Geoff's FAQ

Geoff is a member of the TTM mailer and have set up this FAQ with the help of others on the TTM mailer.  Thanks Geoff!

E) GEOFF DEAN'S TRICH FAQ. (Version 4, Spring 2000.)

by Geoff H. Dean Geoff.Dean@tassie.net.au 
[JRK: with some additional comments by JRK added, in square brackets like this]

Please find enclosed the latest version of the FAQ. The main section is
essentially the same, but the resources and links section has been
extensively revised. Thanks to everyone who has contributed.

Web sites please feel free to link to the FAQ online at
http://www.irishlace.net/trichlibrary .

- - - -

The following are the most Frequently Asked Questions by people new to the
mailer.


1 - EXACTLY WHAT IS TRICHOTILLOMANIA?

Trichotillomania is defined as recurrent pulling out of one's hair,
resulting in noticeable hair loss, which is not due to another medical
condition.

There is an increasing sense of tension immediately before pulling out the
hair, or when attempting to resist the behavior, and there is pleasure,
gratification, or relief when pulling out the hair.


2 - HOW MANY PEOPLE ARE AFFECTED?

The true prevalence of Trichotillomania is unknown, since people are often
ashamed of their behavior and are consequently reluctant to discuss it,
even with their doctor. So it is difficult to get reliable statistics.

Historically it was thought to be rare, but the condition is now better
understood and more people are seeking help. More recent estimates range
from 0.5 to 3.5% of the population, depending on the definition used, and
the nature of the study.


3 - WHERE DO PEOPLE PULL FROM, AND WHAT OTHER THINGS DO THEY DO?

Sufferers as a group pull hair from a wide range of body sites including
the scalp, eyebrows, eyelashes, beard, pubic areas; and, less commonly,
underarms, chest, ears, nose and general body hair. The sites pulled by
particular people vary widely, and may be restricted to one or two sites.

Associated behaviors include searching for hairs that stand out in some
way; repetitive drawing of hair through the fingers, or over the lips,
before or after pulling; picking of associated skin; careful examination of
the hair or roots; compulsively playing with, or splitting the hair; biting
off the roots, or the hair itself into segments.

The behaviors are also specific to the particular person; some just pull
eyebrows with tweezers, for example, and others just pull from their scalp.
Some pull intensively from particular sites; others try to manage their
appearance by pulling less intensively, but from a wider range of sites.

Some people eat the roots or the whole hair. Since hair is not digested,
but remains in the stomach, this condition is potentially dangerous and
medical examination should be sought.


4 - WHAT ARE THE CAUSES, AND WHEN DOES IT FIRST START?

There is no known single or obvious cause, and there may be several
contributing factors, such as genetic predisposition, diet and stress. It
is now commonly regarded as a medical illness, and it may be caused by a
disruption in the system for communication between cells in the brain.

People frequently start compulsive pulling at 12 to 13 years of age,
although commonly at a much younger or older age. The onset may be
associated with hormonal changes at puberty, although many people recall a
significantly stressful event associated with the onset.


5 - WHY DOES PULLING COMFORT ME? AM I GOING CRAZY?

During hair pulling episodes, the sufferer frequently pulls from zones of
heightened sensitivity. It is generally not painful to pull from these
areas, or the pain is mild and the pulling causes great relief, or even
comfort.

The pulling can quickly become compulsive, causing relief and comfort on
the one hand, but anxiety and distress at the increasing hair loss on the
other. Sufferers can quickly become greatly distressed at an apparent
inability to control their own behavior, and the continual increase in
damage to both their hair and self-esteem.

Is it any surprise if some sufferers feel they might be going crazy, even
though they are not?


6 - ARE THERE ASSOCIATED ILLNESSES OR CONDITIONS?

There are apparent similarities with the symptoms of Obsessive Compulsive
Disorder (OCD), but only a low minority of Trichotillomania sufferers have
OCD as well; 15% in one study.

Depression has been reported to occur in a majority of people. However it
is not known if this is due to a direct biological link between the two
conditions, or whether the depression is a consequence of the severe loss
of morale and self-esteem brought on by the hair pulling.

Other behaviors believed to be common include nail biting and skin picking.

Procrastination has been reported as a symptom. This behavior of putting
off tasks is very frustrating to family and friends, and may be disruptive
of personal relationships.


7 - WHAT TREATMENTS AND SUPPORTS ARE THERE, AND WHAT SUCCESS DO THEY HAVE?

Medications are easy to use, but, used in isolation, are reported to have
limited long term effectiveness for the treatment of Trichotillomania
itself. They have been reported as a useful adjunct to other treatments,
and are often used to reduce the symptoms of associated depression.

Behavior Therapy attempts to stop or control specific undesirable
behaviors, or to replace them with new ones. Cognitive Therapy usually
involves identifying the thoughts that make pulling more likely, and
working on replacing them with new thought patterns.

These are often combined and / or used in conjunction with specific
medications. The treatments might include Group Therapy; training in life
skills such as Assertion, Anger and Stress Management, Goal Setting and
Problem Solving; and Relaxation Training. Programs are usually tailored to
the needs of the individual and, where practicable, involve the family and
supporting persons.

Psychotherapy and Hypnosis have also had some reported success.

Diet control has been widely claimed to contribute to easing or eliminating
pulling behavior. It is recommended that all sufferers carefully consider
the impact of diet, since some people have reported benefits from even
simple changes.

Skin care has been shown to be important for control of the condition in
some people. A variety of effective and readily available products has
been identified to relieve intense itching or other associated problems
which are present with some people.

Religion may become a powerful motivating force for healing in some people,
particularly as an adjunct to other treatments. It can contribute to a
sense of community; improved self-esteem; a strong sense of purpose, and
focus on goals; and an easing of depression.

