.
In our typical diet, we are often starving for good nutrients. Our diet must contain 5 essential items to be truly healthy: carbohydrates, proteins (1/5 of our calories), fats, water and minerals. Amino acids are the building blocks of protein which plays a role in every cellular function of the body. Out of 20 amino acids present in the body, 9 are essential, meaning that they must come from diet. Clinical nutritionists have found that deficiencies in B1, B2, B6, folate, B12, C, magnesium and zinc are related to a number of mental health conditions. Since many people do not get what they need from their diet, vitamin supplements are often needed in addition to dietary changes. Be sure to get a good natural vitamin that your doctor approves.
The “E” word. Research has proven the mental health benefits of exercise. It is believed that exercise stimulates the production of endorphins—the feel good hormone. Serotonin, dopamine, and norepinephrine are also released during exercise. (Do these sound familiar? Yep, these are same chemicals that are targeted with many psychotropic medications.) Other benefits of exercise include improved blood flow, increased brain function, increased oxygen, and removal of toxins through breathing and sweat. Time to dust off those shoes with the laces. Start gradually and set realistic goals. For example, if you’d like to exercise more, maybe start with just ten minutes of exercise every day. Ten minutes of walking at a faster pace, ten minutes of jogging, ten minutes on the treadmill or the elliptical….then when that gets easy, add five more minutes. Before you know it, you are exercising for an hour. Talk to your doctor if you have any medical conditions that would restrict exercise.
Sleep is another thing we all know is important, yet is one of the first things to go in our busy schedules. The average adult needs 7-9 hours of sleep each night. Research suggests that people who do not get adequate sleep tend to live shorter lives than those who do. Chronic sleep deprivation also leads to increased risk of obesity, diabetes and heart disease. When we sleep, we produce extra protein molecules to help us fight off infection, stress and toxins by helping the immune system mend our bodies. Take good care of your body and your body will take good care of you. Again, remember that picking and pulling serve a function. If any of these areas are out of whack, you may notice urges on the rise in attempts to self regulate.
Take the time to evaluate your pillars of health. When we rush things, they tend not to be effective. In working with my clients, I’ve found that focusing on the pillars of health can be a big factor in getting someone unstuck when a traditional behavioral and cognitive plan are not enough.
How I Live My Life
Another piece of the Personal User’s Guide that I want to cover in Part One is how we live our life. So many times people plow through the day, just to work toward another goal—the weekend, a long-awaited vacation, or milestones such as graduation, retirement, etc. Yikes! There is often quite a bit of time spent waiting for something good to happen!
Draw two circles in your notebook. Label one circle “real Life” and the other circle “Ideal Life.” In each circle complete a pie chart: one on how you spend your typical day and the other on how you would like to spend your day.
How do they compare? Is there anything that you can take from your ideal and build into your everyday/real life? It is important to take time now to spoil yourself a bit—listen to music, get and receive hugs, sing, pet an animal, smile, pray, make good wishes for others, take a nap, get a massage, acknowledge yourself and your accomplishments, or try to find a quiet place to rejuvenate. We often cannot live every moment in the ideal, but it is good to not get stuck in long patterns of unfulfillment.
Can you think of a few ways you can incorporate goals from your ideal life into your real life? Write them in your notebook.
Okay, one more thing to think about in Part One of your Personal User’s Guide: Spirituality.
Pretty big topic and I am not talking about religion, although that can fall into this category. Focusing on one’s spirituality involves developing an inner life to experience greater connectedness through practices such as prayer, meditation and contemplation. These practices help us to experience a more comprehensive sense of self and the interrelatedness to others, nature and/or religious experiences. Recent research has shown the medical and emotional benefits of these practices including a more complex range of brain activity, stress relief, decreased heart rate, improved lung capacity, and decreased anxiety, to name a few. Please take a few moments and think of how you might summarize your spiritual life.
My Spirit: Take some notes on the following questions
What gives me inner strength and connectedness to things outside of myself ?
How can I build on this?
In Part Two of the Personal User’s Guide, we will discuss emotions, thoughts, and behavioral strategies that can help give your body what it needs. By learning and listening to ourselves it is possible to improve one’s overall well-being and decrease undesirable behaviors and patterns. In the meantime, best wishes in reinforcing or changing any experiences that you may have realized in completing.
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 http://www.lakesidecenter.org.