Can Skimping on Sleep Make Trichotillomania Worse?

As you read through the numerous articles and research on this blog you will quickly see that we have found that imbalances with certain neurotransmitters (which are brain chemicals that control most of the body’s functions) can lead to a great many disorders, including trichotillomania and the urge to pull, depression, anxiety, compulsive and/or obsessive thoughts and behaviors, food cravings, binging behavior, addictions, migraines and many others, including sleep disturbances. Therefore, it would not be surprising to find a relationship between these seemingly varied imbalances.

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A Very Trichy Case

Many of the testimonials and case studies I write about are about very fast results where people suddenly have a complete elimination of the urge to pull within days or weeks of starting balanced amino acid therapy. Truth-be-told, most cases of trichotillomania do resolve within a relatively short period of time, so these case histories and testimonials are representative of what we typically see at the clinic. However, we do have a few cases where things aren’t quite so cut and dry; in these instances, it can take months to get the amino acid dosing right. This obviously requires incredible dedication on the part of the client, as well as their family, as this case history illustrates.

Jenna came to us after her mom had been searching the internet for three years trying to find a solution for her daughter. Jenna had started pulling the hair out of her sheep-skin blanket before progressing to pulling out her eyebrows and then from her head. By the time we spoke with Jenna’s mom, the right side of her head was bald and she didn’t have any eyelashes or eyebrows.

In addition, Jenna had been diagnosed with obsessive compulsive disorder (OCD), with the onset of symptoms occurring when she was just six years old. Her mother stated that she had a period of several years when she did exhibit any OCD symptoms, but that about three years ago, she started constantly washing her hands (to the point that her hands cracked and bled), “straightening things”, developing extensive bedtime rituals and became very worried about contamination and germs. Jenna had been on Prozac for about a year when we first spoke. Both she and her mom were desperate.

We began by attempting to balance out Jenna’s neurotransmitter levels as we always do. However, it became obvious quite quickly that this was not working, so we ran some testing to help guide her care. Jenna’s body was requiring incredibly high levels of amino acids to show any kind of change and the testing was extremely valuable to help make sure we were on the right track.

It took 12 tests and 10 months until she got the result she was looking for. The dedication and support exhibited by Jenna and her parents was incredible over this time period, especially considering that Jenna did not experience any relief of symptoms for the first 10 months we worked together. However, her diligence, and her parents dedication paid off. Like flipping a switch, everything changed.

I spoke with Jenna recently and she told me it was suddenly “easy to control my trich and OCD” and that she “didn’t need reassurance as much”. She was sleeping well, eating normally and doing well in school. Her mom was ecstatic. She said both she and Jenna were realizing most of the repetitive actions were now only habits versus being due to OCD or anxiety and that Ana was now able to differentiate between them and stop when she wanted to. This was a HUGE improvement according to her mom; “We have a life again, and we have our daughter back!” said mom. Now, Jenna’s work is awareness; becoming aware of when she is doing something mindlessly and asking herself if she wants to continue. Now she has control.

Everybody wants instant gratification – and why wouldn’t we? Getting something for less or little effort is always preferable, especially when we are talking about ending what could be a debilitating condition such as trich or OCD. However, when things don’t happen right away and our resolve is tested, then we find out how badly we want a solution. In this instance, desperation was the key to sticking with the program until we achieved the desired result. This means preparing for the long-haul knowing that a resolution will come when we determine exactly what your body needs to achieve balance. We will help you reach your goals, but it is your resolve and dedication that will matter most if and when the going gets tough or the journey grows long.

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:

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 – that many people with gastrointestinal disorders develop or have one or more disorders related to neurotransmitter imbalance and that correctly 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.

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.

A Touching Story

Lacey was at wit’s end with trichotillomania. She had pulled for 28 years, with no end in sight. She had constant, uncontrollable urges and could not stop pulling hair out. She thought she was mentally ill, and worse, she feared that she’d pass along trich to her 4 year-old son.

Then she met Dr. Chad Oler, and everything changed. Listen to her story, and find out how she learned to stop pulling hair out.

Lacy’s Podcast

When Lacey found Dr. Chad, she discovered a way to stop pulling hair out that’s surprisingly easy, has produced dramatic results, and is ready for you to start IMMEDIATELY.

