Trichotillomania: What is problematic hair-pulling?

Trichotillomania: What is problematic hair-pulling?

Trichotillomania (TTM) is currently classified as an impulse-control disorder. TTM entails the phenomenon of repetitive hair pulling that results in hair loss. The diagnostic criteria for TTM include: an increased level of tension immediately before hair pulling or during attempts to avoid pulling and a feeling of relief, pleasure, or gratification in response to hair pulling. Trichotillomania must also cause the individual distress or impairment in occupational, social, or other areas of functioning. Hair is most often pulled, one hair at a time, either from the scalp, lashes, or eyebrows. Hair pulling from the pubic area is also common.

Pulling is generally executed by way of the fingers; however, tools such as tweezers, brushes, or combs may be used as well. TTM suffers will often partake in post-pulling actions that involve handling the pulled hair using the mouth, hands, or face. The hair can be chewed or ingested as well. Ingesting hair may also lead to a number of significant health issues. TTM is considered to be more common among females, although it is not certain whether this sex difference results from an actual variance in the occurrence of the disorder, represents a female treatment-seeking bias, or simply reflects higher acceptability in society of hair loss in men.  

At the Better Living Center for Behavioral Health we treat patients with trichotillomania with evidence-based treatments including Habit Reversal. Habit reversal helps the individual break down the series of actions that lead to hair pulling and engage in alternative behaviors to reduce hair pulling. If you would like to learn more about treatment of trichotillomania or other Body Focused Repetitive Behaviors (BFRBs) please contact us at 972-332-8765.



Woods, D. W., Flessner, C., Franklin, M. E., Wetterneck, C. T., Walther, M. R., Anderson, E. R., & Cardona, D. (2006). Understanding and treating trichotillomania: What we know and what we don’t know. Psychiatric Clinics of North America, 29(2), 487-501. doi:10.1016/j.psc.2006.02.009

Differences in Early and Late Onset OCD

Differences in Early and Late Onset OCD

Pinto et al. (2006) defined OCD as “a neuropsychiatric condition characterized by recurrent intrusive thoughts (obsessions) and repetitive behaviors that the individual feels driven to perform (compulsions)” (pg.1 ).  The researchers sought to investigate predictors of remission/relapse among those treated for OCD.

Over five years, 293 adults were monitored and researchers measured their OCD symptoms. Researchers found those with early and late onset symptoms experience an increase in symptoms over time without effective treatment. Additional findings show a considerable amount of time between symptom onset and first initiation of treatment. Individuals in the study reported an average of 17 years from initial symptom experience to treatment initiation and 11 of delay from meeting diagnostic criteria for OCD until treatment initiation. Many clients reported spending a number of years misdiagnosed before initiating appropriate treatment for OCD.  

Researchers found the average onset for early onset OCD was 11-12 years old, while late onset OCD was 25-26 years-of-age. The first clinical symptom(s), obsessions and compulsions, 53% of participants indicated an obsession and 47% experiencing a compulsion. Interviews also found aggressive content obsessions, hoarding obsessions and compulsions as primary themes in distress. Contamination was shown as the most frequently reported subcategory for obsessions. Those with earlier onset symptoms also experienced higher rates of panic symptoms and disordered (Pinto et al., 2006).

Written by Perry Leynor, MA, LPC Associate supervised by Paula Maloney, LPC Supervisor.

Pinto, A., Mancebo, M. C., Eisen, J. L., Pagano, M. E., & Rasmussen, S. A. (2006). The Brown Longitudinal obsessive COMPULSIVE Study. The Journal of Clinical Psychiatry, 67(05), 703-711. https://doi:10.4088/jcp.v67n0503

Identifying and Treating Race-based Trauma

Identifying and Treating Race-based Trauma

Statistics indicate the United States of America (USA) is becoming more diverse and a nation of plurality. Despite statistics, USA has consistently struggled with its ability to respect, accept, and include diverse populations. Individuals of color experience direct and indirect health care disparities such as unequal access to material, social, and educational resources on a prevalent and consistent basis. They are often not able to afford health insurance, in addition, experience racist behaviors and discrimination amongst healthcare providers.

Racial and ethnic discrimination can cause negative psychological consequences that cause race-related stress and could eventually cause race-based trauma (Hemmings & Evans 2018). These psychological issues encompass feelings of helplessness, paranoia, anxiety, fear, medical health issues, numbing to their emotions, denigration of one’s sociocultural in-groups, and the onset of PTSD.

One solution is improving the health of individuals of color. Healthcare professionals would need to make better efforts to address racism when working with minorities. Research shows facilitating multiculturally competent care would require awareness of race, racism, discrimination, and how these factors contribute to subpar healthcare practices (Hemming & Evans 2018). Multicultural training within the mental health field also needs to be improved. A solution would be more effective training and treatment models for counselors to be better prepared to establish a therapeutic relationship with a person of color.

Written by Victoria Fontenot – Behavior Therapist. To seek care with us – please call 972-332-8765.

Hemmings, C & Evans, A. M. (2018). Identifying and treating race-based trauma in counseling. Journal of Multicultural Counseling and Development, (4), 20-37. https://doi:10.1002/jmcd.12090

Offering Your Anxious Clients the Standard of Care

Offering Your Anxious Clients the Standard of Care

                              Offering Your Anxious Clients the ‘Gold Standard’ of Care

         Exposure therapy has long been supported as the ‘gold standard’ treatment for anxiety disorders. Despite strong empirical support for the effectiveness of exposure therapy, many therapists underutilize exposure therapy in the treatment of anxiety and related disorders.

