Trichotillomania: A Body-Focused Repetitive Behavior

By: Lauren Zoneraich

Trichotillomania, also known hair-pulling disorder, is a chronic psychological condition in which one feels the urge to pull out pieces of hair from the scalp, eyebrows, eyelashes, and other body areas.  Hair pulling can be an intentional or an unconscious behavior. Some people purposely pull their hair because it produces a pleasurable feeling. Hair pulling relieves stress, anxiety, sadness, and tension for people with trichotillomania. A motivation for pulling hair may simply be to relieve the urge to pull hair. Others may unconsciously pull their hair when they are relaxed or distracted. Hair-pulling causes the formation of bald spots and the thinning of hair, which induces anxiety and distress in people with trichotillomania. People with trichotillomania may feel ashamed and embarrassed about their appearance, which may lead to low self-esteem and the avoidance of certain social activities in which they must expose their head.

About 2% of people experience trichotillomania in their lifetime. Trichotillomania is categorized under “Obsessive-Compulsive and Related Disorders.” Symptoms and signs of trichotillomania include:

  • Repeatedly pulling out hair
  • Tension before pulling or when resisting the urge to pull
  • Pleasure or relief after pulling out hair
  • Hair loss, hair thinning, balding
  • Rituals for hair-pulling, such as a preferred spot to pull from
  • Biting, chewing, or eating pulled out hair
  • Inability to stop pulling out hair
  • Social distress related to hair-pulling

A possible pharmacological treatment for trichotillomania is N-acetylcysteine (NAC), an amino acid which targets glutamate levels in the nucleus accumbens, which is the reward center of the brain. The nucleus accumbens also houses neural circuits involved in aversion. Glutamate is an excitatory neurotransmitter, which means that it activates these pathways in nucleus accumbens. Altering glutamate levels may alter the strength of reward responses to certain behaviors, which may allow patients to decrease unwanted behaviors. In a study, researchers found that 56% of subjects reported improvement to their trichotillomania after 9 weeks of taking NAC. NAC can be bought at nutrition and health stores. This was a relatively small study, so more research must be done to determine the clinical effectiveness of NAC.

If you or someone you know is struggling with trichotillomania or skin-picking, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/

Sources:

https://www.bfrb.org/learn-about-bfrbs/treatment/self-help/123-n-acetylcysteine-for-trichotillomania-skin-picking-and-nail-biting

https://www.bfrb.org/learn-about-bfrbs/trichotillomania

https://www.mayoclinic.org/diseases-conditions/trichotillomania/symptoms-causes/syc-20355188

Image Source:

https://youngwomenshealth.org/2019/02/06/trichotillomania-hair-pulling/

Body Image: The Negative Effects of Zoom

By: Lauren Zoneraich

Due to the transfer of meetings, classes, and other events from in-person to Zoom, people are experiencing an increase in self-consciousness from looking at their faces on a screen. In normal interactions, we do not need to confront our own image, but on Zoom we constantly face it. During Zoom meetings, it may be difficult to avoid focusing on how we look when we listen, talk, and emote. Continually staring at our own image can bring our insecurities to the forefront of our minds. In fact, our perception of our image may become distorted the longer we look at ourselves.

Zoom meetings may be especially difficult for people who already struggle with body dissatisfaction, or its more severe form, body dysmorphia. Body dysmorphic disorder is a preoccupation with one’s appearance, especially minor aspects of appearance which one perceives as a defect or flaw. People with body dysmorphia may have low self-esteem and believe that the perceived defect in their appearance makes them ugly or deformed. The preoccupation with the perceived flaw may cause anxiety in social situations. People with body dysmorphia may frequently check their image or groom themselves as a means to “fix” their perceived flaws. Features on technology, such as the “selfie camera” on the iPhone, serve as mirrors that enable people to repetitively perform these checking behaviors. The selfie camera also promotes preoccupation with one’s appearance. The Zoom screen is a permanent, overstimulating mirror.

A survey of a class at Cornell University revealed that the main reason students do not keep their cameras on during Zoom classes is due to insecurities about how they look. Zoom has implemented some features to combat these body image issues. Users can choose to “Hide Self View” so that they cannot see their own image on the Zoom call. Still, although they cannot see themselves, people may still worry about how others see them. If one is constantly staring at oneself or worrying about how one looks, one may not be able to focus on the content of the meeting.  Mind-wandering may decrease the level of happiness one feels while participating in a certain activity. Thus, eliminating distractions may make classes and meetings more enjoyable for participants.

