Tag Archives: Dermatillomania

Persistence not Perfection

Trichy Insights

Let’s strengthen those weak muscles!  

Just persist until you are successful!

My solace tonight as I persist in my journey to recovery from trich comes from comments of some of the people on the Fairlight Bulletin Board posted on Amanda’s Trichotillomania Guide.

Definition of Success

I just wanted to add another observation to all that has been said about making a commitment to not pulling. Think of it as exercise. When I started walking a couple of months ago, I thought a mile was forever. Now that I’ve been walking regularly, my stamina has increased, and a mile goes by quickly. I can’t run a marathon (yet!), but I am stronger. In the same way, as we practice not pulling, we’re building “muscles” that make it easier not to pull. The first couple of weeks are horrible, but then it gets easier–if you persist. I’ve slipped a couple of times…

View original post 924 more words

Treating the Whole Person

imageTreating 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:
Breakfast
Lunch
Dinner
Snacks
Caffeine
Vitamins:
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.

This is part 1 of a two-part article. Read part 2, here >>

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.

 

 

BFRB (Body-Focused Repetitive Behavior)

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

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

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

Why are they not considered self-harm?

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


Common Types of BFRBs

 

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

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

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

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

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

Other BFRBs include:

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

Who is affected and when does it typically develop?

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

Why do I pull or pick?

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

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

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

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

Reflections: Peace

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

It’s quite natural to crave a feeling of peace.  This is true whether you are experiencing a significant mental health issue, coping with a personal crisis such as a divorce or the death of loved one, or just trying to effectively manage the vicissitudes of every day life.  If you have Skin Picking Disorder or Trichotillomania, peace is likely something you have been “wishing” for throughout your struggle.  Of course, it would be wonderful if a feeling of peace would descend upon us just by wishing for it.  But in reality, peace requires action. If you are committed to finding peace, you must wholeheartedly agree to do the work involved in attaining it.

Sometimes, the urge to pick or pull can be so powerful that you might find it difficult to even have a few moments of peace.  In many ways, peace is a function of acceptance, in that it requires you to accept reality as it is, rather than as you would like it to be.  Some with Dermatillomania or Trichotillomania describe urges as being like a loud sound that can’t be ignored – as if someone has turned the volume of the urge up so high that it is the only thing you can pay attention to.  In order for you to move through and past this extremely distracting urge, the first thing you must do is to fully accept its existence.  If you spend your time attempting to control or avoid your picking and pulling urges, all you are doing is spending time engaging with something you simply cannot control.

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

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

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

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

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

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

Written by
Kelley Franke, BA and Tom Corboy, MFT
© 2014 OCD Center of Los Angeles

Refections: Willingness

The goal of willingness is to feel all of the feelings that come up for you more completely, even – or especially – the bad feelings, so that you can live your life more completely.   ~ Steven Hayes

Quite often, those struggling with Dermatillomania or Trichotillomania have developed picking and pulling in an effort to control or avoid uncomfortable emotions.  Engaging in these impulsive behaviors provides a way to “check out” emotionally, and gives the sufferer temporary relief.  But the more unwilling you are to feel your uncomfortable emotions, the more suffering you will actually experience.  For example, if you pick your skin after a stressful day at work, you may briefly escape reality, but you will likely be more distressed because your skin will be bleeding, and your feelings of self-loathing will be in overdrive.  When you are “unwilling” to experience your uncomfortable feelings, you are making the decision that certain feelings are intolerable.  Conversely, when you are “willing” to accept all feelings, even – or especially – the “bad” feelings, you make the decision that your feelings are, in fact, bearable.

One helpful way of viewing willingness is as a stance, or a point of view, that a person chooses.  Willingness means you are choosing to make room for, and agree to let your self have, all of the unwanted inner experiences that are a part of Skin Picking Disorder and Trichotillomania – all of the uncomfortable thoughts, feelings, sensations, and urges. You will experience many of these uncomfortable inner experiences throughout your recovery, which is why it is so important that you be “willing” to accept all of them as a normal and expected part of the journey.

Willingness is also an action that you take.  Willingness means you are willing to take any necessary or appropriate action, even (or especially) if that means not picking or pulling when you have strong urges, or when you are experiencing very uncomfortable thoughts, feelings and sensations.  Willingness also means that you are willing to take proactive steps to respond more effectively to all of these unwanted inner experiences. That may mean using logs, habit blockers, or other behavioral techniques that have been found to be so helpful in the treatment of these conditions, even if doing so is irritating, time-consuming, or just plain uncomfortable.

