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A Novel Way to Improve Trichotillomania

A Novel Way to Improve Trichotillomania

We talk a lot about using amino acid therapy to help correct underlying neurotransmitter imbalances to help people overcome trichotillomania and other disorders related to neurotransmitter imbalance, such as depression, anxiety, OCD, ADD/ADHD, migraines, obesity, fibromyalgia and insomnia. However, recent research has shown that you may be able to fine-tune your neurotransmitter levels by using the right combination of probiotics.

Probiotics – good for your (brain) health

Probiotics are the “good” bacteria that normally reside in your gut. It is known that if these bacteria become imbalanced in some way (due to illness, improper diet or toxin exposure), a condition called “dysbiosis” results, which can have many dire consequences including decreased immunity, improper immune function, food allergies, inflammation, indigestion and numerous other physical disorders. However, until recently it was not known that these bacteria can also generate neurotransmitters that can also affect your brain, impacting your mental and emotional states.

Researchers at Texas Tech University Health Sciences Center found that the following bacteria can produce neurotransmitters in the gut:

Bacteria Neurotransmitter
Lactobacillus, Bifidobacterium GABA
Escherichia, Bacillus, Saccharomyces Norepinephrine
Candida, Streptococcus, Escherichia, Enterococcus Serotonin
Bacillus, Serratia Dopamine
Lactobacillus Acetylcholine

This could mean that the microbial balance in your gut could be a key player in improving and maintaining your neurotransmitter levels, and therefore alleviating the urge to pull. It also provides more scientific evidence for something that we routinely see in the clinic. Many people with gastrointestinal disorders develop or have one or more disorders related to neurotransmitter imbalance and that correcting the underlying gastrointestinal disorder is imperative to long-term recovery. Think of it like this, the gastrointestinal disorder (like IBS, Crohn’s disease, food allergies or Celiac’s disease) is like a hole in a bucket, causing neurotransmitter levels to decline (or become imbalanced). In order to fill the bucket back up (using amino acid therapy) over time, you have to first fix the whole.

Certain gastrointestinal disorders create neurotransmitter imbalances through inflammatory, immune or genetic influences. This research provides another potential way to explain, and address, the resulting neurotransmitter dysfunction. Obviously, more research needs to be done to define just how this can be useful in real life, but for now, it seems logical that anyone that suffers from trich or other disorders associated with neurotransmitter imbalance must heal any underlying gut issues while restoring proper neurotransmitter balance using amino acid therapy to achieve long term success.

http://stoppullinghairout.com/blog/2011/12/22/a-novel-way-to-improve-trichotillomania/

Amino Acid Therapy and Trichotillomania

Amino Acid Therapy and Trichotillomania

Amino acid therapy can be very effective at restoring proper neurotransmitter function and alleviating the insatiable urge to pull that some many people with trichotillomania experience. There are really two ways in which amino acids are used for people with trichotillomania. The first is to use n-acetyl cysteine, or NAC, which has been shown in clinical trials to reduce the urge to pull in about 56% of people that use NAC (see our post entitled N-acetylcysteine and Treatment of Trichotillomania for more information). NAC is thought to work by increasing the concentration of glutamate (an excitatory neurotransmitter) in a part of the brain that reduces compulsive behavior and hair pulling. Glutamate works in conjunction with GABA (an inhibitory neurotransmitter) to control many functions in the body. Thus, NAC provides a safe and moderately effective strategy to use amino acid therapy to decrease the urge to pull associated with trichotillomania.

However, we have found that a more effective way to implement amino acid therapy in regards to trichotillomania is to address the serotonin/dopamine system. By providing the brain the proper proportion of the necessary amino acid precursors and cofactors necessary to achieve optimal serotonin and dopamine function we have had an 86% success rate with eliminating the urge to pull, as opposed to just reducing the urge to pull.

This increased success rate is attributed to the fact that dopamine exhibits control over the release of glutamate and GABA in certain parts of the brain. Therefore, the imbalance between glutamate and GABA that leads to trichotillomania in most people is likely to be caused by an imbalance with dopamine and serotonin (as they are farther upstream). By optimizing serotonin and dopamine function, all the systems downstream, including glutamate and GABA normalize as well. When this happens, the urge to pull disappears.