Support for People With Trich

One of the things we hear most often in the clinic from people suffering from trich is that they feel very alone, very isolated and very fearful. They are usually afraid that someone will find out about their pulling and they are burdened by the stress of guilt and shame. Most of the time, this only adds to their stress levels, which causes anxiety and an increased need to pull. Obviously, in order to stop pulling their hair out, they need to break this vicious cycle.

Many people find relief in some form of counseling. As we’ve mentioned in several other posts, cognitive behavioral therapy (CBT) works especially well for some people with trich. For many people, simply telling their story and how trich has affected their lives allows them to release a HUGE burden – for this, support groups are wonderful.

If you live in a large city, you may be able to find a local support group where you can go in person. Here is a great resource to see if there is a support group in your area: http://www.trich.org/treatment/support-groups.html.

Going to an actual group can be a big stretch for many people and/or they don’t have the luxury of having a local support group, so online support groups can play a vital role. There are many support groups out there, so find one that works for you. Here are a couple to get you started:

http://trichotillomania.supportgroups.com/

http://www.dailystrength.org/c/Trichotillomania-Hair-Pulling/support-group

http://www.mdjunction.com/trichotillomania-ttm

http://health.groups.yahoo.com/group/TLCTrichSupport/

Check some of these out, read some of the posts and get involved to your comfort level. There are a LOT of people out there that know exactly what you are going through and just connecting with them may help ease some of your pain. It certainly won’t hurt.

There is a great quote that I have posted in my office – “True understanding is found through compassion.” Nowhere is this more true than with trich. Reach out and let yourself be supported.

Treatments for Trichotillomania – What Works and What Doesn’t

A search of the internet for ‘treatments of trichotillomania’ brings back over 335,000 results. This can make the search for a viable treatment option very difficult, if not downright impossible.  However, upon closer investigation, you will find that there are really only a few treatments for trichotillomania that have any scientific evidence behind them, although even within this select group of therapies, results are highly individualized.

Treatments for Trichotillomania

Cognitive Behavioral Therapy (CBT): Cognitive behavior therapy attempts to alter behavior by identifying environmental factors that trigger hair pulling and then helping a person learn skills to interrupt and redirect their responses to those triggers. Used over time, the new behavior replaces the old (i.e., pulling). CBT should be performed by a therapist trained in this method, ideally with experience in the treatment of trichotillomania. Certain methods of CBT such as Habit-Reversal Training and the Comprehensive Model for Behavioral Treatment of Trichotillomania have shown to be the most successful CBT treatments for trichotillomania, so be sure to ask your provider if they use or have been trained in these therapies.

Medications: many medications have been tried as a treatment for trichotillomania. Unfortunately, the results have been disappointing (see other posts on this site for more information on drug treatments for trichotillomania). That said, some people do benefit from drug therapies, either alone or in conjunction with cognitive-behavior therapy or amino acid therapy. The effect, however, is almost always temporary because drug therapies cannot address the underlying cause of trichotillomania in most people. In addition, the use of medications for the treatment of trichotillomania in children or adolescents brings additional concerns. Very few drug trials involve children and to date there have been no studies of the use of medication for the treatment of trichotillomania in children.  Due to the limited evidence supporting these medications effectiveness, as well as concerns about the long-term effects of medications on the developing brain, several groups, including the Trichotillomania Learning Center’s Scientific Advisory Board have advised that “for most children and adolescents with trichotillomania, medications should not be used as a treatment of first choice.”

Amino acid therapy: Amino acid therapy involves providing the body the nutrients it needs to optimize neurotransmitter balance in the body. One of the main underlying causes of trichotillomania for many people is an imbalance in one or more neurotransmitters. The ONLY way to correct this for the long term is to supply the body the amino acids and co-factors it needs to restore proper neurotransmitter balance, which will eliminate the urge to pull, allowing you to stop pulling.  Once the urge to pull is gone, other therapies, like Cognitive Behavior Therapy are much more effective as a treatment for trichotillomania in order to address any remaining behavioral and/or habitual triggers to pull.

It can be a confusing and frustrating experience for people searching for treatments for trichotillomania. However, after looking at the scientific and clinical evidence, only two have shown reproducible results – cognitive behavioral therapy and amino acid therapy – for people with trichotillomania.

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’.

Stephanie’s Story

We just did a post on Stephanie’s story with trich and how amino acid therapy helped her ‘beat trich’ in her words. I wanted to follow up with a couple points regarding Stephanie’s story to point out a few things that we see often when working with people with trich.