Ultimately, willingness is a vital skill for real recovery from Skin Picking Disorder and Trichotillomania.  It is a skill that helps you to choose to experience all of life – the bitter and the sweet – and to take healthy actions, even when doing so isn’t the easiest way to respond to the curve balls that life throws you.

1. In what ways do you currently practice willingness?

2. What thoughts, emotions, sensations, and urges are you truly willing to experience in order to recover?

3. Once you have decided on what you are willing to experience, what actions are you willing to take to ensure that you reach your goal?

Tip of the week: Notice throughout the week when you are, and are not, truly willing to experience all of your uncomfortable thoughts, feelings, sensations, and urges related to picking or pulling.  Keep a log of these times, and ask yourself what actions you are willing to take to more effectively respond to these uncomfortable inner experiences.

Written by Kelley Franke, BA and Tom Corboy, MFT
© 2014 OCD Center of Los Angeles

 

Just Allergies…?

In my research I have been looking into John Kender’s idea that people with trichotillomania have a natural biochemistry irreversibly inclined towards certain allergic reactions. They are allergic to a normal yeast (Malassezia) that is found in the skin and gut of virtually everyone, but they react to it with itching and irritation and a need to remove the allergen. I have posted an insightful article below.

Trichotillomania and Dermatillomania: A root analysis

 with special thanks to Jeannette Johnson for her kind advice and attention. 

Hair roots contain sebum.  Sebum contains fatty acids and tryglycerides, and plays a role in some crucial body functions, such as hydration, inflammation, antioxidants, antimicrobial lipids, and pheromones.  Sebum levels increase during puberty and excessive levels of sebum are often associated with skin problems, making it relevant to skin picking and hair pulling.

Why is this so relevant?  You probably know that the body’s energy levels revolve around its production and use of insulin. a hormone which regulates fat and carbohydrate metabolism.  It is insulin which prompts cells to absorb glucose from the blood. In fat cells, glucose it is stored as triglycerides .. see above paragraph for relevance of tryglycerides.

A normal skin yeast, Malassezia, may be overgrown in people with trichotillomania and dermatillomania.  Overgrowth of malassezia is linked to higher levels of oleic acid in the sebum, which we think is caused by a delta 6 desaturase deficiency.  According to wikipaedia, Malassezia is related to most skin disease in humans, certainly to eczema and acne.  Malassezia growth depends upon the presence of fats, and sebum, which you will recall is present in hair roots.

Relevant Testing

Pickers and pullers may benefit from an essential fatty acid (EFA) analysis, particularly looking for elevated arachidonic acid and suppressed dihomo-gamma linoleic acid;  These  could contribute to a number of conditions such as irregular hormone production, insulin instability and prostaglandin problems.

Our research at Trichotillomania Support UK reveals that many women experience worsening symptoms of trichotillomania during ovulation, which is also often delayed.  it is very likely that a sebum/malassezia imbalance is the cause, as ovulation affects EFA conversion to prostaglandins. To balance prostaglandin-to-estrogen ratio, a wild yam cream (progesterone cream) could be used on the skin prior to ovulation.  Keep thorough records of your menstrual cycle and your pulling or picking.  Apply the cream one or two days before ovulation, around the time when your estrogen levels should begin to decline and progesterone levels increase.

Diet

Evening Primrose oil supplementation may help, because it is rich in GLA, which would be low in the case of delta 6 desaturase deficiency.  Consider eating tahini or whole sesame seeds, as these may help prevent over-action of delta 5 desaturase.

To give the body what it needs to make delta 6 desaturase, a diet rich in magnesium, zinc, and vitamin B6.  Avoid high-oleic acid oils on your skin, such as olive oil and jojoba.  Coconut oil is also a high oleic acid but may be ok as it is also high in lauric acid.

Take a good  probiotic daily. 

SKINCARE

Try a liquid probiotic scalp treatment, such as a goats milk kefir scalp rinse

GOATS MILK SOAP/SHAMPOO

For those of you who enjoy home made solutions, search online for a goats milk soap or shampoo recipe.  This old remedy for psoriasis/eczema is based on fact.  Goats milk is high in lauric acid, which has potent anti-fungal properties: Use sesame oil instead of olive oil, and add some chamomile, and/or other anti-fungal herbs in the infusion. Cloves/clove essential oil also have an anaesthetic effect that might help with the itching or more subtle sensations that feed the urge to pull or pick. Use cloves with caution – and please don’t get the mixture in the eyes!

UNLESS OTHERWISE STATED, NONE OF OUR SKINCARE SUGGESTIONS SHOULD BE USED AROUND THE EYES.

http://charizmatic.com/dynamic/self-control/overcoming-obsessions/bfrb-freedom/trichotillomania-and-dermatillomania-a-root-analysis