Another key distinction between using NAC or this balanced amino acid approach is the ability to remain symptom free once the amino acid(s) have been discontinued. With NAC, the urge to pull often returns once the supplement is discontinued (this provides further evidence that NAC may not be addressing the root cause of the imbalance). However, with balanced amino acid therapy we have found that once optimized neurotransmitter function is established and maintained for a period of time, most people can reduce or eliminate the amino acids and remain symptom free utilizing dietary and lifestyle factors to maintain optimal neurotransmitter status. This means that it is very likely you won’t have to take these supplements forever and you can remain trichotillomania-free. This occurs because we are addressing the underlying root imbalance that seems to lead to the urge to pull for most people with trichotillomania. By correctly the underlying neurotransmitter imbalance with balanced amino acid therapy you effectively eliminate the problem, which allows you to stop pulling your hair out.

Source:

http://stoppullinghairout.com/blog/2011/12/15/amino-acid-therapy-and-trichotillomania/

5-HTP vs Tryptophan

5-HTP vs Tryptophan

Both tryptophan and 5 HTP are amino acids and precursors of serotonin. They are also both available as over-the-counter dietary supplements for treating depression, obesity, sleep disorders etc. Find out which of the 2 is the better supplement for increasing serotonin levels in the brain.

What is Tryptophan?

Tryptophan is one of the essential amino acids commonly found in human diet. It is available in 2 forms: D- and L- isomers.

The L- isomer is more common and it is the form of tryptophan found in proteins in the body.

Tryptophan is found in most dietary proteins but it is especially abundantly found in meat, poultry, milk, yogurt, egg, fish, banana and peanut.

While some believe that turkey is the richest source of tryptophan and plants are poor in the amino acid, both beliefs are untrue: turkey contains no more tryptophan than other poultry and meat, and excellent plant sources of tryptophan are abundant.

Even though there are several dietary sources of L-tryptophan, different studies have found that these food sources cannot dramatically increase the blood levels of the amino acid. Therefore, tryptophan is widely sold as a dietary supplement and even drug.

As a drug/supplement, L-tryptophan is used because it is a precursor of serotonin, an important neurotransmitter in the brain. L-tryptophan is first converted to 5-hydroxytryptophan or 5 HTP (another dietary supplement) which is then converted to serotonin or 5 HT in the brain.

However, these biochemical reactions happen in the brain, therefore, tryptophan has to cross the blood-brain barrier.

L-tryptophan only represent about 1% of the amino acids available in dietary proteins. Since the other amino acids also want to get into the brain, there is a competition for the transport mechanisms that carry them across this blood-brain barrier.

For example, L-tryptophan shares the same transport mechanism with valine, leucine and isoleucine.

Therefore, the extent of absorption of this amino acid is much reduced especially from protein-rich foods. To improve the uptake of tryptophan into the brain, carbohydrates are required.

After the ingestion of carbohydrates, the body releases insulin in response. Fortunately, insulin drives valine, leucine and isoleucine (but not tryptophan) into the cells of the body. Therefore, the proportion of tryptophan among the amino acids left in the blood is increased and this increases the chances of tryptophan crossing into the brain.

The use of tryptophan as a dietary supplement was banned for most of the 1990s. This is because of cases of eosinophilia-myalgia syndrome (EMS) associated with the amino acid.

This syndrome was blamed on bacterial contaminants left in the final product by one major supplier of the amino acid. This was never conclusively proven and some other experts believe that the large doses of tryptophan taken are responsible (tryptophan metabolites block the breakdown of histamine and the symptoms of EMS resembles the effect of prolonged action of histamine).

However, tryptophan is now commonly sold as dietary supplement and drug. It is obtained from high-quality sources and regarded as safe.

What is 5 HTP?

5 HTP is a naturally occurring amino acid produced from L-tryptophan. There are no dietary sources of 5 HTP although the 5 HTP used in supplements is obtained from the seeds of Griffonia simplicifolia, a plant native to Africa.

5 HTP is a direct precursor of serotonin and an intermediate in the synthesis of melatonin, a neurohormone.

The conversion of 5 HTP to serotonin is catalyzed by 5 HTP decarboxylase, an enzyme whose cofactor is vitamin B6. All the effects of 5 HTP are solely due to its ability to increase serotonin levels in the brain.

However, 5 HTP is also converted to serotonin in the liver. In fact, more serotonin is produced outside the brain than inside. But since serotonin cannot cross the blood-brain barrier, only the amount of 5 HTP crossing into the brain can increase the level of serotonin in the central nervous system and also the psychoactive effect of the neurotransmitter.

