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TRICH, FOOD, AND SKIN CARE



                             
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TRICH, FOOD, AND SKIN CARE BY JR KENDER



Here's some info about hairpulling, particularly about nutrition, skin care,
and yeast.  This compilation was orginially created in July 1997, and should
be accompanied by an updated article, "A Theory of Trichotillomania", written
in August 2008, which focuses more on the possible chemicals involved.  Please
write me if you have not received it.

As of July 2012, more than 600 people (including more than 100 children or
adolescents) have been reported to me via email as obtaining from "good" to
"total" relief, from at least one week to over eight years, using some or all
of these techniques.  I have used them since July 1992, and (except for
experiments with new things and an occasional deliberate dietary lapse) I have
been pull-free for that time.  I have also received several reports that
skin-picking and even nail-biting are also responsive to these methods, and
that five dogs have stopped their compulsive paw-licking similarly.

Also included is some info about the TTM mailer, if you haven't heard of it.
And, at the very end of this message, in a fine FAQ about TTM written by Geoff
Dean, is some info about the TTM Parents group (if you are the parent of a
puller), and some info about the TTM Teen group (if you are a teen).  For some
additional info on nutritional means of TTM control posted by people other
than me who were interested in it, go to their web pages at:

   http://home.intekom.com/jly2
   http://www.geocities.ws/ttmlarchive
   http://www.trichotillomania.co.uk/trichotillomania_research/diet.htm

Please let me know if I can help you further.  If you do try a nutritional
approach to TTM, please let me know your results so that we all can learn more
about this disorder.

Thank you,
John

= = = = =

TRICH, FOOD, AND SKIN CARE 
(Submitted to the TLC newsletter "InTouch" in August 1999, so references to
 dates and times have to be adjusted somewhat.)

by John R. Kender and Michael J. Grant

In this letter, we outline some observations about several simple at-home
procedures that have proven to be helpful to many pullers.  These procedures
involve various foods and skin care practices.  We guess that for many people,
hairpulling is aggravated by a particular biological cause that these
practices help to address.  At the end of this letter, we list postal and
email addresses where you can get more detailed information about our ideas
and methods.

1) Who We Are and What We Have Done

Let's first introduce ourselves.  One of us, John, is a university professor
who pulled eyebrows for 30 years, but is currently enjoying a more than seven
year remission which he attributes to dietary control.  For the past four
years, John has run the TTM remailer program, a private internet email
exchange about trich, which has about 400 subscribers and participants.  John
has spoken at two TLC retreats about his experiments with nutrition and its
effect on trich.

The other of us, Mike, is the father of a hairpuller.  He and his daughter,
Terri, have experimented with several skin and hair treatment approaches to
hairpulling.  Mike started and is an active contributor to an email support
group for PoPs (Parents of Pullers) on the internet.  Mike has attended
several TLC retreats, at which he has demonstrated on multiple volunteers his
various scalp care procedures, which use only non-prescription preparations.

The two of us, in our combined 12 years of experimentation, have observed that
for many people some of the trich experience is directly affected by diet and
by skin condition.  By continuing to use the internet to gather the
experiences of other hairpullers, and by combining these with our own
experimentation, we have become convinced that for many people it is possible
to achieve significant amounts of relief and control by taking some
straightforward measures with regard to nutrition and skin care procedures.
Although our observations have not yet been medically verified and our guesses
as to their biological roots remain unproven, in the past four years we have
gathered reports of significant improvement from an encouragingly large number
of people.

We aren't selling anything--there is really nothing to sell--and we realize
that what we have noted does not work for all forms of trich.  But we offer
them to the readers of InTouch, who can try them for themselves as they see
fit.  Please be aware that we are not medical doctors and that anyone
considering these approaches should check with their doctor first.

We will describe first some nutritional means, then some skin and hair care
means, and then suggest a possible explanation for why these two seemingly
unrelated approaches may both be ways of attacking a common biological cause.
If anyone then wishes further information, we list where we can be reached.

2) Nutrition and TTM (John writes)

Seven years ago, by keeping careful records of what I ate, I noticed that
certain foods tended to increase my urges to pull.  By avoiding those foods, I
began what is now a seven year remission: no urges, and no hairpulling.
Numerous experiments, some even with my dog who had a problem with compulsive
paw licking, confirmed that some foods were "bad", meaning that they increased
hairpulling urges and sometimes increased an itchy "this hair is out of place"
feeling.  I wrote in a previous issue of InTouch four years ago about some of
these experiments.