A sense of community is a powerful force for healing with many people - to
know that you are not alone; to discover after years, or even decades, that
your condition is known to medicine; to share your thoughts and feelings;
to feel understood and accepted; to see people, who share the same
affliction, caring for one another.

There are reports from sufferers that aspects of hygiene may be important
for some people. Specifically, those who pull from eyebrows or lashes may
benefit from avoiding furry pets and frequent washing of the hands and eye
area with soap and water.

We should also consider what we regard as success, as so eloquently stated
by a parent, "Improvement tends to be incremental rather than total or
complete, and must be viewed in a broad perspective [rather] than simply
the reduction or cessation of the hair pulling behavior itself. Rarely can
a given course or therapy be viewed in such absolutes as success or
failure, but rather as a process of continuous improvement in all aspects
of the child's overall quality of life" M.J.Grant, TTM mailer, 5 Aug'99.


8 - HOW CAN I MEET OTHER SUFFERERS?

There are two broad ways to interact with fellow sufferers: via support
groups in your own locality, and via the various internet networks.

There should be a Mental Health organization in your own area who can put
you in contact with local support groups. In any case, the
Trichotillomania Learning Center attempts to maintain a comprehensive
listing of support groups.

For those who have an internet connection, there are support groups using
email which are knowledgeable, helpful and provide a safe environment for
interaction and learning.

Options for contacts include email networks (e.g. the TTM mailer); the
Fairlite Bulletin board; online chat groups; private email with users met
via these groups; and private web pages featuring contacts and links.

Some groups organize, or facilitate activities, such as retreats, picnics,
an International Day, and a bracelet symbolic of unity within the trich
community.


9 - WHAT CAN I DO FOR SUFFERERS?

The best way to help sufferers with Trichotillomania is to care about them,
to try to understand them, and to help them to learn more about their
condition, and how to manage it.

Sufferers commonly express enormous relief to discover that they are not
alone; to find that the condition has a name; and to be reassured that they
are not weird or crazy. It can be a profound experience for a sufferer to
describe their behavior and associated feelings to others people, and for
this to be accepted.

Parents of sufferers have often sought guidance about what is a helpful
approach toward their children, and specific information and contacts are
available for parents.


10 - WHERE CAN I FIND MORE INFORMATION?

Please note that this is not intended to be a comprehensive list of
information sources. Readers are referred to the pages below with the
comment "resources and links".


BOOKS

Dan Stein, Gary Christenson, Eric Hollander, "Trichotillomania", 1999,
American Psychiatric Press, 344 pages, ISBN: 0880487593, Price: US$45,
Publisher phone in the US, (202) 682-6262. Also in online bookstores

Jeffrey L. Anders, James W. Jefferson, "Trichotillomania - A Guide", 45
pages, by the Madison Institute of Medicine, 1989, ISBN: 189080214X Price:
$4.95. Postal address: Information Centers, Madison Institute of Medicine,
P O Box 628365, Middleton, WI 53562-8365; or by phone in the US, on (608)
827-2470. This is online at
http://www.trichotillomania.ab.ca/rwpeta/Aguide.html 

Cheryn Salazar, "You Are Not Alone: Compulsive Hair Pulling, the Enemy
Within", 1995, Cheryn Intl., 262 pages, ISBN: 0965067009, Price: US$14.95,
Web: http://www.cheryn.com/book.html  Also in online bookstores.

Jack M. Gorman, M.D., "The Essential Guide to Psychiatric Drugs", Revised
edition December 1998, paperback, US$6.99, St Martins Mass Market Paper,
416 pages. In online bookstores.
[Comment: Expert but non-technical information on psychiatric drugs]


WEB RESOURCES

TLC (Trichotillomania learning Center)
URL: http://www.trich.org/ 
Email: trichster@aol.com 
[Comment: Key site for resources and information; non-profit, subscription]

TTM Mailer library web site
http://www.irishlace.net/trichlibrary  
[Comment: Aims to make available select material from the mailer]

Parent Group (email mailer + web)
You can subscribe by sending a message to:
parents_ttm-subscribe@egroups.com  containing only the word subscribe. The
group is also online at http://www.egroups.com/list/parents_ttm  This
will require a free registration.
[Comment: An forum to share ideas, hopes and concerns with other parents of
pullers]

[JRK: Teen Group (email mailer)
You can subscribe by asking Trina:
Send email to Trinski54@aol.com  asking to be added and she will sign you up.]

Online full text articles.
http://mblcommunications.com/trichotillomania.html 
[Comment: Medical information about Trichotillomania - drug treatments;
Behavior Therapy; Classification; Trichotillomania in Children and
Adolescents; etc]

JK Diet Pages
http://jkdietpage.tripod.com 
http://soul4ce.home.texas.net 
[Comment: Information on dietary control of Trichotillomania]
[JRK: not JRK's own pages, but one set up by Mari, who liked the diet]

Amanda's Trich Web Guide
http://www.jly2.com/ttm 
[Comment: Excellent private site, resources and links]

Tina's Trichotillomania Site
http://www.trichotillomania.AB.CA/rwpeta/ttm.html 
[Comment: Excellent private site, resources and links]

Fairlite BB
http://www.fairlite.com/trich/index.shtml  
http://chatinfo.trich.fairlite.com/ 
[Comment: Chat room, contact others, very popular]
[JRK: Site discontinued in August 2000]

Stephanie's FAQ
http://www.geocities.com/~modularforms/trich/FAQ.html 
[Comment: Excellent and extensive FAQ]

Open Directory Project
http://search.dmoz.org/cgi-bin/search?search=trichotillomania 
[Comment: Useful links]