If you or someone you know is struggling with body image or body dysmorphia, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/

Sources:

https://cornellsun.com/2021/05/03/zoom-classes-heighten-self-consciousness-introducing-new-classroom-distraction/

https://www.vogue.com/article/body-dysmorphia-zoom-face

https://www.mayoclinic.org/diseases-conditions/body-dysmorphic-disorder/symptoms-causes/syc-20353938#:~:text=Body%20dysmorphic%20disorder%20is%20a,may%20avoid%20many%20social%20situations.

https://greatergood.berkeley.edu/article/item/does_mind_wandering_make_you_unhappy

Image Source:

https://www.pcmag.com/how-to/how-to-prevent-zoom-bombing

Habits: Body-Focused Repetitive Behaviors (BFRBs)

Body-Focused Repetitive Behaviors (BFRBs)

By Lauren Hernandez

            Body-focused repetitive behaviors (BFRBs) are a group of disorders composed of “self-grooming” behaviors in which a person might pull, pick, bite, or scrape one’s hair, skin, or nails. BFRBs can be considered “impulse disorders,” however; it is still undetermined whether they are either impulsive or compulsive behaviors. People suffering from BFRBs typically lack awareness towards engaging in the repetitive behavior. BFRBS are problematic when they occur repetitively and cause a person distress in their physical, social, and emotional lives. The cause of BFRBs is still being researched; however, for some, habitual behaviors such as biting nails, chewing on their cheeks, and pulling their hair may develop into an impairing pattern associated with other mental illnesses.

Most BFRBs are associated with anxiety disorders, impulse control disorders, and obsessive compulsive disorders because they are difficult for individuals for control. BFRBs not only have an emotionally distressing impact, as an individual may experience high levels of shame, but BFRBs can also cause physical injuries such as scarring, skin infections, or bald spots.

The most common BFRBs include:

  • Trichotillomania- compulsive hair pulling
  • Dermatillomania- Compulsive skin picking
  • Onychophagia- Compulsive nail biting

Treatment of BFRBs include cognitive behavioral therapy, medication, and supplements, however, there are lower rates of treatment success due to lack of research on the disorders and effective treatment methods. Treatment for BFRBs should be discussed with a psychologist or psychiatric nurse practitioner in order to tailor treatment for an individual.

If you or someone you know is struggling with a Body-focused repetitive behavior, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/ .

 

Sources:

https://www.psychologytoday.com/us/basics/body-focused-repetitive-behaviors

https://www.psychologytoday.com/us/blog/touchy-subject/201805/habitual-behavior-or-bfrb-disorder

Image Source:

https://www.google.com/search?q=body+focused+repetitive+behavior&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjxvLyi6_DiAhUDA6wKHUvMC_AQ_AUIECgB&biw=990&bih=595#imgrc=VSq0qyAtsKNwDM:

What is Trichotillomania?

By Stephanie Osuba

Trichotillomania is a hair pulling disorder categorized in the Obsessive Compulsive and Related Disorders section in the DSM-5. It is one of the other Body Focused Repetitive Behaviors (BFRBs) – along with excoriation (skin picking) and onychophagia (nail biting) – in which the individual will pull, pick or bite at various parts of the body resulting in damage.  Symptoms include recurring hair pulling, hair loss, and related stress and impairment because of the behavior. The disorder is not considered self-mutilation like cutting or burning because the behavior is not intentional and research suggests that there is no connection between the disorder and unresolved trauma. Often people are ashamed of the behavior and their resulting appearance because of it and try their hardest to stop. Comorbidities include, tic disorders, mood disorders, and anxiety disorders, although, trichotillomania can also occur in the absence of any other psychopathology.  The regular age of onset is between the ages of 11 and 13, however, baby trichotillomania is a rare phenomenon that seems to go away as the child grows older. Research also suggests that the disorder is primarily genetic as it appears in the first relatives of people with trichotillomania than it does in the general population.

Available treatments include cognitive behavioral therapy (CBT) and habit reversal training (HRT) with adjunctive dialectal behavioral therapy (DBT) and acceptance and commitment therapy (ACT). These therapies help the person to be aware of the pattern of the behavior and helps to identify triggers to pulling. It also teaches methods to redirect that urge to pull into a new healthy pattern of behavior in order to reduce or eliminate the urge. While there is no FDA-approved medication specifically for BFRBs, research is being conducted. OCD medication such as selective serotonin reuptake inhibitors (SSRIs) and anafranil can help alleviate symptoms as well.

Sources: Deibler, M. W., Psy. D. (n.d.). Trichotillomania (TTM) and related Body-Focused Repetitive Behaviors (BFRBs). Retrieved from http://www.thecenterforemotionalhealth.com/trichotillomania-and-related-disorders

Zwolinski, R., LMHC. (2013, October 03). Cause And Treatment Of Trichotillomania. Retrieved from https://blogs.psychcentral.com/therapy-soup/2012/04/cause-and-treatment-of-trichotillomania/

If you or someone you know appears to be suffering from trichotillomania, the licensed psychologists, psychiatrists, psychiatric nurse practitioners, and psychotherapists at Arista Counseling & Psychotherapy can assist you. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, visit http://www.counselingpsychotherapynjny.com/.