Wednesday, August 5, 2015

Don't Try to Stop Pulling or Picking Before You Do This

After nearly 20 years of working with people who suffer from BFRBs and 20+ years of recovery from Trich myself I feel qualified to say that most people approach recovery from these disorders all wrong. Here is why: most people think that if they could stop here pulling her skin picking their life would work. Most people think that having a BSRB is their only problem. There are experts that will tell you that this behavior is simply an anomaly and is not indicative of any other issue at all. I must respectfully disagree. The good news is that having a BFRB does not indicate any kind of serious psychological condition but rather is a self Susan behavior. And I believe strongly that the need for this kind of soothing is related to certain types of issues. this is based on having worked with hundreds of people who have these disorders, and in nearly every case finding that addressing the issues of codependence, perfectionism, shame, and self acceptance have been the only and the primary way to guide my clients into a state of either pull/pick-free or mostly pull/pick-free recovery. The reason is that it's simply not possible to recover as long as your self-love and self-acceptance is conditional and based upon whether or not you pulled or picked that day

Every time I say that new clients say to me, but I don't want to accept the picking! I hate the pulley. I cannot accept it. And I say, first of all, when I am talking about is self acceptance. I am talking about excepting oneself as one is in this moment. I am talking about loving oneself as one is in this moment. If you had a child who had a problem, any problem, that they were trying to come back you would not withhold your love for your child until they had solved that problem. You might not love the problem but you would love your child and you would love him as he is. You would also accept your child. You would accept him exactly as he is now even if you continued to encourage him and support him in his quest to overcome this problem.

Here's the other thing. Acceptance is not in any way the same thing as resignation. Accepting where you are now does not mean you are resigned to staying where you are now. First of all that isn't even possible (or desirable) since we grow and change and evolve as people throughout our lives. Say I have a client who weighs 300 pounds. And let's say this clients doctor has told her that she must lose weight and that it is crucial for her health and her lifespan. I would tell this client also that the only way to succeed is to start out by accepting herself as she is now. at the same time this client may be on weight watchers, May be walking every day for an hour, may be incorporating a variety of new behaviors into her life. However weight loss is relatively slow and it may take a year before this woman can see in the mirror what she would like to see. However in order to succeed on this journey she must begin to see that this excess weight, while it is frustrating and while it is something that she wants to do something about does not mean that she is unworthy or a lovable or a bad person. she must learn to cease saying things to herself in her head like you're fat and disgusting and horrible. Because each time she does or says something like that to herself she begins to identify her worth as a human being with her excesss weight and she begins to reinforce the fact that she isn't worthy and she isn't good enough and if she isn't those things how can she possibly summon the strength to face this challenge? If she is only worthy and lovable and acceptable and worthwhile if she is thin, how can she possibly take on the work both emotional and food-related that is required to recover from food addiction and emotional eating?

In order to begin the journey to address a disorder like hair pulling more skin picking (or overeating), One must be prepared to face some uncomfortable feelings, because these behaviors numb feelings. One must be prepared to begin to set boundaries with people in their lives and take care of themselves, which in some cases may mean people will be disappointed. in order to do these things one most value and accept oneself, and One must even learn to let go of concern about the opinion of others. this is truly possible to do but it's only possible if you do the work needed to begin to love yourself exactly as you are now, with or without hair, with or without good skin. These things can improve greatly for you over time, but you have to start by loving yourself as you are now.

I believe BFRBs are inextricably tied to perfectionism, codependence, insecurity/lack of self acceptance, Constant worry about what other people think of you or at least what certain people think of you. And what happens when you slowly reduce the amount of pulling or picking that you do is that you begin to feel more. And you begin to feel many of the feelings that are the very feelings that cause you to engage in codependent and perfectionistic behaviors. this is why I work with people on learning to be in the moment with their feelings and to allow rather than resist painful feelings. When my clients start to realize they won't fall apart if they feel sad or scared or hurt, they become more prepared for the process of recovery. When my clients learn that even if someone disapproves of them, or even, gasp, if they fail at something, they are still OK and worthy and lovable, it becomes possible to let go of hair pulling and skin picking.

