(this is raw unedited text transcribed directly from the audio)
Dr. Kenner: Here’s a question I received from Amanda. You know, people can have mania where they’re going crazy. They’re dating many people, sleeping with many people when they shouldn’t be and they are driving down the highway at 150 mile an hour and drunk and they’re just making very bad decisions. So this, what I’m about to say, is called trichotillomania. And what do you think trichotillomania is about? Kind of brings up images of spiders to me. Well, let me tell you – it’s none of the above. It’s not mania. It’s not having to do with spiders. It’s not having to do with anything that trickles. It’s having to do with compulsive hair pulling. You know you see that gray hair and you’ve got to pull it out, or you’ve got hairs growing in places you don’t want them and you pick them out and just can’t stop doing it. You do that once and a while, it’s normal. Absolutely, totally normal. We all groom. We all pluck our eyebrows. We all take hairs out of our ears or nose or chin if we’re getting older. We all dye our hair. We do a lot of things with hair. So here is a question from Amanda, and see what help you might offer her and we’ll talk about it too.
“Hi Dr. Kenner. Should I seek help for my constant need for hair picking? I pick my eyebrows nonstop, everyday, and I have been doing this for years, since I was 5 years old. I am now 18 and it’s ruining my social life. My eyebrows are really oddly shaped. They are chunky and end about halfway where my eye is. There is a VERY large space between both my eyebrows. How attractive is that? If I don’t pick them, I get incredible tension and I give into the temptation. I will obsess with one hair. After I pick one out, I have a sort of ritual for the hair I pick out. Do I have trichotillomania? And is there any way I can stop? Amanda.”
Amanda, yes to both. Yes, it’s called trichotillomania. I wish we would all just call it a hair picking tic, rather than this crazy name. But that’s what we’re stuck with. And there is incredible help. There is no reason for you to have to go another decade with pulling out your eyebrows. There are wonderful, wonderful skills and you’re obviously motivated because you wrote to me. So a little bit about trichotillomania. It’s called repetitive hair pulling, and it can be anywhere on the body. Some people pull hairs off their chin. Say a guy’s got a beard. Some may do it on their scalp or eyebrows or eyelashes. I worked with a case many years ago with eyelashes. And it’s a noticeable hair loss. It isn’t just one out of place hair or one gray hair. That’s fine to do. It’s the dynamic that goes on with trichotillomania, the hair pulling, that is the problem. You feel a lot of tension prior to pulling and when you try to resist that urge, it becomes more intense. You just need to get, you’ve got to pull that thing out. When you pull that bugger out of your eyebrow, that hair, you feel a sense of pleasure or gratification. Some people feel relief momentarily. Then you feel shameful. You look in the mirror, you look at the weird eyebrows that you now have that start midway through your eyes and you’ve got this large space, and you feel like you’re an embarrassment anywhere you walk. You talk to friends – what do they notice? Of course they’re looking at your face. That’s what we look at with people mostly. You try to date someone and they bring you home to the parents and this is my girlfriend and you’ve got this weird space. It looks like you’ve lost control. And you have lost control. But not of your whole life. Don’t beat yourself up about that. You’ve lost control of a habit, you’ve built up a habit that’s very well engrained. You may have some cover-up strategies. Some people maybe darken their eyebrows or people who pull the hair on their scalp might wear wigs or actually color their scalp.
So I’m going to now jump in with a taste of cognitive therapy. You can go to my website, DrKenner.com, or you can go to the AcademyofCT.org, the cognitive therapy website and look up trichotillomania. Here are the skills:
First, some cognitive therapists will actually have you keep a log of your activities during the day. You don’t do this forever, but you do it to get information, like a scientist. Who, what, when, where, why and how. When do I pick? When do I not pick? So you jot this down. You go through a day. You actually log in what happens during the day regarding the picking. When am I more relaxed? What happened just before I started picking? What did I say to myself when I went to pick? People say all sorts of things to themselves. I deserve to pick. I’ve had a hard day. I can just pick one hair and it won’t matter. I can’t stop this. It’s compulsive. I have to pick. If you tell yourself that it’s compulsive and you have to pick, what are you going to do? You’re going to pick. So, people tell themselves all different things.
Then cognitive therapy takes you, once you get your information of what you say to yourself, what are your triggers, what are the high risk situations – maybe you’re watching TV, maybe you’re at a magnifying mirror, maybe you’re driving and pulling your hair out – what emotions are you having? Anxiety, guilt, shame, boredom, maybe excitement or joy? What is the function of pulling out your hair? You want to answer that question for yourself. Then you want to raise your awareness. Sometimes people pick, like you can pick your fingernails or bite your fingernails and you’re not even aware you’re doing it. You need to raise your awareness. You need to be able to identify, “Oh my God, I’m about to pick. What can I do?” Then you want to get rid of the “oh my God” because you don’t want to make it catastrophic. Some people put tape on their fingers so that they’re more aware when they’re going into picking, or they hold their hands down by their sides. You can learn relaxation skills which will help. You can understand why you pull. Maybe it was frustration from your past. You said you’ve had it for decades. Be prepared for slipups. They are never a problem. If you have a slipup, just be kind to yourself. Who cares. And go back to your skills. So cognitive therapy can give you wonderful skills to deal with trichotillomania.
Male 1: Did she say anything, mutter anything at all?
Male 2: Yes, come to think of it, she did. A bad seed.
Male 1: Oh yes, she was starting to write a book. Something around the theory … let me see. That a child can inherit criminal tendencies in their blood.
Male 2: If you forgive me, that’s a pretty [inaudible 00:08:05] theory.
Male 1: That’s what I told her myself. It’s all a matter of environment, isn’t it?
Male 2: Of course.
Dr. Kenner: That’s from the movie The Bad Seed. You might have a kid in your own family and you say, “He’s just the bad seed.” Must have been something wrong with him genetically. Or maybe it was the environment. Maybe it’s their family. You’re looking at someone else’s family. Maybe it’s the way they brought him up that has to do with it. Definitely the way you parent matters a lot. But there’s another part that matters even more. And that is you, as that child, the bad seed, how have you run your life? What thinking have you done? I have seen kids make decisions. I used to work with a lot of very young children, at the age of 2 and up, and you could see the process of decision making. Am I going to steal from Dr. Kenner’s office or not? I like that toy. Should I put it in my pocket or not? Maybe I shouldn’t. Maybe I will. And then you see their choice making. “Hey, hon, it looks like you’ve got something in your pocket there, what’s going on?” “Nothing, I have nothing.” They make choices all the time. And we make it look like kids don’t have free will, they don’t have volition. They do. They do need moral guidance and if you give them rational moral guidance, it’s a lifetime gift. If you give them irrational moral guidance, telling them that they have to sacrifice themselves all the time, then it’s the biggest disservice you can ever give them. Hopefully they can think themselves out of it, but it’s very tough to think about the deepest moral questions and many people avoid it. They just think with whatever morality their parents had or they just switch it up a bit and pick up things in the culture and never question what their moral code is.