First, many people see results in just a month or two, just as Stephanie did. In fact, about 80% of people can completely eliminate the urge to pull in that time frame. For those 20% that don’t, additional testing is used to help them eliminate the urge to pull.

Second, once we find the right dose of amino acids that a person needs, they need to take them about 6-9 months before we can start tapering the dose without the recurrence of symptoms. If a person misses a dose or multiple doses, the urge to pull will often return within a few days and will persist until a person gets back on the recommended supplements for about 3-5 days. This means that the person continues to need the amino acids to eliminate the urge to pull.

Third, eliminating the urge to pull does not mean that a person automatically stops pulling. We’ve talked in other posts about the difference between the urge to pull (the compulsion) and the behavior of pulling. Once the urge is gone, a person can still find themselves pulling when they get triggered by certain events (the most common one is stress). When this happens, they may find their hands playing with or pulling their hair before they even realize what is happening. The difference is that once they become conscious of it, a person on the proper dose of amino acids and stop pulling and not think about it anymore. This is where other therapies, such as stress reduction, exercise and Cognitive Behavioral therapies can be a big help.

Fourth, exercise, lifestyle and dietary recommendations can often decrease the need for amino acids. If a person addresses the day-to-day reasons for neurotransmitter imbalance, they can often substantially reduce the amount of amino acids they need over time to eliminate the urge to pull.

And finally, just like Stephanie, many people can reduce and eliminate the need for the amino acids and still have no urge to pull. Most of the time, these people have taken the amino acids as recommended for at least 6-9 months and have incorporated other strategies to help deal with the behavioral and environmental component of pulling (we help guide them through this process as well). This provides them the life skills that they need to function as they want to without the need for the amino acids. This doesn’t always happen, but it happens a great deal of the time, and it’s so wonderful to see the confidence, the pride and the relief in the people that ‘beat trich’ as Stephanie did.

Image: scottchan / FreeDigitalPhotos.net

Urge, Drug, and Supplement Free!

The following is a compelling story from one of our clients:

“I was diagnosed with trich in 1^st grade and I’ve pulled every 1-3 days since then. By the time I found Dr. Oler I was 17 years old and had pulled out all my eyebrows, eyelashes and about 50% of the hair on my head. My dad’s a doctor, so I’ve tried pretty much every possible medical treatment and drug for trich out there. They didn’t help me get rid of the urge and I usually felt awful when I took them.

Within a month of starting the amino acid therapy my urge to pull was completely gone! It was great! And unbelievable! Dr. Oler told me to continue my current dosing for 2 months and follow up. Over those 2 months, I pulled a couple times, but it wasn’t an urge; it felt more like the hairs weren’t growing right and I just pulled those and left everything else alone. My eyelashes, eyebrows and hair on my head all started growing back. During this time, I stopped taking the amino acids a couple times, but noticed the urge to pull increased, so I went back to Dr. Oler’s recommendations.

After 2 more months, all my hair was grown back and I wasn’t having any urges anymore. However, I forgot to take my supplements with me when I went away from Christmas and New Years and the urges came back BIG TIME and I pulled everything out again in about 5 days. As soon as I got home, I started the supplements again and didn’t have any urge to pull after about 5 days.

I continued at this dose for 6 months. I wasn’t pulling, my energy levels were great, I slept well, my cravings were gone and I started playing rugby again. I also noticed that my focus, concentration and memory had improved and I was doing better in my classes. I was very content.

After a couple more months, Dr. Oler recommended that we start to decrease the amino acids, as by this time, my neurotransmitter stores should be back to where they belong. I was apprehensive, but reassured that I could always go back to taking what I was currently taking and get the same results within a few days even if the urge to pull returned. I had a little bit of an increased urge to pull after changing the dose, but it only lasted a few days and it wasn’t too bad, but no urges after that.

We continued to decrease the amino acid dosing over time, adjusting as needed if I had an increased urge to pull or stress triggered me to pull. I also started learning some other ways to manage stress, like deep breathing, taking a quick walk around the block and aerobic exercise which helped.

It’s now been two years since I started working with Dr. Oler and I (1) don’t have any urges to pull, (2) am no longer taking medications for trich, and (3) haven’t taken any of the amino acid supplements for over 3 months. All my hair is grown back and I have absolutely no urge to pull anymore unless there is a lot of stress in my life. Even then, I can get through it without pulling very much. I am very content where I am at. Thank you for helping me beat trich!”

-Stephanie, 08/02/11

Image: Graeme Weatherston / FreeDigitalPhotos.net