So if you're dealing with these issues and haven't had any luck at all with having these behavior subside, I strongly suggest that you work on self acceptance and self-love. As long as you hate yourself for having a disorder that you can't help having, trying to work on it becomes impossible. I have a lot more to say on the subject but I wanted to post something soon since it's been a while. I think it's so incredibly important to understand that without self acceptance and self-love as you are now the possibility of long-term recovery doesn't exist. If by some chance hypnosis or cognitive behavioral therapy helps you in the short term, in the long term it won't work because in the long term you have to have the ability to tolerate feelings and to set boundaries and to except yourself in order to remain in recovery.


Wednesday, March 25, 2015

Recovery from Trichotillomania / Hair Pulling

As a psychotherapist who's worked with hundreds of hair pullers, and as someone who personally suffered from daily hair pulling until I was 27 and has been pull free for 20 years, I know all too well the pain, shame and despair that pullers experience. I also know firsthand the frustration and hopelessness of trying *everything* to stop with no success. Or worse, having short-lived success--a day, a week, maybe even a month--and suddenly without warning you find yourself pulling again.

Maybe you pull your head hair, or your brows or lashes, or other body hair. My clients tend to be equally divided in that nearly half pull head hair and nearly half pull brows and/or lashes, a small number pull both, and the remainder pull from various areas on the body.

For those who don't have Trich, also known as a "body focused repetitive disorder" (BFRD, and don't understand it, but are close to someone who does, their own frustration and sadness about their child's, friend's, sibling's or partner's suffering may lead them to make constant suggestions (have you tried __ or ___), say to you, "Stop pulling, Honey," if they see you do it, or try to "convince" you to stop by "reminding" you: "But Honey you have such pretty
hair.." "You don't want to be bald, do you?" "Remember how upset you were about your lashes when you went to that dinner party, school dance, work, saw yourself in a picture, your friend asked you about it?"

As if you don't already more desperately want to stop than anyone else could ever imagine. What's hard to explain even to yourself is why you keep doing it, or why you do it at all. Why stopping seems so impossible when the behavior itself makes no sense. It just seems "crazy" or "gross" or you may feel "weak" and "pathetic".

What others don't know, and what you may not know, is that for people with Trich, hair pulling is a self-soothing mechanism (not an attempt to cause harm to yourself), and it feels pleasurable. It's not an addiction to pain. The other even more important thing is that you are being prompted to pull by a physical urge that can best be compared to an itch. When people have an itch, they tend to respond to it without thinking or even being aware they are doing so. That's why, if you have poison oak or chicken pox, you may not want to scratch, the doc may even say not to scratch, but the moment your attention is diverted (you're watching TV or you're on the phone), you "find yourself scratching." And at that point, the need to "complete or finish" scratching is extremely compelling, even if you don't want to. This comparison may help your spouse or parent or even you yourself to understand a little better what it is that causes you to start pulling in any particular moment. Either a physical or neurological urge occurs in a split second, as if you had an itch, and without conscious awareness you respond automatically. That's why you may not have any idea of a precipitating factor.

Now, if it were that simple, it might well be easier to treat. But it's important for pullers and their families to understand that this is not a willful behavior. Most people know what it's like to respond to an itch and begin scratching, sometimes for a minute or more, before you realize what you're doing. And most people also understand that, once you start scratching, poison oak for example, the craving to do so can overtake you, even though you know you shouldn't. Most folks also know that, when at its itchiest, you may find yourself scratching, stop doing so, tell yourself, OK, I'm not going to scratch anymore, go back to
your movie, and find yourself scratching again and again. Imagine if this urge was daily and constant. Imagine if it resulted in hair loss. Yet no matter what you did, you would suddenly and repeatedly "find" yourself doing it. That's, in short, what is happening to pullers. And because it as relieving to someone with Trich as it is for anyone to scratch an itch, you continue the behavior even when you're aware. It is extremely important to understand that you (the puller) are not "crazy." And anyone who experienced these urges, which occur in a microseconds, would respond the same way.