The serotonin produced outside the brain is released from the enterochromaffin cells found in the gastrointestinal tract. In the gut, serotonin promotes intestinal motility.

The excess serotonin released from these cells are removed by the veins draining the gut. While in the blood, serotonin is carried through the circulatory system and stored in platelets. Therefore, the serotonin produced from 5 HTP can reach the cardiovascular and musculoskeletal systems.

5 HTP is commonly sold as a dietary supplement and marketed as a sleeping aid, antidepressant and appetite suppressant. It is usually prepared in 50 mg and 100 mg capsules.

Besides the uses listed above, 5 HTP is also taken to treat fibromyalgia and anxiety disorders.

Although 5 HTP supplementation has not been extensively studied in large clinical trials but in the 60 years that it has been used, there are only very few reports of serious side effects.

Moderate doses of 5 HTP is safe and well tolerated but it may cause vomiting and diarrhea. These gastrointestinal side effects are due to the increased production of serotonin outside the body. When released from the enterochromaffin cells, the increased serotonin levels increase gastrointestinal movement.

5 HTP supplements were also believed to cause EMS due to contamination during production. However, such cases have not been reported since FDA’s GMP (Good Manufacturing Practice) regulations came into place.

The Differences Between 5 HTP and Tryptophan

Although tryptophan and 5 HTP are both amino acids and used as dietary supplements for the same indications, they do differ. The major differences between these 2 precursors of serotonin are discussed in the table below.

5 HTP vs Tryptophan

Precursor: 5 HTP is the direct precursor of serotonin and an intermediate in the synthesis of melatonin while tryptophan is the direct precursor of 5 HTP. In addition, tryptophan is also used in the syntheses of other biochemicals including niacin, proteins and enzymes.

Source: The L-tryptophan used in dietary supplements is obtained from the bacterial fermentation of serine and indole. 5 HTP is extracted from the seeds of Griffonia simplicifolia, a wild plant native to Ghana and Ivory Coast.

Uses: Both 5 HTP and tryptophan are used to treat diseases arising from serotonin deficiency including depression, anxiety disorders, sleep disorders and obesity. However, L-tryptophan is also used to treat tryptophan deficiency since it is the one among other essential amino acids that is most commonly deficient in diet.

Administration: Because nausea is a common symptom of 5 HTP supplementation, it should be taken with food. Tryptophan, on the other hand, can be taken with or without food. However, since tryptophan competes with other aromatic and branched chain amino acids such as itself, it is best to take the supplement with low or no protein diet but with carbohydrates to help reduce the competition.

5 HTP is a better supplement than L-tryptophan for increasing serotonin levels in the central nervous system because of the following reasons.

Why 5 HTP is better than L-tryptophan5
  • It does not compete with other amino acids to cross the blood-brain barrier
  • The conversion of tryptophan to 5 HTP is the rate-limiting step in the synthesis of serotonin; this means that this conversion is the weakest link in the production of serotonin. Therefore, 5 HTP supplementation represents a bypass of this step in the synthesis of the neurotransmitter
  • Tryptophan is an amino acid that is also utilized in the production of other biochemicals while 5 HTP is solely committed to the synthesis of serotonin
  • Tryptophan is more likely to be converted to serotonin in the liver than 5 HTP. This happens because 5 HTP faces no competition to cross into the brain, therefore, it is easily taken up. Tryptophan, on the hand, is easily converted to serotonin in the liver while it waits to cross the blood-brain barrier
  • 5 HTP is obtained from plant sources while L-tryptophan is produced from bacterial fermentation; therefore, there is a lower chance of contamination in 5 HTP supplements (and thus, lower risk of EMS) than tryptophan supplement

“L-tryptophan works better with people who suffer from insomnia and depression. “Julia Ross author of The Mood Cure

Combining 5 HTP and Tryptophan

Because 5 HTP and tryptophan increase the level of serotonin in the body, some people may be tempted to use both supplements at the same time. This practice should be discouraged especially since it can dramatically increase the side effects of both drugs and cause serotonin toxicity.

Mild gastrointestinal side effects such as nausea, vomiting and diarrhea are immediately triggered.

Taking 5 HTP and tryptophan concurrently will increase the synthesis of serotonin in the liver and in the central nervous system. This may cause serotonin syndrome in the nervous system and cardiac fibrosis in the cardiovascular system

Of the two, serotonin syndrome appears first. It is characterized by the mild and serious symptoms. Mild symptoms include shivering, sweating, tremor, restless limbs and headache while serious symptoms include hypertension, hyperthermia, mania, hallucination and ataxia.

