Trichotillomania Diagnostic Criteria

I have had many questions on this blog as well as several others that I regularly comment on regarding whether or not a person ‘has trich’. We have reviewed this information before, but it is worth restating here.

From a clinical perspective, the diagnostic criteria used by clinicians to officially diagnose trichotillomania comes from the Diagnostic and Statistical Manual of Mental Disorders, 4^th edition, better known as the DSM-IV, that is published by the American Psychiatric Association. The DSM-IV diagnostic criteria for trichotillomania are:

(1)    Recurrent pulling out one’s hair resulting in noticeable hair loss

(2)    An increasing sense of tension immediately before pulling out the hair or when attempting to resist the behavior

(3)    Pleasure, gratification, or relief when pulling out the hair

(4)    The disturbance is not better accounted for by another mental disorder and is not due to a general medical condition (e.g. a dermatological (skin) condition)

(5)    The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

Only a licensed mental health professional can make a diagnosis of trichotillomania. However, in layman’s terms it is likely that you have trich if you (1) pull out hair anywhere on your body and/or have an intense urge to do so, (2) have anxiety or tension before you pull or if you try to resist pulling along with some form of pleasure or relief after you pull, (3) do not have some other condition that causes you to pull and (4) find that puling or the urge to pull is negatively impacting your life.

In addition, it is often beneficial to differentiate between two distinct types of pulling – “focused” hair pulling and “automatic” hair pulling. Focused pulling involves conscious pulling, often in reaction to an unpleasant sensory, emotional or mental state. This type of pulling is best illustrated in a person that tends to have an intense urge to pull during or after stressful situations, when they are emotionally upset or when triggered by other environmental factors. Focused pulling is very hard to stop, as the underlying urge is very strong.

Automatic pulling, in contrast, involves habitual pulling that often occurs outside of your conscious awareness. Automatic pulling is when somebody pulls and doesn’t even realize they are doing it, such as while driving, while doing homework, or while talking on the phone. Normally, a person that is pulling automatically can stop once the behavior is brought to their conscious attention. However, sometimes when this occurs, the urge to pull kicks in and it becomes focused pulling.

If you think you may have trichotillomania, you should speak with your doctor about options. However, we have found the best approach incorporates properly balancing your neurotransmitter function using balanced amino acid therapy. You can find much more information about this approach on this blog.

Trichotillomania Cures

I am often asked if our approach ‘cures’ trichotillomania. The simple answer is ‘it depends’.

The word ‘cure’ or ‘curing’ are used and strictly protected as medical terms, only to be used by medical doctors and other health care professionals that are licensed to practice medicine. Judging by the number of law suits against integrative, complementary and alternative practitioners who have mistakenly used this term in regards to what they do, I’d say that it is strictly enforced. As I am a naturopathic doctor and do not practice medicine, I am not entitled to use the terms ‘cure’, ‘cures’ or ‘curing’ in relation to what I do or to describe the effects that what I recommend may have on or for a person.

Interestingly, the general public often use these terms without recourse. I even had one client look up the word ‘cure’ and forward me the definition: ‘A cure or remission is the end of a medical condition’, so they stated that because we helped them eliminate the urge to pull their hair out, we helped them ‘cure’ their trichotillomania and should therefore be listed in any list of ‘trichotillomania cures’.

While I am glad this person feels better, this discussion brought up a couple additional points that are important to keep in mind (not only for a person considering amino acid therapy, but also for me as a complementary health care practitioner). In addition to the above discussion about the use of the words ‘cure’, ‘cures’ and ‘curing’, we are not specifically addressing any medical condition(s), including trichotillomania using amino acid therapy. What we are doing is looking for and addressing fundamental root imbalances in body or brain chemistry and addressing them using natural methods if at all possible. These imbalances can manifest themselves in conditions that are diagnosed by medical professionals as trichotillomania. However, they can also manifest themselves in other ways that prompt people to seek medical help; these diagnoses can include depression, anxiety, OCD, ADD, ADHD, insomnia, migraines, fibromyalgia and numerous other sets of symptoms labeled as ‘diseases’ by the medical profession.

