Washington Times article (Jul 2001)

Credit TLC & Washington Post


  *(If you don't already know what TLC is, it is the
Trichotillomania Learning Center - and the only Not-for Profit
Association for Trichotillomania. Their Website is www.trich.org. They
have encouraged me and others to post and distribute our notes from the
TLC Retreat sessions, in order to help as many people as possible!) I
recommend that you look through their site ... the Calendar section
lists events and Support Groups (who know they may be in your area). 

** This was originally an email sent to me although I was not one of the
people interviewed ... 

**Dr. Mansueto, who is mentioned in the article, is on the Scientific
Advisory Board of TLC. 

______________________________________________ 

Plucking out one's hair 
by: Christian Toto 
THE WASHINGTON TIMES
Published 11/6/2001 

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 

*****As a third grader, Judy Brown watched with wonder as her teacher
systematically pulled out her eyelashes between lessons. Judy went home
and tried to pluck out her own eyelashes, curious whether it could be
done and how it might feel. 

*****That innocent fascination led to a full-blown case of
trichotillomania, a little-known but emotionally crippling disorder in
which sufferers pluck out their eyelashes and eyebrow and scalp hair,
often until very little remains. 

*****Trichotillomania often begins between 10 and 12 years of age, a
vulnerable time for children beginning their trek toward adulthood. 

*****"When you're a kid, you want to fit in. I really didn't. I looked
like I had cancer," says Judy, now a 17-year-old Springfield resident. 

*****Trichotillomania's onset can be accompanied by a stressful event,
such as a parent's death or a change of schools, but it also can begin
as innocuously as Judy's disorder started. 

*****Judy has taken a measure of control over "trich," as many who have
the disorder call it, through behavior therapy. The approach teaches
sufferers to create structured methods of keeping tabs on the symptoms
that lead to the pulling, then to introduce other, less destructive
habits. 

*****Judy kept a box of toys, full of stress-relieving balls and other
comforting objects, as one way to keep her hands occupied and her
thoughts away from pulling. 

*****She credits her progress to Charles Mansueto, a trichotillomania
specialist and director of the Behavior Therapy Center of Greater
Washington D.C., in Silver Spring. 

*****Mr. Mansueto says researchers have just begun to study the
disorder, and much about its causes and treatments remains a mystery. 

*****Toddlers occasionally develop the disorder, only to outgrow it, Mr.
Mansueto says. 

*****Others aren't so fortunate. 

*****"There's probably a biological vulnerability that exists that may
predispose some to trichotillomania," Mr. Mansueto says, adding that the
cause involves "a complex array of experiences and biological
predispositions." 

*****He estimates that 2 to 3 percent of the population has battled the
disorder at some point, but that figure may not be accurate, given the
tiny body of research compiled so far. 

*****"Our data is really not excellent simple questions like, 'How many
people have it?' We have to hedge a bit," he says. 