There are however, two other factors that come into play. I believe these urges have a cause that goes beyond that physical urge, and that are psyche comes to play a part in the constancy and intensity of these urges. Most people describe hair pulling as occurring in or even causing a "trance-like" state. This trance-like state kind of numbs one out emotionally, just like using a substance of some kind and also much like eating excessive amounts of carbs and sugar. This is why lots of people who have issues with weight may be engaging in what is called "emotional eating." One may crave carbs and sugar in a way that feels like "regular" hunger. You may feel like you have to have a muffin or donut or cookie or hunk of sourdough bread. Yet underneath that craving, outside your present awareness, it may be fear or loneliness or shame that in a sense causes those cravings to happen. And once fulfilled, the emptiness or loneliness or shame is covered up.. Numbed out. So people tend to think that "their only problem is overeating." Otherwise everything is fine. And this is exactly the same for hair pullers. The act of pulling numbs the longing or dis-ease, so it's easy to believe that if I could just stop pulling, everything would be fine.

I work with people to get beneath this fallacy, generally dealing with issues like perfectionism, a lack of self love and self acceptance, or rather, a self-acceptance that is conditional. If they make a mistake, don't finish their endless to do lists, aren't thin enough, productive enough, accomplished enough or smart enough (which they rarely if ever think they are), they see themselves as unworthy, "lazy," weak or just not good enough- And self love or acceptance is undeserved. That's why many clients I see who have Trich and who generally also have this overly harsh, critical, perfectionistic attitude toward themselves tend to seek external validation since they are unable to give it to themselves. And this causes a pattern of people pleasing behaviors that also lead to living an inauthentic life, a life where one is not true to one's self (since others' opinions of their lives tend to be more important than their own.

Once my clients are able to access some of the painful feelings beneath the urges, and begin to experience greater self-acceptance and self love, two things happen: They begin to lead lives that are more authentic and true to themselves, and their urges to pull begin to diminish. And using mindfulness and learning to embrace gradual reduction rather than instant total cessation of pulling, they are able to slowly let go of some, most or all of tbeir hair pulling.

Friday, April 18, 2014

Therapy Groups for Adults and Teens with Trichotillomania (Hair Pulling Disorder) in Los Angeles

Therapy Groups in Los Angeles for Adults and Teens with TRICHOTILLOMANIA (HAIR PULLING DISORDER) and Skin Picking Disorder. Pico-Robertson Area

Nine-Week Therapy Groups (which may become ongoing) for adults (and separate groups for teens) who suffer from hair-pulling or skin-picking. Groups led by Claudia Miles, LMFT who has 17 years experience working with this OCD-related disorder. In Pico Robertson area. Group will help members learn how to effectively address these disorders and feel hopeful again. Recovery happens!  Los Angeles. $60/group 

Contact Claudia Miles, LMFT at 

Friday, April 4, 2014

A Foolproof Plan For Recovery from Trich and Skin Picking

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. 


Sunday, December 22, 2013

You CAN Recover From. Hair Pulling in 2014: Here is How

There's all this talk about CBT therapy being the "most" effective. I agree more with the "C" (cognitive) part than the "B" part (behavioral). The bottom line is, if you don't change the way you look at hair pulling* (*applies to skin picking throughout) there is no lasting recovery. Just today someone told me, "I was doing better and having lower numbers* for several months. Then I started pulling more and more and felt hopeless, and now I'm back where I was." (*Earlier in this blog I suggest people write down ONE number every day re their pulling or picking. Rate your pulling from 0 to 10, 0 being zero pulling, 10 being your worst day. That will be your "scale." That will be the one and only way you know you are recovering. NOT the hair on your head or lashes or brows. JUST the numbers. And the goal is to move from month to month having overall lower numbers with the understanding that you will have some bad days and that real success is accepting those and moving on.)