Studies examining why clinicians tend to underutilize exposure therapy indicate several important factors.

These factors include:

  • Lack of appropriate training or supervision to learn these methods.
  • Holding negative or inaccurate perceptions about exposure therapy and when it is contraindicated.
  • Clinician belief that clients will reject the treatment, drop out of treatment, or that exposure therapy may cause harm to clients by asking them to engage with aversive experiences.

In summary, clinicians tend to underutilize the ‘gold standard’ of treatments for anxiety and related disorders because they tend to have little training or experience with it. A key factor in alleviating these issues is offering more training and consultation on utilization of exposure-based treatments.

If you would like to learn more about using exposure therapy in your practice:

  • Sign up for our blog, below.
  • Contact us at 972-332-8733 to join our consultation group or to set up individual case consultation.

     by Perry Leynor, LPC Associate under the supervision of Paula Maloney, LPC-S.    

Meyer, J. M., Farrell, N. R., Kemp, J. J., Blakey, S. M., & Deacon, B. J. (2014). Why do clinicians exclude anxious clients from exposure therapy? Behaviour Research and Therapy, 54, 49-53. https://doi:10.1016/j.brat.2014.01.004

Racial Bias and Ethnic Disparities in Health Services

Racial Bias and Ethnic Disparities in Health Services

For centuries, women of color have experienced a prevailing and insidious disparity in their reproductive healthcare. Social and structural factors of minorities have been negatively impacted in the flowing ways: fewer neighborhood health services are available, less insurance coverage, decreased access to educational and economic attainment, and racial bias and stereotyping at the practitioner level. This phenomenon of a racial-ethnic gap has been deemed a human rights issue, as declared by The Center for Reproductive Rights.

One such disparity are barriers to proper access to contraceptives. Women of color are less likely to afford birth control medication due to the high cost of adequate health insurance. Disparities in maternal mortality have been a prevalent and well-documented opposition, due to clinician-level biases and racism, has contributed to delayed or absent care leading to death. Statistics have revealed that African American, Native American, and Native Alaskan women were 2.5 to 3.3 times more likely to die from pregnancy-related complications than White women. Disparities surrounding HIV prevention and treatment management for Black and Latina women have also not been properly addressed. 75 percent of new HIV diagnosis are within these demographics. The following recommendations need to be taken to decrease the percentages above: addressing disproportionate poverty, emphasizing equal access to educational and career opportunities, increased reproductive healthcare opportunities, and increased access to biomedical prevention treatment. Data shows pre-exposure prophylaxis has not been afforded to Black women as an option for HIV prevention as opposed to White women and men.

The Patient Protection and Affordable Care Act (ACA) is an example of a social-structural-policy–level intervention that was supposed to help establish more health care access to previously uninsured and underinsured individuals. Due to federal and state rulings, continuously diminishing portions of the ACA, inefficient reproductive healthcare access and services, an all-encompassing national health insurance reform strategy needs to break down barriers and fortify access.

There are systematic and positive change solutions that would ensure more opportunity for women of color. Entailing the deterioration of social and structural barricades for underprivileged minority women would increase access to adequate reproductive health services without clinical racial bias. Women of color need to be heard with empathy and compassion to ensure care and treatment management will be appropriate. Change requires a more racial and ethnically diverse workforce, full clinical training pertaining to anti-racism education, and increased utilization of doulas and other patient advocates in maternal care.

By Victoria Fontenot – Behavior Therapist with Better Living Center for Behavioral Health

Sutton, M. Y., Anachebe, N. F., Lee, R., & Skanes, H. (2021). Racial and ethnic disparities in reproductive health services and Outcomes, 2020. Obstetrics & Gynecology, 137(2), 225-233.


Postpartum OCD

Postpartum OCD

When we hear “postpartum” it is usually followed by “depression”. While the postpartum period IS often associated with depression, other disorders are overlooked. Outside the scope of obsessions harming infants, the effects of Obsessive-Compulsive Disorder (OCD) have limited investigation into pregnancy and the postpartum period. This is concerning for two reasons. One, research shows that obsessive compulsive symptoms (OCSs) can be as severely debilitating as other disorders, including schizophrenia. Two, clinical research reflects psychological disorders, commonly depression, cause poor infant outcomes. It is alarming OCD is often overlooked due to the potential impact on infant outcomes. Pregnancy and parenthood constitute major events that create major life obstacles. Studies show these periods can create a greater risk of causing and increasing the severity of OCSs. OCSs are associated with the overall well-being of the infant (House et al., 2015).

House et al. (2015) examined if preexisting OCSs increased throughout the perinatal period. Researchers followed 56 women diagnosed with OCD over a period of 52 weeks postpartum. The study relied on assessment measures for OCD and follow-up with clinicians. Researchers found the severity of OCSs did not increase or fluctuate throughout the pregnancy and postpartum period, unlike other disorders. Maternity age and delivery method were both associated with predictors of increased OCSs. Women who gave birth having a cesarean section showed an increase in OCSs postpartum, and younger woman were associated more with OCSs. Future studies would replicate this data and include comorbid disorders.

By Perry Leynor, MA, LPC-A – Behavior Therapist with Better Living Center for Behavioral Health

House SJ., Tripathi SP., Knight BT., Morris N., Newport DJ., Stowe ZN. (2015). Obsessive-compulsive disorder in pregnancy and the postpartum period: Course of illness and obstetrical outcome.