We don’t concern ourselves nearly as much with what a group of symptoms is called by the medical profession as we do with figuring out what imbalances created these symptoms and addressing those underlying imbalances. By addressing the underlying imbalances, our clients often see a reversal of many previously diagnosed medical conditions, not just the one(s) they are seeking us out for. That is why when you read the many testimonials and background information about amino acid therapy throughout this site, you see that many, many conditions can be corrected through the proper use of amino acid therapy. We cannot say amino acid therapy ‘cures’ trichotillomania or any other diagnosed medical condition as I am not a medical doctor; I am a naturopath.

But what really matters is that by finding and addressing the underlying neurotransmitter imbalances that a person with trichotillomania has, they can eliminate the urge to pull. If they want to find out if they are ‘cured’ or if this ‘cures’ trichotillomania, they just need to ask their medical doctor if no longer having the urge to pull means that they are ‘cured’.

What is Trichotillomania?

This question was posed to me by a potential client just the other day and the ensuing conversation was so interesting that I thought I’d share some of the conversation in today’s post. According to the Trichotillomania Learning Center (www.trich.org), “trichotillomania is a disorder that causes people to pull out the hair from their scalp, eyelashes, eyebrows, pubic area, underarms, beard, chest, legs or other parts of the body, resulting in noticeable bald patches.” It goes further to state that “Trichotillomania (also referred to as TTM or “trich”) is currently defined as an impulse control disorder but there are still questions about how it should be classified. It may seem to resemble a habit, an addiction, a tic disorder or obsessive-compulsive disorder.”

When I stopped to see if this was registering with the potential client, her eyes were kind of glossing over, so I knew this didn’t completely register with her, so I simplified it with this statement, “In essence, trichotillomania means that you have an urge to pull that can sometime be very intense.” This seemed to register right away, because she said, “That’s me! Sometimes I have such an intense urge to pull I can’t think of anything else!”

We have seen cases of trichotillomania that don’t just involve pulling of hair on one’s own body; it can also encompass pulling or picking at the skin; pulling the hair on pets, dolls or toys; biting the insides of the cheeks; or severe nail biting. The key underlying factor is the intense, and seemingly often unconscious, urge to do something (like pulling, picking or biting) over and over again and feeling as though one is not able to stop, even if they want to.

Trichotillomania often goes unnoticed because the person with trichotillomania is often ashamed or feels guilty for their pulling and/or the inability to stop pulling, so they do their best to hide it.

At this point, tears began to form in this potential client’s eyes as she recounted the endless ways she tried to hide the bald spots on her head, arms and legs, how she felt so shameful for pulling and feeling like she couldn’t stop herself and how every time she pulled, the guilt and shame she felt grew stronger and stronger. After she had recounted her story, she looked at me with eyes that were puffy and still clinging to tears and asked, “I’ve tried everything and nothing worked. Is there any hope for me?”

“Of course there’s hope,” I said. “Trichotillomania is often due to an underlying imbalance in brain chemicals called neurotransmitters. Once we rebalance these, the urge to pull often goes away completely. This allows you to take back control of your behaviors, setting you free to do as you choose in regards to pulling.”

So this person left my office with a little spark in her eye and little hope in her heart. Chances are she will eliminate the urge to pull with amino acid therapy, and I’ll be sure to write about it when she does.

Resources For Those With Trichotillomania

I was asked by a recent client about what resources were available for those that wanted to find out more about trichotillomania. The woman sitting across from me was bewildered with all the information on the internet in regards to trich and wanted my help to try and sort through it. Here are some great places to get you started if you need a reference point to learn more about trich, if you or someone you love has the disorder and what you can do about it.

General Information

WebMD: http://www.webmd.com/anxiety-panic/guide/trichotillomania

Trichotillomania Learning Center: http://www.trich.org/

Tests for Trich

http://www.pamguide.com.au/anxiety/ttm_test.php – provides an easy self-test

http://www.ocdla.com/trichotillomania-hair-pulling-test.html – provides a more in-depth questionnaire, but you have to send your information out to get results from them

Treatments/Therapies for Trich

Neurotransmitter Function: http://www.neuroassist.com/trichotillomania-treatments.htm and http://stoppullinghairout.com/blog/

Cognitive Behavioral Therapy: http://www.trich.org/treatment/options-cognitive.html

Is Trichotillomania a Medical Mystery?

