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.

 

References:

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

Can mindfulness help with anxiety and depression?

Can mindfulness help with anxiety and depression?

According to Google Trends, “Mindfulness” has become an increasingly popular search term over the past decade, and a variety of resources are available to date, including books, blogs, videos, and courses. In addition to its popularity, mindfulness has been studied empirically and become an evidence-based treatment for common problems such as anxiety and depression. Generally speaking, mindfulness involves bringing intentional focus to the present moment and observing the things you are experiencing at that moment for what they are, without judgment. Your observations may involve noticing thoughts, feelings, or bodily sensations. Mindfulness interventions are commonly carried out in person, but this form of intervention is difficult for people who live in rural areas and has become particularly challenging due to the COVID-19 pandemic which has restricted social interactions. Fortunately, a group of researchers found that the positive effects of mindfulness could also be achieved via an online platform.

In 2013, Krusche and colleagues evaluated the effects of a web-based mindfulness course for stress, anxiety, and depression with 273 participants. The authors developed 10 online interactive sessions led by mindfulness instructors, and participants participated for at least 4 weeks, but the course was designed to follow the same sequence as an 8-week mindfulness course. Participants were also given audio and video clips for guided meditation and assigned work to complete outside of sessions, including informal practice of mindfulness (i.e., being present while doing an everyday task such as washing the dishes). After the course had ended, results showed significant decreases in scores related to stress, anxiety, and depression, and these effects maintained at a 1-month follow up. The results of this study are promising and suggest that many people experiencing emotional challenges during this time might benefit from online interventions such as telehealth and video-based mindfulness instruction and guide practice.

Krusche, A., Cyhlarova, E., & Williams, J. M. G. (2013). Mindfulness online: An evaluation of the feasibility of a web-based mindfulness course for stress, anxiety and depression. BMJ Open Science. doi:10.1136/bmjopen-2013-003498