These symptoms will subside 24 hours after stopping both supplements but the more serious symptoms may need urgent medical attention.

Cardiac fibrosis is caused by high doses and prolonged use of drug combinations that increase serotonin levels.

In the circulatory and cardiovascular systems, serotonin acts as a vasoconstrictor and healing factor. It repairs damaged tissue by promoting the production of fibrins to cover the site of damage.

However, the kind of connective tissue caused by serotonin action is thicker and less flexible than normal connective tissue. This causes cardiac fibrosis and heart failure from thickened right heart valve.

Although these serious side effects of 5 HTP and tryptophan combination are rarely in medical literature that is mainly due to lack of large-scale and thorough clinical studies on the use of this dietary supplements.

Therefore, the potential for these side effects should be considered when 5 HTP is combined with tryptophan.

The Problem with Perfectionism

Although there is no scientific evidence that Trichotillomania is associated with any particular personality, perfectionism appears to be extremely common and often provides a real roadblock to recovery in a number of different ways. One common problem is the false belief that in order to stop pulling, all urges to pull must cease. It is highly unlikely that urges to pull will ever completely vanish. While one can attempt to decrease urges to a manageable amount (such as through medication or naturally over time with relative abstinence from pulling), the main goal is to manage the urges in a different manner than before. It is sometimes a giant leap in recovery when the hair puller realizes that they don’t have to pull whenever they have the urge.

Another threat to recovery comes when the puller experiences success with not pulling, then has a setback. The perfectionist in them says it is all-or-nothing, so they might as well give up. Virtually everyone successful in recovery from hair pulling has times, perhaps during periods of great stress or illness, some degree of relapse. It is hard for many not to feel that they are starting over again. One hour of pulling can mean the total loss of hard-earned lashes or brows-a bad week may result in a large bare area on one’s scalp.

The amount of hair one has at any given moment is not synonymous with the degree of recovery. It is important to realize that all that has been learned about how to stop pulling is not lost in that hour or week. Each setback is simply a new challenge to be figured out. Recognizing through trial and error that, for instance, premenstrual times are uniquely difficult or that studying for final exams inevitably leads to total loss of control allows one to build upon or add to the techniques learned or medications taken.

Yet another roadblock may come when hair starts to grow back. It is bound to be uneven, asymmetrical, stubbly, gray, or in some other way bothersome to the puller. These hairs are, after all, for many, what triggers the pulling in the first place. The urges then become stronger than ever and the tendency to feel or look at these “wrong” hairs has to be avoided in favor of changing the cognition that drives them in the first place. A number of techniques individualized for each puller can be used at that time. For instance, a person who craves symmetry may need to practice asymmetry in a number of areas to eventually tolerate asymmetry of hair (especially of eyebrows in many cases.)

Rather than hiding all imperfections as the hair puller generally spends much time doing, practicing appearing deliberately imperfect, and experiencing the real lack of importance this has in life, can be a helpful step. This needs to be done in hierarchical stages with the imperfections least important to the puller shown first and the hardest revelations put at the top end of the list.

Recovery, then, is a complicated process fraught with barriers-hidden or overt, real or imagined. Overall, it requires giving you time, effort, assistance, and forbearance. What does the recovered hair puller look like? A woman or man with imperfect hair, urges to pull, possibly occasional bouts of pulling, who has healthy relationships and a positive self-image and identity as a whole, worthwhile human being.

Full Article: Barriers to Recovery from Hair Pulling By Carol Novak

Carol Novak, M.D., is the founder of the Pioneer Clinic, specializing in the treatment of Trichotillomania and Obsessive-Compulsive Disorder. She has treated approximately two hundred hair pullers.

A Fool Proof Plan for Recovery

Below I’ve posted a fantastic blog post by Claudia Miles MFT, a psychologist who specialises in Trich & CSP. The original post is on her blog “help for hair pullers”: http://helpforhairpullers.blogspot….

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A Foolproof Plan For Recovery from Trich and Skin Picking
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Whether you want to stop picking or hair pulling one thing will stop you from recovery: not understanding and accepting the gradual nature of recovery. The pattern generally goes like this: you suppress the urge to pull* (pull or pick) for an hour, a day, maybe a week or more. You are happy about it. Briefly hopeful. Then you find yourself pulling again, or suddenly feel unable not to give in to the urge. Then you may check the mirror, see a bald spot or scabs on your skin, believe you “undid” your progress and decide it’s hopeless. What’s the point of trying?