The person above who did better for a while and then had some bad days and felt hopeless again and gave up, her story embodies all our stories. Whether the length of time you've done better is a few months, a few weeks, a few days, a few hours or a few minutes, and the return to increased pulling is a moment, a day or a week, that step backwards is everyone's undoing. It was my story when I was pulling. Unless you can live through that moment and know it's part of the process, CBT or meditation or any other method will fail You. Because recovery is, will be, two steps forward, one step back. It will be three steps forward, two steps back. It may be eight steps forward, five steps back. You have not "gone backward," you have not "undone your progress." Because progress won't show on your head or your face (lashes, brows, skin) until later. Until you've done well, had that bad day or two, put it into context (the addiction trying to trick you into hopelessness so you will pull or pick), accepted it, checked not your hair or face right then but rather the general improvement in overall numbers, you CAN NOT RECOVER. Once you can see that those bad days will come and not let them deter you, your recovery is ASSURED.

 Prepare for that. Because as you learn to live without the comfort of pulling to turn to, the part of your psyche where your addiction is lodged, will get scared. For food addicts it is scary not to have comfort food to turn to. And that fear will inevitably cause, urge, cajole and tempt you to binge on something in the midst of changing over to healthy eating and moderation. With pulling that fear will cause you to have a few binge pulling days. And if at that time you say, "Forget it. I can't do this. I messed up. I failed, I'll never lose the weight," YOU WILL GIVE UP. You will say, as we all have, what's the point? It doesn't matter. I've ruined it.

Ah but you have not. Because you won't stop suddenly and completely. You'll stop gradually. And you'll have bad days in there. And if you learn not to judge them or panic or tell yourself, SEE I have failed, THEN you will have succeeded. Eventually you won't have to have those bad days. But the problem isn't those bad days. It's allowing those INEVITABLE bad days to stop you.

Because this will take a year. A year on the path. And then your hair will grow back. Your skin will heal. And if you demand this take three months, well it just won't happen at all. I know a year is a long time. But so is FOREVER. Do you want to pull one more year or forever?

During this year your motivation simply cannot be about how you look or your hair growing in but about feeling good about yourself. About feeling whole. Saying "fuck it I'm ugly" is the addiction talking. Saying "there is no point" is the addiction talking. Saying "I don't care" is the addiction talking.

The only way to avoid that is to understand that at the beginning you must focus on feeling good or at least better about yourself because you are working on the pulling. And writing down a number every day and focusing on improving the numbers and seeing them get lower each month that goes by, will keep you motivated. Knowing that you could feel proud the next day or next week is motivation. Knowing that judging yourself along the way is simply the addiction talking will keep you motivated.

It is NOT YOUR FAULT you have Trich or skin picking disorder. But it is your responsibility to face it. When you say, "I don't care" to give yourself temporary permission to pull you are lying to yourself. Of course you care. That doesn't mean you can always stop in that moment but you care. Pulling for all intents and purposes is an addiction. And you are a slave to it. So care about THAT.
It's NOT, I am bad, what's wrong with me, it's more, This is costing me a lot and is keeping you from living the life you want. That's why I care.

Above all else do not beat yourself up. Do not ask yourself WHY over and over again or What is wrong with me??. (Answer: Because you have trich or CSP. There is no other reason.)  

One cannot recover without shifting the center of motivation from hair to how I feel about myself, how this affects my life. Because the hair takes time to grow. If it's about the hair everyone fails. Because it's too easy to say that, well it looks like shit now so I may as well pull.

That is pretty much why people can't recover: Well my hair or lashes and brows or face looks like shit anyway (thus there will be no immediate payoff) so I might as well pull.

Imagine a person who weighs 350 lbs trying to lose weight. All they have is the scale to help them to see they are losing weight. They can't see it on their body right away. All you'll have for now is those numbers going down. This person who weighs 350 lbs must be proud that they are undertaking the journey. No new clothes shopping now perhaps. Maybe they don't feel pretty. But they are achieving a goal. Of lower numbers on the scale. And they can and must feel good about in order to keep going.

