Hair Pulling is a mental illness- trichotillomania.

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Anxiety provoking.

Anxiety.
Photo courtesy of Pixabay.com

Hair-Pulling Disorder – Trichotillomania.

Yes Hair-Pulling Disorder, the repetitive uncontrolled kind of hair pulling is a mental health issue. Humans are not the only creatures who resort to this kind of self-mutilation when under stress. Caged animals, especially birds do this when stressed also.

Hair-pulling Disorder sounds like an odd problem to have at first glance unless you or someone you know has had this disorder and then it takes on huge importance.

The way we understand this one has been changing. This is in flux and will take some time to sort out.

In the past, as reflected in the DSM-4 this was seen as a form of impulse control disorder. Much of the way it was treated in the past was behavioral. The focus was on the behavior and not the meaning or function it had for the person pulling the hair.

As an impulse control disorder, it was in with Pathological Gambling and Intermittent Explosive Disorder. Hair pulling was for sure different than compulsive gambling but most people who had to treat clients with this problem didn’t know what else to do with it.

In the new DSM-5, when all the professionals switch to the DSM-5, this disorder will move to the section on Obsessive Compulsive Disorders. This will put it more in the class of disorders with Hoarding and Body Dysmorphic Disorder. We are seeing that obsessions and compulsions are more driven than chosen behaviors.

This change in thinking makes a whole lot of difference in how it might get treated and it makes even more of a change in how the person who has the problem might react to that treatment.

Behavioral treatment is focused on the behavior and interrupting that behavior. So grandma might have used a treatment that consisted of slapping that hand each time the young person reached for the hair. The idea was that stop the behavior and you had the problem cured.

If we see this as OCD behavior, then this is not something the person is consciously doing. The behavior is functioning to reduce tension and there is this overwhelming need to do it. This would not be something that the person thought about beforehand and no amount of slaps or yells will change anything.

You might as well yell at someone for yawning. Once they yawn it is over. Besides we think yawning is about physical sensations, not inappropriate behavior. Despite that feeling, we still can get annoyed at people who yawn and we all try to stifle the yawn from time to time.

But if you got smacked for each and every yawn eventually you might give up and just avoid the person slapping you or you might feel that you were a bad person for not being able to control this sensation and you could punish yourself in some way.

So if this is a form of OCD we would want to know what the function of the behavior was. What anxiety or tension is the person trying to relieve by hair pulling? Reduce that tension; treat the anxiety and the hair pulling stops on its own.

Young women are ten times more likely to get this diagnosis than young men. We do not mind seeing young men with very little hair but a young girl with bald spots, that gets noticed.

People who have Hair-Pulling Disorder (Trichotillomania) are also at higher than average risk to do others self-injurious behaviors. Someone with hair pulling disorder might also pick at their skin excessively, technically called excoriation, or they might nail-bite excessively.

There are also likely to become depressed and or develop another anxiety disorder.

So if you or someone you know is finding their life messed up because they are constantly pulling out hair, they develop bald spots for which there is no known medical cause and when they try to stop find they can’t, consider professional treatment.

Yes, absolutely Hair-Pulling Disorder (Trichotillomania) is a real mental illness of the obsessive-compulsive disorder type.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

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Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

National Problem Gambling Awareness Week

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Problem and problem solving

Problem solving.

This week, March 3-9, is National Problem Gambling Week.

Problem Gambling is currently described as Pathological Gambling in the Diagnostic and Statistical Manual of Mental Disorders (DSM-TR-4.) Pathological Gambling is one of a group of disorders that currently are considered “impulse control disorders.”

Pathological Gambling is one of a group of disorders that currently are considered “impulse control disorders.”

 

DSM-5 Update.

In the DSM-5 this is named Gambling Disorder (F63.0) Essentially the same features.

Other impulse control problems not classified as an addictive disorder.

Other impulse control problems are intermittent explosive disorder, kleptomania, pyromania, and trichotillomania. Intermittent explosive disorder gets treated by far the most, but many more people need to get treated for pathological or problem gambling than are currently receiving help.

In California, this week-long effort to make people aware of the difficulties people may have with problem gambling is spearheaded by the California Department of Drug and Alcohol Programs via their Office of Problem Gambling. In a few other states Gambling issues are treated by separately trained and licensed counselors.

One reason for the interest in problem gambling among drug and alcohol counselors is the tendency for clients in early substance abuse or addiction recoveries to “switch addictions” and now off drugs and alcohol, to develop a new problem with compulsive or pathological gambling.

The similarities between addictive disorders and pathological gambling are so large that it was proposed that Pathological Gambling be moved to the addictive disorders rather than the impulse control disorders when the new DSM-5 comes out. We will need to look at that again in the future when the DSM-5 is available.

One of the controversies among treatment professionals is about the choice between trying to control an issue like drug use or gambling and the need to stop doing that activity completely.

If we view drinking excessively or pathological gambling as an addiction then we would expect the client to need to totally abstain. If it is an impulse control issue then we might reasonably try to teach the client to control the impulses and drink or gamble in moderation.

Most people who self-describe as addicts or alcoholics will tell you that control is an illusion. For them, the only answer is complete abstinence.

One reason for the conflict is that funding for treatment often comes from the people who make the most profit from the activity. The alcoholic beverage manufacturers would like counselors to teach people to drink responsibly not tell them to stop drinking altogether. The same issue occurs when problem gambling programs are funded by casinos.

So if you are one of those people who are able to control your drinking or gambling and for whom it is mostly just a source of entertainment, then problem gambling week is not of much interest to you.

But if you are one of those people who has lost the ability to control your gambling or your drinking consider getting help. If you live with someone who has a Pathological gambling problem, consider getting help for yourself as well as for them.

The web address for the California initiative is www.problemgambling.ca.gov

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.