Let me explain why that will NEVER work. You will not go from being an active puller to being completely pull-free in one fell swoop. The nature of these disorders is such that as much as you consciously want to stop, there is a part of you that does not want to stop because you get emotional soothing from the behavior. Further your body has some dependence on the behavior. And while that doesn’t mean you can’t stop pulling or picking, it does mean there will be some resistance. And what THAT means is that recovery looks like this: you’ll have good days followed by some bad days, then more good days followed by less bad days, until you eventually have nearly all good days and almost no bad days.

In order to note good days and bad days, you’ll need to rate each day with one number. No extensive journaling or record keeping, but one number a day. The pulling / picking scale I have devised is similar to the pain scale that you may be asked about at the doctor. You rate each day from 0 to 10. Zero means zero pulling, and 10 means YOUR worst day (use the last year as a way to measure your worst day). This is a subjective rating and does NOT have to be exact. You will know the difference between an 8 on the scale and a 2 once you start doing this.

Here is the thing about good days: They aren’t zero pulling days, they are lower number days. Depending on what your average pulling or picking day is, the days you actually pull or pick if you don’t do it daily, you will choose a number that is not lower than 3, and that is within your reach right now, to be a good day. If you get lots of 5s and 6s, a few 3s and 4s, and a few 8s through 10s, pick 4 and below as your good day. If on the days you pull or pick you get mostly 8s, 9s and 10s, and a few 6s or 7s, use 7 and below as a good day. If you get mostly 4s, 5s and 6s, a few 8s and 9s, a fews 3s, 2s and 1s, use 3 and below as your “good day.” For many people 3 or 4 will be your good day. But again, if that is currently out of your reach and you never get 3s or 4s, then choose a 7 by all means.

The important thing is that what you consider a good day is a) not lower than 3, and b) not out of your reach right now.

You might keep a record of these numbers on your electronic calendar or on a paper calendar that you can make. But every day that is “Good” (a number you choose like 3, 4 or 5 or below) make a big X on that day. That’s a recovery day. The idea is that each month you will have more and more of these good days. Once that is easy, you can lower the number you use for your good day, and work toward a slightly lower number. Your goal always and only is to lower your numbers each month, NOT to have your hair back or your skin looking great. So long as your goal is focused on the results not the journey, you will get discouraged and give up.

So shift your goal from “having my hair back” or “having my skin clear” to collecting 30 good days, then 60 good days, then 90 good days, but NOT sequentially. That’s right. NOT sequentially. That means you can still have some very bad days. See if you can get 30 good days in a total of 60 days. (If you get 30 good days in 75 days, that’s great; now try again to get 30 good days in 60 total days. Once you achieve that, work toward 30 good days in 45 days. Keep counting the good days even if you reach 45 and don’t have the 30 good days. See how many days it takes. If it takes 50 or 60, great. Try again for the 30 days in 45 days.

If this is not going well for you, do NOT panic. That only means you must shift your goal. The most important thing here is to find a small goal you can achieve. If that means your good days are a higher number and in a larger total number of days, that’s fine. When you get there, see if you can improve it just a little the next time. If you do this, you will succeed. However, remember this: If you are someone like most pullers and pickers who a) cannot set boundaries (no Mom, I don’t want your opinion) or say no to people easily; b) who is a workaholic and perfectionist; c) has constant self criticism running through your head or d) who does not take time for yourself; or have any other issue that is troubling you including you depression, hating your job, being in an unhappy relationship, then you must deal with these things in order to recover. Get into therapy. Get into group. Go to a 12 step meeting if one applies. There are interns and trainees who can see you for little money. You must prioritize self care if you are to recover from these behaviors.

Being able to handle having had a bad day and put it in perspective may well be the single most important thing necessary to recovery. I believe that once we have a string of good days, the part of our psyche that has always had the behavior (addiction) to turn to, will panic. And the fear of never being able to do this again causes the addiction in those of us with these disorders to have really overwhelming urges on any one day. And the addiction always wins at that point if we look at our hair and skin and say, Ugh I have ruined it. What’s the point?
If however your goal is to get more good days in a shorter period of time, you cannot fail. See how long it takes to get 30 good days (days that anywhere from a 3 and below to a 7 and a below). Next time around try to do it in a slightly shorter period of time. No matter how much you pull or pick, you cannot “undo” the success of having worked toward 30 good days in, say, 45 (or whatever your goal is). Eventually yes you will have hair and skin you are far happier with. But racking up good days is always your goal.