At the end of this thing you will have your hair. But at first make it your business to have lower numbers one month to the next and prepare for those inevitable bad days and they need not take you down.

I KNOW that you can recover from pulling. And believe me, I never thought I could either. But now I know different. The only substitute for pulling is self-acceptance and self-love, self-care and setting boundaries. Read Radical Acceptance. Read Codependent No More. And since it should be said, Take a day or night off just for you.  Exercise. Eat healthy good. Sleep well. Say NO once in a while.  Don't remain friends with people who are takers. Don't wait till you stop pulling to live life and to enjoy life. I'll be happy to answer questions here if you have them.

Thursday, July 18, 2013

For Parents of Children With Trichotillomania and Compulsive Skin Picking

Since 1996 I've met hundreds of parents of children and teens with trichotillomania and CSP, both in my practice and at talks and workshops I've given all over the country. I've discovered that even the most well-meaning parents--especially the most well-meaning, perhaps--need guidance as to what their role is in trich recovery and that getting it can make all the difference for their kids.

First of all, as parents you must accept that what your kid has a problem with is not life-threatening, is not evidence of a severe psychological order or that your child was abused.  It is not a deadly disease and it's not the end of the world: It is just HAIR. (Or skin as the case may be.) The more YOU panic, the more your child will. The only way to conquer trich and skin picking is to do so from a calm place, a place of acceptance, a place where one can tolerate the fact that recovery is two steps forward, one step back. And the only way these things can be conquered is when the person who is experiencing them are ready.

Yes I KNOW you are worried about your child at school, your child at prom, your child's self-esteem, your child loving him or herself.  But if your child isn't ready, if the hair pulling is not yet bothering your child at age 8, then dragging him or her to doctor after doctor, and therapist after therapist, and putting them on medication, will only do one thing: Convince your child she is defective. And what you need to do is just the opposite.

I've met MANY 8-year-old hair pullers. When I ask them if they want to stop, at first they say yes. When I ask them if they are bothered by the pulling, they ultimately admit that what they are bothered by is that their mom is so upset. I cannot tell you how many times I've heard this.  If that is where your child is, then sure, they will benefit from knowing about trich, from attending a Trichotillomania Learning Center (TLC) conference with you (, which is great for the whole family.  I will often meet with a child that age once and explain to them what trich is and that it's a disorder, that other kids have it, and that it's not their fault.  I also tell them that I used to pull my hair out, too, and that if they ever want help with this, to ask their mom and I know she will bring them back. And in many if not all of those cases, the child will ask their parents to bring them back to see me when they turn about 11 or 12.

Then there is the child or teen who is upset about having trich.  Please hear me on this. If you go into panic mode here that is how you are teaching your child to deal with having trich.  And that most assuredly will fail.  What you MUST do is console your child.  Say, I know it is upsetting honey, and it's certainly not fair, but we will get through this together. I will take you to see someone who knows about trich and they will be able to help you. I know you're upset and scared honey, but, you know what? I believe in you and I love you.  I know you are upset about your hair/skin, but I want you to know you are a wonderful, beautiful, lovable person. You don't have to stop pulling for that to be true. Trich is a disorder that they are learning more and more about.  We will find someone who will help. And in the meantime, don't blame yourself or get mad at yourself for having this disorder.  It is not your fault. I want you to know you a extraordinary person and this does not change that fact one bit.

In terms of exactly HOW your child can stop, the answer is, you cannot help them stop. They MUST see a professional. You as a parent, even if you ARE a psychotherapist, cannot help your own child stop pulling, although you can help your child have the best chance of recovering by accepting them just as they are and loving them no matter what. If you do nothing else, please stop telling your child things like, "Stop pulling, honey." "Get your hands out of your hair," or "Stop touching your skin." Do not ask them how the recovery from pulling is going every day. Do not examine their head to see how much they've pulled.  Do not say, you had better stop or you will be bald, if you don't stop you won't have any lashes or brows and those may not grow back. All these messages will create anxiety and fear in your child and make it that much harder to stop. And that anxiety and fear is YOURS, not your child's.