*****The disorder's impact, though, isn't up for debate.  "We have to
acknowledge it has the potential to be a deeply entrenched problem that
can spoil lives," he says. 

~~~~~~~~~~~~~~~~~~~ 

*****Some of its physical effects also can be permanent, Mr. Mansueto
says. Repeatedly pulling out hair can damage the follicles, or hair
roots, causing scarring and infections. In rare cases, the hair will
never grow back. 

*****Generally, the hair will return even after years of damage, though
eyebrows are less likely to regenerate. The returning hair may be a
slightly different color or texture. 

*****Treatment typically involves medication, behavioral therapy or a
combination of the two. Medication, involving drugs similar to those
given to people with depression - such as Prozac, Zoloft and Paxil -
haven't shown long-term efficacy, Mr. Mansueto says, and in some cases
cause deleterious side effects, such as extreme drowsiness. 

*****For some patients, the medication lowers stress levels, which can
have the benefit of decreasing hair-pulling if stress is a contributing
factor. 

*****Behavior therapy differs for each patient, in part because the
triggers and situations involving each hair-puller are different,
requiring a customized approach. 

*****Dr. Philip Ninan, professor of psychiatry at Emory University in
Atlanta, says the term "trichotillomania" was coined more than 100 years
ago - from "trich," meaning hair; "tillo," meaning pull; and "mania,"
meaning madness. Yet significant interest in trichotillomania did not
begin until the late 1980s. 

*****Dr. Ninan says about nine in 10 people with the disorder are women,
though men may camouflage its effects by blaming male-pattern
baldness.  "You can have normal baldness on the scalp. That's more
societally acceptable," he says.            

*****The social stigmas of hair pulling are far worse for women, he
says. "We have a society where perception is everything," he says. "Hair
is associated with beauty in women."   

*****Part of the shame hair pulling fosters stems from the perception
that pulling should be under a person's control. Those who can't stop
themselves perceive themselves as failures and internalize that
defeatist attitude. 

*****Recent research hints at a biological root to the disorder, Dr.
Ninan says. Magnetic Resonance Imaging (MRI) tests completed on patients
with trichotillomania have shown areas in the brain that in
trichotillomania sufferers seem to be smaller in size. 

*****Judy doesn't mind telling others about her ordeal. "Now, I can talk
about it," she says of her disorder. "I want people to know about it."
  

*****Several people with trichotillomania contacted for this story
preferred to use pseudonyms. Shame arguably is the disorder's most
devastating side effect. 

*****Alexandria resident "Mary" says her 16-year-old daughter, "Jane,"
developed the disorder during a particularly stressful time at school.
Once established, the disorder struck at random, during periods of
stress and times of tranquillity. 

*****"When she was less busy it was worse," Mary says. "She couldn't
read the Sunday comics without pulling out her hair." 

*****Jane wore gloves while studying, put bandages on her fingertips to
impede her pulling and buried herself in school athletics as a
distraction. 

*****"It didn't go away, but it seemed to get under control," says her
mother, who bristles when recalling her daughter's struggles. "I cannot
tell you how frustrating it is." 

*****"She said to me she'd rather have cancer," Mary recalls of her
daughter's struggles. Then, she says her daughter reasoned, she would
have an excuse for the bald spots peeking through her hair. 

*****"Melissa," 24, of the District, recalls how she started pulling her
hair - as a 16-year-old student in chemistry class. 

*****"It was a horribly boring class," she says. "My finger wandered up
to my eyebrow." 

*****For the first year, she only pulled at her eyebrows. "I used to
have thick, full eyebrows. I just said I had gotten them waxed," she
says of what she told people about the thinning hair. Then she began
plucking her eyelashes, then her pubic hair, before moving to her scalp.
Now she fights daily to stop pulling from all four areas. 

*****She describes the sensation leading up to pulling as "a ball of
tension that's about to explode in my belly." 

*****She takes two anti-depressant drugs, Effexor and Wellbutrin, to
help stave off the temptation to pull, but their impact has been
minimal. She also is working with Mr. Mansueto's center and has had some
initial success. 

*****For now, she uses various hair coverings to hide several bald
patches. She has considered buying a wig, but her family fears that
would lead her to pull her hair more aggressively. 

*****Yazmin Fuentes, a 22-year-old student at the University of Miami
who began pulling out her hair a decade ago, doesn't mind having her
name associated with the disorder. 

*****"One of the things that made it worse was hiding it, making up
excuses for it," Miss Fuentes says. 

*****Miss Fuentes began when she was 12, pulling out her hair by
accident while sitting in front of the television. "I saw what the root
looked like. I became extremely interested in the structure, of how it
looked," she says. 

*****Miss Fuentes says she has tried every medicine and therapy
available, but nothing has worked. 

*****"I'm starting med school next year, and I know it's going to get
really, really worse," she says. 

*****Fairfax County resident Cynthia, 46, began her hair pulling at 8,
after her orthodontist yelled at her for not wearing her head gear. 

*****"People think it's like biting your nails, but you can't stop it,"
she says. "I've taken all the drugs, and they just don't work," adds
Cynthia, who runs a support group in Northern Virginia for those with
trichotillomania. 

*****Though Judy's trichotillomania is under control, the urge to pull
hasn't disappeared, and she doesn't expect it to entirely. 

*****"If I'm stressed out or bored, I'll start thinking about
[pulling]," she says. 

__________________________________ 
Copyright (c) 2001 News World 
Communications, Inc. All rights reserved. 
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