Reddit reviews The Hair-Pulling Problem: A Complete Guide to Trichotillomania

I’m currently reading The Hair-Pulling Problem: A Complete Guide to Trichotillomania , I was fortunate enough to find this book in my school library and I think you’ll find it helpful. Right now I’m at work but I don’t mind taking some pics of the pages for you that might be beneficial as a family member.

Also just want to point out that it’s so amazing you’re here making an effort to be more supportive for your brother. I come from a family/culture that doesn’t even acknowledge mental health issues so this disorder has always been something that is “all in my head” . It really makes me happy to know that you’re supporting a fellow trichster in as many ways as you can.

I conceptualize dermatillomania and related disorders like trichotillomania (trich) as overactivity of the genes that govern grooming behavior. Because we evolved from animals that groom themselves and others, lots of people find grooming-like behavior such as picking at scabs, picking at their skin, pulling out their hair, pulling out ingrown hairs, and cleaning their ears/nose, etc, to be very rewarding.

It often starts as a self-soothing behavior, done when people are stressed, anxious, or bored (the same circumstances under which other mammals groom a lot), but it may soon become more of a habit.

I rarely think of this type of behavior as a "problem" unless (a) the person really wants to stop and can't, (b) the person is spending so much time doing the behavior that it is interfering with their ability to get anything else done, and/or (c) the person's social or occupational functioning is impaired (e.g., relationships suffer because of it; can't get a job because you're covered in scars). At that point, treatment is probably warranted.

Treating any of the above problems is very similar to treating OCD - there are medications (usually SSRIs or tricyclic antidepressants), and there is cognitive-behavioral therapy. The therapy usually consists of things like self-monitoring, figuring out when you pick, figuring out if there are any cognitions related to the picking (e.g., obsessive thoughts that the picking helps alleviate), learning adaptive ways to deal with stress in general (if needed), and replacing the picking with an alternate behavior. You can either work through such a program yourself, or with a therapist. Although I'm not sure if there are self-help books out there specifically for skin-picking, it's so closely related to hair-pulling that you could get one of the many available trich books and just mentally replace "hair-pulling" with "skin-picking" while you read it.

A quick tip for reducing the frequency of any of the above behaviors is to apply hand lotion whenever you feel like you want to pick or catch yourself picking. This works especially well if you live with someone who will help you really monitor yourself and 'nag' you to put lotion on when you're picking. Having hand lotion on reduces the 'hold' your fingers can get on your scabs (or hair, or whatever) and makes the picking a lot less rewarding, thereby helping you break the habit.

I do any of the following:
Examine the hair.
Pull it between two fingers to feel the texture of it.
Rub it against my lip
Save the ones with follicles, either sticking them to a paper, or the light switch panel if in the bathroom.
Curl them into springs, by dragging a hair strand between a finger and finger nail. (scalp only)
If I end up with a split hair, I pull the strand into two


I have a major preference for ones with follicles as it allows me to play with the follicle or stick it something.


From Page 12 of The Hair-Pulling Problem by Fred Penzel
"Beside providing visual and tactile stimulation, pulling also seems to provide needed oral stimulation. In Dr. Christensen and colleagues' study of sixty hair pullers, 48% reported a minimum of one of a number or oral behaviors performed with pulled hairs. Some 25% rubbed the hair around their mouths after pulling it out, 33% chewed or bit off the end of the hair, and 8% licked it. In addition 10% reported eating the hair. Other studies have reported higher rates."

If you interested in that book you can find it here: https://smile.amazon.com/Hair-Pulling-Problem-Complete-Guide-Trichotillomania/dp/0195149424
Note you can select to support the TLC foundation when shopping on smile.amazon.com, so that TLC gets a small percentage of the sale. The book was published in 2003, and thus the data and research in it is a bit out of date now, but overall it's an amazing in depth book about trich.

My GF has trich problems and offers this advice:

> In a book that I read, it mentions how people who pull their hair have a hard time living in the moment. They're either worried about the future, or are living in the past. By pulling our hair, it grounds us to think of the present. If you can find a way to touch something other than your hair, and focus on your breathing, it may help. The book is called The Hair-Pulling Problem.

When I catch my GF pulling her hair and I point it out to her, she was unaware of it. I help her by holding her hand for the moment, so she can ground herself. When I'm unavailable, and she catches herself pulling hair, she switches to squeezing a pillow or whatever she can get her hands on. I'm not sure how this will mix with your OCD, but maybe you can turn it into something positive, rather than debilitating.