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.