You must be the one who is calm and reassuring. You are the adult.  If you see your child pulling, feel free to say, Honey, could you come here for a moment? Or, Take a look at this! Or say something that allows them to stop without calling attention to it.  If they are sitting somewhere, go over to them and hug them. The thing you need to do is to help your child learn to self-soothe.  If their anxiety is met with your anxiety, they will have no way to deal with things that scare them or upset them or make them feel stressed.  And we all know there are plenty of those.  At present they are using hair pulling to calm themselves down.  So getting upset with them and constantly pointing out what they are doing and making them feel just the opposite of soothed will only cause them to pull more.  Telling them, Sweetie, I know it's upsetting but you will get through this.  This disorder is challenging and I know you feel sad and upset, but we will get help and do everything we can to help.  You are not "ugly" and you are not "weird." You are my beautiful daughter and trich can't change that! A lot of people have this disorder.  I know it still hurts and is upsetting, but I want you to know how much I love you and believe in you. This will be OK. We will find out all we can and we will face this together!

This kind of support, where you reassure your child, you tell your child that it's OK to hurt, but also to know that you will get through this, to reassure your child that he/she is still beautiful and lovable, that he/she is still worthy, that these confusing things happen and that they can get through them, this will help your child learn to self-soothe.  And learning to self soothe is pretty much the only "substitute" for hair pulling.

One other thing about examining their head or eyes, knocking on the bathroom door, telling them to stop touching their hair: It is their body, not yours. They have the disorder, not you, and they have to become ready to deal with it, rather than work on recovery because you want them to.  It's quite important for children with trich to have those boundaries respected, because often they feel so exposed to the world as it is.  Children, all children, need dignity and respect.  But when you have a disorder that is exposed to the world, even more so.  Once you let your child know what trich is, maybe meet with a therapist to have them explain it further and allow your child to ask any questions, then allow your child to decide when she is ready to address the trich. The more you allow your child space to decide and respect their decision, the quicker that time will likely be. And yes I know it's hard to see your child hurting. But pain is a part of life, even for a child.  The more you comfort him, the more you let him know that it's OK to be sad or upset and reassure him that he will get through this, the more equipped to deal with emotional pain he will be.

Most importantly, don't forget all the other things about your child (or your other children).  Don't make trich the sole topic of conversation with your child. Ask about school work, friends, dance, track or whatever else your child is doing. Chances are most 8-yr-olds won't be able to address this themselves at that age. You can consult with a therapist, you can help them understand what is happening to them, you can find a way to cover up their hair or brows in some way.  But you cannot force them to stop or motivate them to stop.  Those of us who have trich do not need additional motivation. We want to stop and you can't make us want it more. Or if we are 8, we may actually not care what we look like that much. So it's really you that is upset, not us.

The reason I say that parents need help too is because most parents are not able to be calm and relaxed and supportive when their child says, I'm so upset about my hair. Or when their younger child has some missing lashes or patches of hair. Of course it's important to seek help, to find a therapist, to become a member of TLC and receive all their information.  But what is also important is that you not panic and that you not hold this as if it's the end of the world.  Your child will learn how to see him or herself from you. The more you panic and the more you behave as if this is a disaster, the more pressured and stressed your child will feel. The main source of stress from most kids I see is their parents' relentless worry about the trich. The child ends up having to calm the parents down and ignore their own feelings.  This is SO common I cannot tell you.  And it becomes a huge block to recovery.

So if you cannot calm down, that's human and understandable.  But seek help rather than sharing your fear with your child via constant advice and questions.  Find a therapist you can vent to, someone who knows not to panic, who can hear your panic and who can help you get through your own fears. If you don't, you will pass your fear on to your child and your child will become the caretaker.  The more you can remain centered, the more you can comfort your child, reassure your child, let your child know that he or she is not defined by trich, that he or she is lovable just as she is right now.

Saturday, May 11, 2013

Straight Talk on Trich

I was interviewed last week about Trichotillomania and we covered so much the interview is being run in two parts. Check out Part I on the link below: