Trichotillomania

Trichotillomania (TTM) is a condition in which people feel an overpowering urge to pull out their hair.  The urges seem uncontrollable and are often exacerbated by stress or other emotional upsets. The term was coined by the French dermatologist François Henri Hallopeau in 1889.

 

People who suffer from TTM will pull, pluck, or twist their hair until it comes out. Others may use instruments to achieve this goal. Sufferers will pull hair from any part of their body: scalp, face, eyelashes, arms, legs, or sometimes a combination of these areas. However the scalp is the most common pulling site. Some people may also have the compulsion to eat the hair. Less common is unconscious (or sleep-induced) hair pulling, in which the person doesn't consciously realize he or she is doing it. Symptoms usually begin before the age of 17 and it is more often seen in women, but can inflict either sex.

 

Analogous to self-injury , the act of hair pulling is usually followed by a period of intense self-blame, shame and sometimes anger because the 'puller' knows that the behaviour is in some way self-damaging, yet they can feel helpless to stop.

How many people does it affect?

The true prevalence of TTM isn't exactly clear, since people are often ashamed of their behaviour and are subsequently reluctant to discuss it, even with their GP. So it is therefore difficult to get reliable statistics. Historically it was thought to be rare, but the condition is now better understood and more people are seeking help. Recent estimates range from 1 to 3.5% of the population, depending on the definition used.

 

Treatment

Behaviour Therapy approaches include several techniques. The most central of these is Functional Analysis, or identification of the antecedents (precipitating behaviours, events, emotions, sensory experiences), behaviours (when, where and how does pulling occur?), and consequences (what does the youth get out of pulling?) associated with pulling. Other behavioural techniques include Habit Reversal Training (HRT) which consists of developing an awareness of sensations preceding and during pulling behaviour through self-monitoring and related techniques and the use of competing responses or compensatory behaviours that are incongruous to pulling. Stimulus Control which focuses on reducing environmental or other circumstances that trigger pulling is often included as well. Relaxation and other anxiety-management strategies, cognitive restructuring of thoughts related to pulling and self-soothing, and strategies to enhance motivation for treatment compliance may also be utilized as part of a behavioural approach.

 

 

 

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''It's a bit bigger than what you look like. It does something to you inside. Both happy and sad''.

Stigma - A major barrier to Suicide Prevention

According to the WHO and the latest Burden of Disease Estimation, suicide is a major public health problem in high income countries and is an emerging problem in low and middle income countries. Suicide is one of the leading causes of death in the world, especially among young people.

Nearly one million people worldwide die by suicide each year. This corresponds to one death by suicide every 40 seconds. The number of lives lost each year through suicide exceeds the number of deaths due to homicide and war combined. These staggering figures do not include nonfatal suicide attempts which occur much more frequently than deaths by suicide.

                                                                                                                Suicides in Republic of Ireland from 2001-2013

2001 - 519
2002 - 478
2003 - 497
2004 - 493
2005 - 481
2006 - 460
2007 - 458
2008 - 506
2009 - 552
2010 - 490
2011 - 525
2012 - 507

*2013 - 475 (6% drop, with males accounting for over 83% of all suicide deaths last year.)

A large proportion of people who die by suicide suffer mental illness. Recent estimates suggest that the disease burden caused by mental illnesses will amount for 25% of the total disease burden in the world in the next two decades, making it the most important category of ill-health (more important than cancer or heart diseases.)

A significant number of those with mental illnesses who die by suicide do not contact health or social services near the time of their death. In many instances, there are insufficient services available to assist those in need at times of crisis. Lack of access to appropriate care is one of the many factors that magnify the stigma associated with mental illness and with suicidal ideation and behaviour. This type of stigma, which is deeply rooted in most societies, can arise for different reasons.

For some people, the term 'suicide' alone evokes panic and one of the causes of stigma is a simple lack of knowledge - that is, ignorance. This type of stigma can be directly addressed by providing a range of community-based educational programs that are targeted to specific subgroups within the society (that is, by age, educational level, religious affiliation, and so forth). Negative attitudes about individuals with mental illnesses and/or suicidal ideation or impulses (prejudice) is common in many communities. These negative attitudes often do not change with education about mental illnesses and suicidal behaviour.

Many health professionals who feel uncomfortable dealing with persons struggling with mental illnesses or suicidal ideation often hold negative, prejudicial attitudes towards such patients. This can result in a failure to provide optimal care and support for persons in crisis.

Stigma is also the underlying motive for discrimination - inappropriate or unlawful restrictions of the freedom of individuals with mental illnesses or suicidal behaviour. Such restrictions can occur at a personal, community or institutional level. One extreme example is the criminalization of suicidal behaviour, which still occurs in many countries. Discrimination can prevent or discourage people affected by mental illness and/or suicidal ideation or behaviour from seeking professional help, or from returning to their normal social roles, after receiving treatment for an episode of illness or crisis.

In both high-income and low and middle-income countries stigmatized conditions such as mental illnesses and suicidal behaviour receive a much smaller proportion of health and welfare budgets than is appropriate, given their huge impact on the overall health of the community.

Unless the stigma is confronted and challenged, it will continue to be a major barrier to the treatment of mental illnesses and to the prevention of suicide. Events like World Mental Health Day (October 10th) and World Suicide Prevention Day (September 10th) are ideal times to highlight and inspire people to work towards the goal of developing creative new methods for eradicating stigma and helping to save lives.
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Each morning when you open your eyes, say to yourself:  “I, not external people or events, have the power to make me happy or unhappy today.  It’s up to me.  Yesterday is gone and tomorrow hasn’t come yet.  I only have today and I’m going to be happy in it.” 

Some Principles that allow me to understand Self-Injury.

With 12,000 people attending Irish hospital emergency departments in 2010 due to self-harm (Ring, 2011), it is important that ways of alleviating its prevalence in society are addressed. Furthermore, it is believed that cases which present to hospital are only the tip of the iceberg. Unfortunately there is no panacea to ameliorate the suffering of the person who self-harms, and it would be naïve of me to assume that the following principles alone would be enough to suffice for an approach to understanding and responding to self-injury. Nevertheless, they stand out amongst others.

        
The first of these principles is that 'the injury is not the problem'. You would be by-passing a host of problems if it was only concern for the person’s actual injury. Having an erroneous assumption that the injury should be the focal point of attention would only be delivering a lump of verbal refuse to the client.

             

There should instead be a focus on their feelings before their behaviours. Most of the 'problems' with self-injury are nothing to do with the person who hurts themselves. While the scars may be psychologically detrimental to them, underlying deep seated issues should be regarded as a lot more insidious. The injury has to be viewed as an outward expression of their inner pain.