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:

Wednesday, April 24, 2013

Does Pulling Split Ends Count? )

Q. Does pulling split ends count as pulling? I'm not pulling the root out... Or is that like an alcoholic licking an empty but frothy beer glass... ?

A. In a sense, yes, since it will likely trigger you to pull other hairs out.  Also, many people who pull do not pull hair out by the root. Many others do. This does not define whether you have trich or not. But it all comes down to what you can live with. I've had clients who find playing with or smoothing their hair with their hands to be a trigger, and others who do not. For a few, being able to smooth their hair down actually makes it easier for them not to pull.  For almost everyone else, that's not the case. If pulling split ends somehow did not lead to you doing more, and you could live with the result of just doing that, that's perfectly fine.  However in 98% of cases, it's going to be a trigger to continue to pull. If split ends both you, I suggest getting your ends trimmed regularly.  

The key is to stop pretending there is certain kinds of pulling that "doesn't count." If you pull out gray or coarse hairs, that is compulsive hair pulling, and that's how we give ourselves permission to start picking or pulling. (I'll just pull this coarse one.) After we pull that one hair of course we disappear into trance and it's 30 minutes to two hours later till we "wake up" filled with shame or disgust and wonder, how did this happen? It's not unlike the alcoholic who tells himself, I'm not drinking to get drunk, I'm just having one glass of wine at dinner. Yet for this guy, every time he has one glass of wine at dinner, he is compelled to have 10 shots of tequila later on in the evening. This guy has to acknowledge that the glass of wine at dinner, for him, is part of the addiction. Next time he needs to be honest with himself: I know I'd love to be able to have a glass of wine with dinner, but the reality is it will lead to drinking alcoholically and I'm not going to pretend if isn't.  

In order to recover from compulsive hair pulling, we have to get out of denial. Even if one is not ready or able to consider pulling any less, all you need to do is simply acknowledge that the coarse hair you are pulling is in fact a response to the craving to pull. And to tell yourself--with kindness and compassion--I know I really want to make it OK to pull this ONE coarse hair and pretend this isn't the trich, but I'm not going to do that right now. I'm at least going to admit to myself that the desire to pull that hair is the same craving that causes me to keep pulling my hair out. I may not feel able to resist that urge right now, but I'm not going to pretend that it won't lead to more pulling. What I will do is acknowledge that even though it will cause me emotional pain, I feel unable to resist this urge to pull. Which just shows how very powerful this addiction is. 

If you are just beginning recovery, or if you haven't done this yet, the important thing is that you acknowledge what's happening. If you start to tell yourself, I'm just going to pull a gray or coarse hair or pick at my split ends, bring mindfulness to the situation. And acknowledge that chances are, you will keep pulling once you start, if you start.  You might say, ah, there's the trich wanting to convince me to start. OK I see. That's how it works... Just observe it, without judgement.  Trich is a disorder, and it causes people to crave this experience of pulling out our hair.  It actually feels good and soothing and that's why we keep doing it. Trich is NOT you WANTING to deface yourself or sabotage yourself or anything of the kind.  It's a pleasurable sensation that frustratingly causes hair loss. 

It's better to choose to pull knowingly than to feel or believe "it just happened." Better to choose to pull the gray hair knowing where it will lead (and being compassionate about how hard it is to resist this urge) than to keep saying, I don't know how this happened.  If you can CHOOSE to pull, ONE DAY you will be able to CHOOSE NOT TO. You WILL be successful. Just don't give up.  

Please send me any questions you have about recovery:  

Tuesday, February 26, 2013

Tune in to Your Own Needs and Feelings

One central issue hair pullers and skin pickers often possess is they aren't really sure how they feel at any given moment.  What they do know is how others feel.  You may be sitting in a room with a few people and be thinking: Jeannette seems mad (is she mad at me?); Bob seems bored, I wonder how I can get him more interested in the topic; Joan seems tired, she should probably sit down instead of helping in the kitchen; everyone must be hungry, I'll make a deli run.  You don't notice it, but you aren't aware whether you are mad or bored or tired or hungry, but rather, focused on taking care of others' needs.

The problem with this is, if you don't know how you feel, you are likely projecting your feelings onto others and taking care of the needs you believe they have, rather than your own. That's probably because fear caring for yourself means you are SELFISH or LAZY.  It's selfish to think of yourself; it's lazy to rest because you are tired. You might be surprised how many people with TTM and CSP believe these things.  That's because most of us with these disorders grew up in a home where for a variety of reasons they felt their survival depended upon taking care of others' needs.

Some examples of this include:

A client whose father was prone to rages and whose entire family was focused on not making him angry which was very hard to predict
A client who, at age 10, found out her mom was having an affair and who told her dad. The two never discussed it with her (or seemingly each other) and it was deadly quiet in the home. This woman planned things like Valentine's Day dinners for her parents, because she feared they would break-up. She was very attuned to what they were feeling, but since everyone was busy ignoring the elephant in the room, no one even asked her how she felt
A client who found out her mom had breast cancer when she was four. She learned to ignore her feelings because she did not want to share them with her mom and add to mom's burden.  Besides, anything she felt couldn't be that "big a deal" compared to what her mom was going through. This wasn't what her mom wanted, but nonetheless it happened.

If you don't tend to know how you feel or what's right for you, if you tend  to agonize over the "right" decision, no matter how big or how small, if you aren't aware of what's right for you, and instead focus on what you "should" do, if you wait to go to the bathroom till the last possible minute, if you try to make sure everyone around you is happy or at least not mad or disappointed and are aware of how most others around you feel, yet you don't know what you feel or whether you are OK, if you do know how you feel but think it would be selfish or lazy to fulfill those needs, then an important part of recovery is learning to tune in to your own needs and feelings. How many times have you had an important decision to make about your life like whether to get a divorce, whether to take or leave a job, whether to move, and you've asked every single person you know what they think you should do? Doesn't it make sense to get advice you ask? Not really. Not about something that will affect primarily you and that only you can know the answer to. Do you want to live the life the person whose advice you are asking would lead, or do you want to live your life? At the very least, you have to know what you really want. The question is not, What if you make a mistake, because you will.  It's more like, how can you start to accept that you will make mistakes and that that does not make you less worthy?

Pulling and picking behaviors may not be caused solely by not knowing yourself, but the behaviors definitely play a part in helping you numb the pain of ignoring your needs and feelings.  The more you learn to tune in to what you feel, what your opinion is, what you need, the less you need pulling or picking to numb these things.  In other words, knowing what you're feeling will help you stop pulling and picking. It isn't that you'll be able to meet every need, address every feeling of course, but that the vulnerable part of yourself, the part that does the pulling, will start of be able to relax and know that IT will be heard. It will no longer be ignored.  Those fears, that pain, can cause urges to pick and to pull to be more frequent and stronger.  The more you learn about what you feel, what you need, what you believe, the more you pay attention to what was likely ignored for a long time, the less anxiety you will have.  Chances are that in meeting others' needs you have some vague hope that they will meet your needs in return.  That rarely happens, though.  One reason is that those who would take take take from you, are takers, not givers!  And those are the folks you are probably giving to.  Another reason is that your partner, spouse, best friend, lover may not realize what you are doing.  I know you think it's obvious but it's not.

Another reason it may be scary to know how you feel is that then you will actually have to feel it. You may be afraid those feelings will last forever or that it's self-indulgent to feel them.  I've heard many people say things like, "If I allow myself to be sad, I'm afraid I'll never stop crying," or "What do you mean allow myself to grieve? That's all I've been doing for 10 years." Sometimes people believe that allowing themselves to feel grief, sadness or anger is self-indulgent or weak or unfair. They will say, "I shouldn't be sad after all this time," "How can I really be angry at my mother when she did the best she could," or "At this point I think my grief is just me being a baby."

The truth is, when it comes to feelings, whatever you resist, persists.  If you refuse to allow yourself to grief or be sad, it will be there all the time, just beneath the surface.  That's why you may cry at movies or Hallmark commercials at the drop of a hat.  In terms of whether you "should" feel how you feel, it's simply not a matter of should.  Feelings just ARE.  They exist.  If we spent 1/4 the energy allowing ourselves to feel them as we do pushing them down, they would be long gone.  And what about being angry? Anger is a feeling, not a betrayal.  And everyone has reason to feel anger at their parents.  It certainly doesn't mean you don't love them.  Even if your parents did do the best they could, it doesn't change the fact that you're affected by them, just as they were affected by their parents. Being angry at someone is different than blaming them or cutting them off.  Underneath the anger you are probably hurt.

1) Practice tuning in to what you feel and what your wants and needs are even if you don't change what you do.  Ask yourself, do I really want to go that event? Do I want to help so and so with her move? If you start to think, I should go, I should help, then you will know you aren't tuned in to what you feel.  It's OK if you go, but ask yourself what you really feel.  Find out if you are resentful.  One person might tell me, "My mom calls three times a week, and I have to talk to her because if I don't she gets really hurt." Well it seems your MOM knows how she feels!  But why does her need to talk to you or her "hurt" supersede your need to have time to yourself, to NOT talk, to rest?

2) Allow yourself to have your feelings (say, OK I'm sad right now, instead of, how can I stop being sad) and understand that you can't know how long a feeling is supposed to take.  That doesn't mean neglect your job, your kids, your partner, your friends, but it does mean that you stop saying to yourself that you "shouldn't" feel sad about X for so long or that you can't be angry at someone in your life because they did the best they could.  All that angry that you believe you aren't allowed to feel you actually are feeling, but only at yourself.  You are judging yourself, criticizing yourself, telling yourself you'r'e a failure or that you are stupid or selfish or pathetic or lazy or weak.  If you aren't allowed to feel your anger it becomes a toxic soup inside you.  You don't need to be violent, you don't need to yell, you don't need to necessarily tell others that you're angry, but you need to allow yourself to acknowledge and know it is OK to feel it.

3) Notice your judgements about all these things. Do you fear you are selfish or lazy? Do you think it's not OK to be angry? Are you unable to separate what you really want with what you think you should do?  Notice your fears of making a decision based on what you believe is right for you.  You don't have to get rid of these judgements, just be mindful of them.

Simply knowing the difference between what you really want and what you think you should do, and what you really feel and what you really should feel, will allow the part of you that has felt neglected or unloved or vulnerable to start feeling seen.  Just the very fact that you know and pay attention to that voice inside will calm the voice down. Someone is paying attention.  You.  It's the beginning of reparenting yourself and it's an important step in trich and skin picking recovery. This is something you can address no matter where you are in your recovery.  I hope you will start to investigate!