I just watched a video on YouTube titled – Trichotillomania: A True Medical Mystery – where they interviewed a medical doctor who explained that trich is baffling because so little is known about it. That was in 2008. Today, although the underlying imbalances that can lead to trich are much better understood, the medical therapies and treatments for trich have changed very little. One of the reasons is that trich is not caused by a deficiency of any drug or medical treatment, so there is no permanent solution using those techniques. However, for many people suffering from trich, imbalances in brain chemicals (called neurotransmitters) can cause or exacerbate the compulsion to pull.

Over the past nine years, our understanding of the underlying biochemical imbalances that can lead to trich (and many other disorders, including depression, anxiety, migraines, insomnia, compulsions, over-eating and chronic pain) has greatly expanded. This site will contain much of that information; you can also visit www.neuroassist.com and www.chknutrition.com to locate other research and products that can expand your knowledge of how amino acid therapy can help you or someone you love eliminate the urge to pull.

Is Trich an Addiction?

I read a post recently that related trich to an addiction.

In the article, ‘It’s Trichy’ thought about the similarities between trich and an addiction, such as alcoholism. There are many similarities, but the most pressing is the very real chemical imbalance that is often at the core of many obsessive-compulsive and/or addictive behaviors. What is known is that imbalances in brain chemistry can create a psychological (and many times physiological) need for or to do something. Most of the research in this area has looked at the ‘pleasure-centers’ of the brain and the chemicals that affect them, including dopamine, norepinephrine and glutamate, which are all neurotransmitters.

Interestingly, we have found that by achieving proper neurotransmitter balance, we can very often reduce or eliminate the ‘urge’, whether that is to pull in the case of trichotillomania or drink in the case of alcoholism (or any other substance in the case of other drugs of abuse). In many cases, once proper neurotransmitter balance is achieved, an immediate response is achieved, often described as a ‘light-switch’ going on. In these cases, there is an immediate and complete release from the compulsive or addictive behavior.

This makes sense if you think about this in terms of brain chemistry – if neurotransmitter imbalance is the cause of the compulsive or addictive behavior, once balance is achieved, the behavior should be dramatically impacted.  Thankfully, it usually takes only weeks to months to optimize neurotransmitter levels and achieve this release from the urge, compulsion or addiction. Then, a person is in a much better position to institute behavioral therapies and support groups to help them beat the habits they have developed. Of note, once people achieve proper neurotransmitter balance, they are much better able to distinguish between the urge to pull and the habit of pulling, which goes a long way to determining what behavioral modifications can help break the habits involved.

Trichotillomania does share many common traits with addictive-type behavior, and thankfully, amino-acid therapy is often successful at addressing the underlying cause that is at the heart of these behaviors.

A Video That Touched My Heart

I’m going to let you all in on a little secret – I’m not very tech savvy. In fact, I’m pretty internet-challenged – I can check my email, post some articles/blogs and find what I need, but aside from that, I don’t spend a lot of time on the web. However, a couple days ago, I thought I’d Google ‘trichotillomania’ and see what came up. I was amazed at what I saw.

After scrolling down through the informational sites, I saw a link to a YouTube video on trichotillomania. It was a video by a 16 year old named Rebecca that has trich; she was describing how she feels, what goes on in her head and how others have reacted to her. Her transparency was palpable and her story touched something in me – I don’t know exactly what it is yet, but something deep. I could connect with her.

Maybe it’s the culmination of working with so many young people with trich. Maybe it was seeing her struggle, right there on my computer screen, trying to explain what is happening within her and how she doesn’t feel she can do anything about it. Maybe it’s because I saw her suffering and watching this incredibly strong and brave soul sharing her personal experience so that others can know they are not alone.

Maybe it’s because I think I can help her eliminate the urge to pull. I know I don’t have all the answers, but I do know we have developed a protocol that is remarkably successful with trich. So much so, that we started this website to get the word out. Like I said, I’m not that tech-savvy, but I am very good at figuring out the underlying imbalances that prevent people from reaching their health goals and addressing them.

I need your help to get the word out. I just completed a very extensive series of posts that details the science behind what we do and how amino acid therapy can help eliminate the urge to pull. They’ll be rolling out this month.

Our protocol won’t get rid of the habit; that’s where other very impactful techniques like cognitive behavioral therapy can play a key role. But it can eliminate the urge to pull 86% of the time – nothing that I know of has this great of an impact on trich. Knowing what I know and seeing these kinds of results in our clinic make watching videos like Rebecca’s even more heart-breaking.

I opened a YouTube account so I could communicate with Rebecca; I sure hope to hear from her. If you have trichotillomania, please read the information on this site and do whatever research you need to do in order to wrap your mind around what we do to help eliminate the urge to pull. When you are ready to give it a try, please contact us – we may not be able to help everybody, but we can help a whole of people.

And if you are tech/internet/web savvy, please share this information with those that can benefit from it. I would love to see 1000s of follow up videos on YouTube about how Rebecca and others that suffer from trichotillomania have eliminated the urge to pull and gone on to fully enjoy every minute of their lives. I know it can happen – I’ve seen it.

Five Things Mothers Don’t Know About Trichotillomania

photo credit: rachaelshapiro

Mothers today have access to a lot of medical information, thanks to the Internet.  Yet even with ubiquity of material on the web, sometimes there can be a surprising scarcity of resources.  Especially with a condition like trichotillomania.

Trichotillomania is a disorder in which people compulsively pick, often targeting eyelashes, eyebrows or the hair on their head.  It affects 3 – 5 percent of the population, yet there isn’t an abundance of good scientific information available on the subject.

Okay, mom, since you’re searching, we won’t disappoint.  Here are 5 things mothers don’t know about trichotillomania. more »

Who’s to blame for trichotillomania? Not you.

photo credit: gcfairch

We visit a lot of different trich blogs.  As we try and educate people about why they can’t stop pulling hair out, we see a common theme:

People just blame themselves for trich.

We don’t think that’s fair, and we know it’s not right.  Because the simple fact is that anyone suffering from trich would stop pulling hair out immediately if it was as simple as saying, “That’s it.  I quit.”

But it’s not.  Because with trich sufferers, there is another culprit who should be blamed.  We encourage you to read on, and find out how the blame game should be played with trichotillomania.

Why pointing fingers will help you stop pulling hair out

We are definitely a culture of finger-pointers.  Just look at our political system for a perfect example.  It’s easy to pass the buck and blame the other guy for your problems.

In this case, however, it’s warranted.  Because you’re not the problem.  You’re not the only one who is telling yourself to pull.

It’s your body.  More accurately, it’s the neurotransmitters in your body.  Of the two main types of neurotransmitters (excitatory and inhibitory), one is significantly off-balance.  And because they’re out of whack, a chemical imbalance is making you want to pull your hair out.

So don’t go dumping on yourself.  You didn’t ask for a neurotransmitter imbalance.  These were the cards you were dealt – so don’t drown in negativity.  You can’t; not if you’re going to get better.

And just how exactly will you get better?

Stop pulling hair out by getting your body in line

Okay, you understand the problem. The underlying cause for trichotillomania is a neurotransmitter imbalance in your body.

But now the onus is on you.

Now is it’s up to you to take the steps necessary to get your body in line.  What will that involve?  It’s simple.  It starts with setting up a phone consultation with Dr. Chad Oler of the Natural Path Health Center.

During the 30 minute phone consultation, you’ll review your history and your goals, and then Dr. Chad will set up a specialized program designed just for you.

What’s included in that program?  That really depends.  Generally it involves taking supplements, which are part of the amino acid therapy to help rebalance your neurotransmitters.  You may also need to make some dietary modifications.

In every case, the exact program is different.  That’s a big reason why we’ve been so successful.

So now the ball is in your court.  We’ve identified the culprit behind your inability to stop pulling hair out – your body and its neurotransmitter imbalance.  Now it’s up to you to take the next step and correct the problem.

Trichotillomania – what is it?

photo credit: AJU_photography

The definition for trichotillomania (trick-o-tio-o-MAY-nee-ah) is often agreed upon by many medical practitioners.  Its treatment, however, is not.

 Trichotillomania, as defined by the Trichotillomania Learning Center, “is a disorder that causes people to pull out the hair from their scalp, eyelashes, eyebrows, pubic area, underarms, beard, chest legs or other parts of the body, resulting in noticeable bald patches.” more »