So in the case of even if you have to white knuckle it (holding on so tight to something your knuckles turn white) to not get many 8-10s in row, do it JUST for today. Just till midnight or 6am the next morning. Not forever. Tell yourself, I can pull or pick tomorrow if I need to. (And you can.). And that there’s a good chance after that day passes the craving will be a little easier the next day. The reason you can’t stop is you tell yourself, I’ll never be able to resist this forever so I may as well just pull / pick. And no you can’t resist the urge forever. And you won’t have to. As you pull or pick less and less, IF you are adding in self care to the recovery process, the urges will slowly die. Self care means checking in on your emotional and bodily needs, saying NO & setting boundaries when you are too tired or sad or hungry or in need of down time to say yes. If you “have a hard time saying no,” then you will need to get help with that. Because until you can set boundaries, you will not fully recover.

You’ll also need to begin integrating relaxation into your life as you slowly pick or pull less and less. One simple example is the 4-4-4 technique. Close your eyes. Inhale slowly to the count of four. Hold for a count of four. Exhale slowly to the count of 4. Do this before you sit down at the computer or to watch TV or before drive or go to bed. You can do it more than once but even once will help.

I marked days off on a calendar with Xs. At that time I didn’t think about the numbers. X was a pretty good day. And I would focus on how I just needed to get through another hour. Or I would shower. Or go to the gym. I figured that if I could string 30 days together that were low pulling if not zero that it would get easier. That’s all I thought about. Not my hair. Just trying to get 30 pretty good days. If I had a bad day I would still see my monthly calendar on the wall with lots of Xs. So I just kept going.

Each day when I wanted to pull badly or in fact had already started to pull, I told myself I just had to do this for the day. NOT forever. The “stopping forever” feeling is sure to cause a strong desire to pull. So I knew it wasn’t forever. Just one more day. If possible. I promised myself I could pull if I needed to the next day. And sometimes if I had to be reading or just needed to relax and I could not stop, I would slather my hair with conditioner (which I’ve told you) because otherwise I couldn’t lie there still. For skin pickers, cover your mirror. Or put a mask on your face at those times. Or change the energy. Jump in the shower. Make tea. Sit and know the tea is symbolic of a needed time out and symbolizes starting over.

It’s basically like, Ok This is the path. It is ALWAYS just for today. Just till midnight. You keep going & you get there eventually. And “there” is having 30 pretty good days within a larger period of time as an initial goal. Nothing more. Ultimately the mind is more in control than the body because the mind can choose to keep trying. The body may force you to give in but the mind will help you to not give up.

Any one day that isn’t good in terms of pulling or picking is a chance to tell yourself, Hey this was going to happen. This is hard! The addiction is what is telling me that this bad day means it’s “hopeless.”. That you will “never” get better so you “might as well keep pulling or picking.). Because the addictive part of the brain just wants to give you one more reason you won’t be able to stop (so you continue doing the behavior the addiction is craving.) One more rationalization. One must say, “ah, there is the addiction talking. Thanks for sharing.” to that thought. It is NEVER about the current state of your hair or skin. It is never about perfection or stopping forever. It is always about doing a little bit better just in this moment.

If you had a bad day, be kind to yourself. You are already bummed after all. You didn’t ask for this disorder and it isn’t your fault you have it. Your addiction wants you to give up and give in because then you will indulge in the behavior you are addicted to. No matter how bummed you are, I PROMISE you this, it is NOT hopeless. I pulled daily constantly for 25 years. Now I don’t. And I know so many people who picked or pulled and have gone through this and have stopped you cannot imagine. Recognize that it is the addiction whispering to you to make you feel and think, there is no point, it’s hopeless, I’ll never get better SO I MIGHT AS WELL PULL OR PICK Whatever else it does, if you refuse to let the addiction get you to give up, that is the most important thing, and then you are in recovery. And it gets easier. It really does.

If you continue to blame yourself and attack yourself and feel you are weak or “pathetic” because have this “disorder” (and perhaps you don’t even believe it’s a “real disorder”), then you will need to work on that attitude first and foremost. Read “Radical Acceptance: Living Your Life With the Heart of a Buddha” by Tara Brach. When you are able to integrate those ideas into your relationship with yourself, you will be able to start making progress.

I wish all of you healing and comfort as you continue on your journey.

Claudia