Since then, based in part on written and email reports from other pullers, the
list of "good" and "bad" foods and of other food-related techniques has been
refined, and there is now a better understanding of the strengths and
weaknesses of this approach.  As of the Summer of 1999, over 100 people,
including about a dozen children and adolescents, and several dogs, have
reported or have been reported as obtaining from "good" to "total" relief, for
a week to years, using some or all of these techniques.  More than two dozen
of these pullers report from two months to three years' worth of benefit.  At
the same time, the number of people reporting increased urges and hairpulling
after eating "bad" foods has been so numerous (on the order of several
hundred) that I have stopped keeping track of them, even electronically.  On
the other hand, we have received a few reports of earnest attempts at dietary
control measures that have failed, most of them appearing to be from lash
pullers.

According to several polls we have taken on the TTM remailer list, we have
gathered the following information.  About one-half of pullers who reponded to
the polls do experience strong hairpulling reactions to one or more of sugar,
caffeine, cola and/or chocolate, egg yolks, legumes (peanuts, mostly), or
fatty fish (tuna, mostly).  First preceded by an growing internal feeling of
agitation, the hairpulling urges begin increasing a few hours after eating
sugar or caffeine, or about one to two days after eating the others.  The
increased urges usually peak after about twice that amount of time.  Often
these urges, particularly the ones due to egg yolk and legumes, take as much
as a week to fully subside down to their usual level.  Although stress
aggravates such food-related pulling, it is not necessary for it: after "bad"
foods, people report they pull regardless of their mental state.

The polls have indicated, however, that scalp and/or body pullers seem to
differ somewhat from lash and/or brow pullers.  Scalp and/or body pullers seem
to be food-sensitive to the extent that their hairpulling is worse during
Premenstrual Syndrome ("PMS")--which tends to be experienced as increased
depression--and to the extent that they "trance out" while hairpulling.  Lash
and/or brow pullers, however, seem less food-sensitive and more business-like
in their hairpulling.  Their PMS tends to be experienced as irritation, and
their hairpulling is more focused; further, their hairpulling may be more
related to the eating and drinking of vitamin-D enriched dairy products.  But
both kinds of pullers in general tend to be far more likely than average to
have allergies, to have sweet tooths, and to have an unexpectedly extensive
experience of being around furry pets.  Most surprisingly, the polls indicate
that pullers tend to have an unusually high number of "trichy" dogs and cats.

If people are interested in seeing if their hairpulling is food-related, there
is a simple test: they should simply eat as many peanut M&Ms or Reese's peanut
butter cups as they can stand at one sitting (sugar! chocolate! legumes!),
washing them down with Coca-Cola (cola! caffeine! more sugar! or aspartame,
which is just as bad!).  Alternatively, especially for children, it could be
peanut butter and jelly sandwiches with chocolate milk.  If in two days there
is a noticeable increase in hairpulling urges, then they could consider
abstaining from "bad" foods.  Unfortunately, it appears to take from 30 to 40
days to purge the gut and skin of their bad effects fully, and it also seems
to take several attempts and about a year of trying for most pullers to get
there.  People report that avoiding sugar and caffeine, which act more
quickly, is the most rewarding way to start.

The "bad" food list given above reflects the worst experiences of many people,
but it is not complete.  The full list is available on written request (it's
too long to explain here).  It includes, among other things, concentrated
natural sugars, tomato seeds, soy products, yams, MSG, and ibuprofen.
However, there are a few "good" foods, which partially counteract the "bad"
ones.  They include garlic, most acidic fruits, dry red wine, unsweetened
yogurt, and a chemical family called gluconates.

Additionally, certain hair care products and certain skin creams carry
chemicals that appear to be similar to those involved with the "bad" foods.
In particular, food-sensitive pullers report that hair conditioners with
stearyl alcohol or other fatty alcohols should be avoided.  Similarly, there
have been reported a few "good" food-related chemicals that can be applied to
the skin and hair to stop them from itching, among them alpha hydroxy acids
("AHA"s, sometimes called "fruit acids"), and a home-made hair rinse made from
a mixture of acetic and boric acids (essentially, dilute vinegar and eye
wash).  We have a theory as to what may hold these unusual collections of
"good" and "bad" foods and chemicals together, which we will briefly explain
below.

3) Skin and Hair Care and TTM (Mike writes)

My continuing interest in the relationship of certain types of scalp
conditions and TTM has been an outgrowth of my daughter Terri's experience
which began more than five years ago.  At the time Terri was diagnosed with
TTM, she had already been under a dermatologist's care.  She had what was
thought to be spontaneous hair loss due to alopecia areata, as well as due to
an inflammatory condition of the scalp that had progressed to the point of
forming sores which she would want to pick at due to their intense itching.
The condition of Terri's scalp was thought to be a medical consequence of her
primary impulse control disorder.

In the years that have followed, through Terri's experience as well as my own
participation with children and adults in the TTM community, I discovered a
group of hairpullers who share the same scalp symptoms.  Further, observing
these scalp conditions over time, I have noticed that in many instances the
scalp conditions preceded, not followed, the hairpulling.  The pulling
appeared to be triggered by the inflammatory process, much like the scratching
behavior most of us have in response to conditions such as mosquito bite,
poison ivy, or athlete's foot.  I speculated that it might be possible in some
instances to reduce or eliminate the hairpulling behavior simply by
alleviating the inflammatory trigger.

The opportunity came when Terri consented to have her head shaved for medical
reasons to help resolve her on-going scalp problems.  Her urge to pull seemed
to disappear literally overnight, an observation agreed with by the medical
professionals attending her.  The conventional explanation was that this had
removed a significant trigger and prevented the self-reinforcement of pulling
behavior.  But the conventional explanation did not explain the suddenness
with which the urge seem to be extinguished, nor the experimental result that
the relief only came when the scalp was wet-shaved with a blade, and not with
a surgical clipper which cut the hair to virtually the same length.  At the
same time, the razor shave was observed to relieve the inflammation, whereas
the clipper shave noticeably exacerbated the redness and itching.

After reading an abstract John posted to the remailer describing a protocol
for treating a particular inflammatory process possibly related to a
biological cause, I noted that there were some similarities between the
article's treatment and what Terri was receiving in the head shave.  The
article's treatment soaked the scalp with a soapy lather beneath hot
water-saturated towels.  This was exactly the preparation done prior to using
the razor.  As an experiment, we did the soak but didn't use the razor.  Terri
experienced nearly the same degree of relief as if her head had been actually
shaved, and it alleviated the inflammation of her scalp as well.  This
strongly suggested it was not the cutting of the hair that provided the
relief--the clipper did that without good effect--but rather it was the
preparation regimen itself.  We also noted with some interest that letting her
scalp get some sun also helped; in fact, an accidental sunburn gave about four
days free of itching.

On the possibility we were dealing with a dermatological disorder, a receptive
dermatologist prescribed the antifungal shampoo Nizoral, then available only
by prescription.  And based on the article, we substituted Cuticura soap,
which is similar to the liquid barber's soap we were using, but which also
contains an antiseptic.  Over time, we found that the optimal regimen was to
alternate the Cuticura with the Nizoral shampoo on a daily basis.  It appears
that the two are good compliments to one another.  Cuticura is anti-bacterial,
Nizoral is anti-fungal.  Cuticura is a soap which is milder but leaves a
residue which can build up.  Nizoral is a detergent which removes the residue
and prevents the build-up.

Some other preparations we tried were pure aloe vera gel, benzoyl peroxide,
and camphor.  Terri's barber suggested the aloe vera gel as a skin conditioner
to soothe and protect her scalp after shaving.  She also tried a lanolin-based
product, but that resulted in intense itching within 30 minutes of being
applied to Terri's scalp, whereas the aloe vera gel seemed to help reduce what
itching there was.  The benzoyl peroxide worked well for an intense itching
area where there was inflammation and a distinct raised area on the skin, but
it was very drying to the scalp and it bleached the emerging hair.  (Along the
way, I discovered that benzoyl peroxide also stopped, within a week, one of my
own year-long bouts with skin picking.)  But with further experimentation we
found that camphor spirit topically applied would alleviate itching for
several hours without adverse effects.  Camphor is also contained in Sea
Breeze astringent, which we found useful and mild enough for general routine
application.

What I believe to be a significant discovery happened while Terri was having
her head shaved on a regular basis.  To alleviate the "shine" which my
daughter did not like, the barber applied to her scalp a mineral clay masque,
made principally from bentonite, to help absorb the excess oils.  As the water
evaporated from the clay, contrasting dark areas would appear in proportion to
the amount of oil that had been absorbed.  (We later found a formal clinical
study in which bentonite clay was also used to collect skin oils from
patients.)  An astonishing phenomenon slowly began to appear.  Terri only
pulls from highly selective areas that have an intense itch-like sensation.
After shaving her head with the straight razor, these areas could no longer be
distinguished from the rest of her head.  But the contrasting dark areas of
the clay masque exactly outlined those "hot spot" areas which were otherwise
indistinguishable on her scalp--even when they were examined by an experienced
dermatologist under magnification.  I believe this to be a physical
demonstration of the correlation between hot spots and excess sebum, present
even six months after the cessation of all pulling.

In an attempt to replicate the observations I made with Terri, as well as to
do a preliminary investigation of a possible biological cause, I made up kits
with various over-the-counter preparations and skin care products for some of
my email TTM friends.  Included were the Cuticura soap, as well as several
other types of soaps we had used.  Also included were a triple antibiotic, a
mild steroid anti-inflammatory (hydrocortisone), an antihistamine
(diphenhydramine), as well as an anti-yeast product (miconazole nitrate).
Only general cautions were provided, together with the instructions to try all
the products and decide which ones worked the best.  At least half of those
who received the kits were not associated with John's remailer, and had not
heard of any possible search for a biological connection with TTM.

The antiseptic Cuticura was by far the preferred cleansing agent over very
similar soaps without the antiseptic.  Sea Breeze astringent for general
overall application, and camphor spirit for intense hot spots, were also
widely reported as being helpful.  The antibiotic ointment seemed to have no
effect, nor did the antihistamine ointment, but the surprisingly effective
agent, widely and independently reported to alleviate the itch and pulling
urge, was the antifungal miconazole nitrate 2% cream.

At this point, I can recommend a specific program for shampooing, massaging,
and treating the hair, skin, and scalp.  The full program is available on
written request (it's too long to explain here).  We have a theory as to what
may hold these unusual collections of "good" and "bad" skin treatments
together, and what may relate them to the "good" and "bad" foods and
chemicals, which we will briefly explain below.

I have had the privilege of demonstrating these techniques at the last two TLC
Retreats, and I would like to thank those individuals who participated.  They
helped to advance our understanding and to make this letter possible.  I would
also like to thank Jo Ann, our family barber, and most of all, my daughter
Terri, for her patience, understanding, and courage.

4) A Possible Theory of Some TTM (both of us)

Putting all these observations together, we guess that some people pull
because of a local skin irritation caused by chemicals released into skin
grease by a skin micro-organism.  Specifically, we guess that some (about 60%
of) hairpulling is aggravated or caused by a local allergic reaction to the
enzymes and/or fatty alcohols produced by a normally innocuous skin yeast,
Malassezia.  Nearly everyone has this skin yeast, particularly in hair
follicles of the lashes, brows, and scalp.  But what may make pullers
different is that their immune system reacts more strongly to its presence.
From this perspective, hairpulling is like sneezing: the body is attempting to
rid itself of an allergy-causing irritant.

What ties the "bad" things together is that the "bad" foods are all
scientifically known to encourage the growth of this yeast, and the "bad"
chemicals are scientifically known to cause allergic reactions.  Oppositely,
the "good" things are known to kill or inhibit either the yeast, the yeast
enzymes, or the yeast-produced chemicals in various ways.

There are more details to this theory, which are available on written request.
For example, common sugar is a powerful yeast food, for all yeasts (including
the different yeast which is known to cause vaginal yeast infections), but
fructose, a somewhat different sugar which does not seem to bother pullers, is
not a good yeast food at all.  Foods rich in sterols, whether they are the
cholesterols in animal foods such as egg yolks, vitamin D-related sterols in
milk or tuna, or the phytosterols in plant foods such legumes, are believed by
researchers to be growth signals to the specific skin yeast we suspect.
Similarly, there are links between the other foods and chemicals to this
yeast's life cycle and health.  One of us, Mike, has even grown a colony of
Malassezia, and has found that its most preferred food is the oil from freshly
ground peanuts.

Further, the irritancy of conditioners containing fatty alcohols, the "hot
spots" of pulling, the slow migration of hot spots over the skin, their
localized overproduction of skin grease, the relief people experience from the
grease-removing clay masks, the effectiveness of anti-bacterial and
anti-fungal shampoos, and the soothing action of the extended grease-
expressing hot-towel scalp massages: these all appear consistent with the idea
of a localized allergic response to an infecting organism.  Seen this way, the
hot towels, high pH soaps, and blade shaving may be removing both the organism
and the grease it feeds on, something an electric razor misses.  Even the
gradual recurrence of the itch after four days or so fits with what is known
about the time necessary for yeast growth.  Further, the propylene glycol base
for the helpful aloe vera gel is a known yeast killer (as is sunlight and as
is benzoyl peroxide), whereas the troublesome lanolin is a complex of
growth-stimulating sterols and irritating fatty alcohols.

We think the theory helps explain why hairpulling is worse premenstrually: the
increased progesterone, a sterol, is a known yeast growth stimulant.  And why
hairpulling usually doesn't hurt and is often done in a trance: this skin
yeast is known scientifically to make a chemical called hexanol that has
anesthetic properties.  (And besides, people with other skin yeast infections
scratch like crazy, sometimes drawing blood, but finding it pleasant.)  And
why hairpulling usually starts in early adolescence: this is when the
sebaceous glands start to produce the grease this yeast needs.  And why
hairpulling is chronic: this yeast, in general, is hard to control, and other
disorders related to it are chronic; in any case, most allergies are
unfortunately chronic, too.

We think the theory may help explain the "fat roots" that hairpullers seem to
go hunting for: skin micro-organisms are able to turn soft grease into a
harder wax-like plug that is easy for exploring fingers to recognize.  (We
have found that non-pullers get them, too, but it doesn't seem to drive them
nuts.)  We think the theory may help explain why such very large doses of
serotonin-specific reuptake inhibitors ("SSRI"s, like Prozac) are found to be
necessary for TTM: it may be that the SSRIs act like chemotherapy, stressing
the human body, but fatally overloading critical yeast digestive processes
(technically, the "cytochrome P450 enzymes", which the human body also uses to
dispose of SSRIs).  We even speculate that hairpulling and furry pets seem to
go together because, perhaps, the microorganisms involved can be shared
between people and dogs and cats; some people have in fact have found some
relief from lash pulling by simply making sure to regularly wash their hands
and eyelids.

5) For Further Information

If you have access to the Internet, a good place to explore these food and
skin care observations is by joining the TTM remailer (send email to
jrk@cs.columbia.edu), or by viewing Amanda's website (at jly2.com/ttm).  The
authors can be reached at jrk@cs.columbia.edu or TTMParents@aol.com.
Otherwise, send a self-addressed stamped envelope to either:

   John R. Kender            M. J. Grant
   169 Ames Ave.             P.O. Box 2825
   Leonia, NJ   07605        St. Louis, MO   63118

6) An Important Final Disclaimer 

Please note that the two of us are simply reporting what we have observed and
thought.  We are not offering medical advice.  We cannot guarantee results, or
even the safety of any these procedures.  It is important that you check with
your doctor first before you experiment.  And, please, let us know of your
results, so that we can keep all these things safe, and share them with other
hairpullers.

= = = = =

THE YEAST HYPOTHESIS: PRACTICAL TECHNIQUES

My guess at this point is that some pullers are sensitive, as are a small
fraction of the population, to certain branched long chain fatty alcohols such
as isostearyl alcohol, which are produced from waxes and fats by the skin
yeast Malassezia.  If so, then pulling can be managed in many ways: by
inhibiting the yeast, by disabling the enzymes, or by avoiding the irritants
their enzymes produce.

Thus, here is a grand summary of things that might be helpful for pulling.  In
general, this list is based on the reported experience of many pullers, but
items marked "possibly" have been reported infrequently.  Please note that
some things appear in more than one category; in general, those things tend to
have a more pronounced effect.

   EXECUTIVE SUMMARY: Basically, it's a nutritional and skin care
   approach.  First, try not eating sugar, caffeine, and chocolate.
   Have some dry red wine or ginger tea instead.  These should have an
   effect in about two or three days.  Then, avoid peanuts, chickpeas,
   beans, egg yolks, tuna, and waxes.  These should have an effect in
   about 10 days.  Take choline bitartrate or magnesium gluconate, and
   take borage oil.  Use Shampoos with selenium (Selsun) or IPBC
   (White Rain).  Keep a food diary to help you track your own
   particular triggers.  Keep your hair and hands clean.  Wash your
   lashes with baby shampoo hot compresses.  Watch out for pet fur.
   Apply fresh cut ginger, or miconazole nitrate cream, or propylene
   glycol/aloe vera/rubbing alcohol, or eyewash/vinegar.  Use Sea
   Breeze or Band-Aid Anti-Itch gel for emergency hot spot care.

   EVEN SHORTER: Avoid sugar, caffeine, lecithin, wax; take borage oil
   and dry red wine; apply fresh cut ginger.

1) Minimizing yeasts
   Via energy supply
      Avoid eating sugars, even natural ones as in: honey, molasses, raisins,
         dates, fruit juices; avoid Splenda (sucralose); use pure fructose if
         necessary instead.
   Via resting stage signals
      Avoid drinking caffeine as in: coffee, cocoa, chocolate, soft drinks.
   Via nitrogen supply
      Avoid eating aginine, as in: nuts, legumes, seeds, especially sunflower
         seeds.
      Avoid eating asparagine/aspartate, as in: coffee, cocoa, chocolate,
         cola; legumes; tomato seeds; possibly seeds; possibly nuts;
         possibly whole grains, whole grain flours; possibly
         aspartame (Nutrasweet).
      Avoid eating glutamine/glutamate, as in: MSG, soy sauce.
      Avoid eating nitrites, as in: possibly preserved meats.
   Via growth signals
      Avoid eating sterols as in: egg yolk; butterfat; legumes,
         especially peanuts and garbanzos/chickpeas, but also beans,
         alfalfa sprouts, licorice, soy products (including "vegetable
         oil"; use olive oil instead); yams; dates; organ meats;
         crustaceans (shrimp, crab, lobster); oily fish such as tuna,
         herring, sardines, salmon, mackerel; hair roots; possibly
         (for lash or brow pullers) vitamin D enriched milk products.
      Avoid eating lecithins as in: brazil nuts, chocolate, whole corn 
         (including popcorn), egg yolk, oily fish, lecithin, margarine,
         peanuts, sesame, soy, wheat germ; no-stick pan sprays like Pam.
      Avoid increasing blood cortisol as in: stress; possibly grapefruit.
      Avoid increasing blood progesterone as in: PMS.
      Take supplements to increase liver clearance of blood sterols as in:
         magnesium and vitamin B complex, possibly (for lash or brow pullers)
         additional B-6. 
      Counter ethanol-induced growth by eating: inositol.
   Via chemical attack
      Eat allicins as in: garlic, possibly onions.
      Eat alpha hydroxy acids as in: whole fruits (not juices) of apple,
         grape, orange/lemon/lime, pineapple; fermented foods of cottage
         cheese, yogurt, kefir, sour cream, or sauerkraut, or hard sausages.
      Eat bromelains/papains as in: pineapple, kiwi, gingerroot, papaya, figs,
         guava.
      Eat beta-glucanases as in: ripening bananas
      Eat gamma-thionins and isothiocyanates as in: mustard, and possibly
         other mustard family vegetables like cabbage, Brussels sprouts, etc.
      Drink tannins as in: unsweetened tea, astringent red wine.
      Take "fruit acid" supplements as in: dry red wine, choline
         bitartrate, magnesium gluconate, "cream of tartar sauce" (see
         below**).
   Via external (skin) environment
      Bleach, color, or relax the hair.
      Have long hot sudsy showers and shampoos, morning and dinnertime.
      Use non-pH-balanced antifungal shampoos like: Zincon.
      Use antifungal shampoos like: Nizoral.
      Use shampoos with the antifungal IPBC (iodopropynyl butylcarbamate) like:
         White Rain Classic Care Extra Body, or most Clairol Herbal Essences.
      Use high pH soaps like: castile, Cuticura; avoid Neutrogena.
      Use a low pH rinse like: 2% boric + 2% acetic (eye wash + vinegar, 
         see below***).
      Apply antibiotic chemicals like: Cuticura and ZNP soap; possibly (for
         very short term use only) terpenes, as in: Listerine, Vick's
         Vap-O-Rub, tea tree oil, spirit of camphor, Band-Aid Anti-Itch.
      Apply antifungal chemicals like: Fresh cut ginger; aloe vera gel;
          miconazole nitrate (Micatin) cream, possibly mixed with Polysporin
          cream; propylene glycol homemade lotion (see below*).
      Apply tannins as in: witch hazel.
      Apply ultraviolet light, local heat, and ozone as through: probably
         sunshine; probably high frequency generation ("violet ray") machines.
   Via internal (gut) environment
      Eat acidophilus as in: capsules, unsweetened "live" yogurt, kefir,
         possibly buttermilk, sauerkraut, or kimchi.
      Probably avoid antacids.
   Via yeast reservoir control
      Avoid close contact with furry pets.
      Wash hands before touching hair or eyes, especially after touching pets.
      Wash eyelids with baby shampoo.
   Via mite vector control
      Use insecticidal shampoos like: Nix, Rid.

2) Minimizing yeast enzymes
   Via all above but also
   Via feeding signals
      Avoid taking medicines with ibuprofen.
   Via direct induction
      Avoid possibly drinking alcohol; avoid probably drinking gin.
   Via enzyme inhibition
      Eat possibly broccoli.
      Take gamma linolenic acid (GLA) as in: borage oil.
      Take possibly eicosapentaenoic acid (EPA) as in: fish oil (only if very
         fresh; rancid fish oil appears to be a trigger).
      Apply fresh ginger juice or drink ginger tea.
      Use shampoos with selenium sulfide like: Selsun Blue.
   Via chemical attack
      Use only olive oil in foods.
      Take gluconate supplements: preferably magnesium, but also calcium,
         ferrous, potassium, sodium, and/or zinc.
      Take tartrates:  dry red wine, choline bitartrate, "cream of tartar
         sauce" (see below**).
      Apply benzoyl peroxide.
   Via control of chemical reactions
      Apply ice cubes.

3) Minimizing fatty alcohol exposure
   Via all above but also
   Avoid waxes as in: lipstick, mascara, some candies and candy-coated gums
   Via skin exposure
      Wick them up by applying solvents like: rubbing alcohol, witch hazel; 
         (for very short term use only) Sea Breeze Sensitive Skin.
      Avoid applying fatty alcohols, especially "-yl" alcohols (cetearyl,
         cetostearyl, cetyl stearyl, stearyl; possibly cetyl) as in:
         conditioners, deodorants, shaving creams, hand and body lotions that
         contain them.
   Via ingestion
      Take antioxidants as in: vitamin E.      
      Avoid eating fatty alcohols as in: hair roots.

* Propylene glycol recipe:
  1 part  PG, propylene glycol (available from pharmacies, about $8/pint)
  1 part  AV, pure aloe vera gel (make sure it has no other ingredients)
  3 parts RA, rubbing alcohol (which comes as 70% isopropyl alcohol, 30% water)
  Apply twice a day with cotton ball.  Stings but works quickly.
  Note: For areas around the eyes, people have found that much less alcohol is
        better, and use instead: 2 parts PG, 2 parts AV, 1 part RA.

**"Cream of tartar sauce" recipe: 
  1/4 teaspoon cream of tartar
  1/2 teaspoon (one packet) fructose (do not use regular sugar)
  1 cup of water
  Starts to work in about 3 hours.  Full effect by 8 hours.
  Note: This mixture is acidic, and overuse has caused throat and stomach
        irritation.  Instead of cream of tartar, using lemon juice (as much as
        can be tolerated) also works, but less well.

*** Acetic-boric (eyewash/vinegar) rinse recipe (and warnings):
    1) WARNING!  Check with your doctor first!  These are my experiences only,
  and are not medical advice.  Boric acid can be dangerous; read the label for
  precautions.  Don't use it if you have broken skin or may be pregnant.
    2) To make it, I put 2 oz. of water in a cup, and add 1/2 teaspoon boric
  acid.  The boric acid dissolves after being zapped in the microwave enough
  so that the water boils.  I let it cool, then add 2 oz. of vinegar.  Apple
  cider vinegar has a better smell than white vinegar, and rice vinegar
  probably has the least smell of all.  This makes me 4 oz. of a 2% acetic
  acid plus 2% boric acid solution.  I would increase or decrease quantities
  proportionately as needed to make more or less of it, but it does not appear
  that exact ratios are critical.
    3) I apply it only to unbroken skin.  (Although this does not apply to me,
  I won't use it at all if I thought I was pregnant.)  I let it sit for about
  five minutes, then I usually rinse it off.
    4) I do this once a day for a week, then stop; I found that sufficient.
  Based on its supposed action, I would guess if there was going to be any
  effect, it should be evident by then, and it should continue for some days
  thereafter.
    5) If you find the rinse useful and your doctor has approved, check again
  with your doctor to determine how often it would be safe for you to use it.
    6) Again, WARNING!  Check with your doctor first!  These are my
  experiences only, and are not medical advice.  Boric acid can be dangerous;
  read the label for precautions.  Don't use it if you have broken skin or may
  be pregnant.

= = = = =

SCALP AND HOT SPOT CARE

by Michael J. Grant

Much of the informal research John and I have done shows there is a positive
correlation between the so-called hot spots some pullers experience and areas
of increased activity of the sebaceous glands.  I have been able to
demonstrate in the limited number of trials I have been able to do that
reduction of the excess oil in these areas significantly reduces the intensity
of the urge to pull from these areas.  Overactivity of the sebaceous glands
has been long demonstrated by established medical research as the primary
factor in skin conditions such as seborrhea, acne and acne like skin
eruptions, not to mention sebaceous cysts or "wens".

The underlying cause, at least initially, for this overactivity is likely
systemic.  The sebaceous glands respond to gonadotropic, thyroid, and other
hormones present in the blood.  Adolescents develop oily skin due to high
levels of testosterone and estrogen.  It is also possible the sebaceous glands
may also trigger off the hormones and other substances in the food we eat,
which my explain John's trigger food phenomenon.  Aside from judicious dietary
changes, dealing with the hot spots on a systemic level is best left to the
medical professionals.  Being a good state of overall health often lessens the
incidence and severity of many disorders when they do occur.  So it is good
idea to do those things such as exercise, eating a healthy balanced diet, and
seeing your doctor for checkups on a regular basis which maintain that state
of overall wellness.

The basic regimen I recommend for those trouble by hot spots, scalp sores, and
other related conditions such as excessive dandruff or flaking is as follows:

Step 1.  

Objective: Remove any possible sources of allergies or irritation.
Action:  Discontinue all regular shampoos, conditioners, etc.
Rationale: Many of these products contain fragrances and proteins which are
   potential sources of allergic reactions.  Hair sprays and mousses can clog
   pores and follicles and prevent normal aeration of the scalp.

Step 2, A through F.

Objective: Cleanse the scalp to remove excess oils and skin debris which can
   plug the follicles.
Action: A) Saturate the hair and scalp with warm water gradually increasing
   the water temperature until as warm as tolerable.
Rationale: The warm water softens and liquefies the sebum which facilitates
   washing it away.  Increasing the temperature of the skin dilates the pores
   and increases blood circulation while promotes flushing out of the
   follicles.
Action: B) Lather the hair with Cuticura soap by first applied a small amount
   of soap, massaging it into the hair, and adding more soap or water as need
   to produce a thick lather.  (It may be more convenient to grate the
   Cuticura bar by means of a cheese grater.)
Rationale: Cuticura soap contains an antiseptic and is anti-comedogenic.  A
   lather help emulsify sebum to facilitate it being washed away.  Grating the
   bar soap allows only that needed to have contact with the scalp preventing
   contamination of the bar.
Action: C) Rinse the hair thoroughly with the same very warm water as before
   to remove all traces of the soap.
Rationale: It is important to maintain the scalp at an elevated temperature to
   keep the sebum liquefied and to promote softening of skin cells at the
   scalp surface as they absorb water.
Action: D) Relather the hair as before working up a thick lather.  Massage the
   lather into the scalp using pressure on the fingertips (never fingernails)
   for a minimum of five to ten minutes, adding water or soap as need to
   maintain the lather.  For those who know the four massage movements, these
   movements may used for two to three minutes each.
Rationale: The mechanical action of massaging the scalp helps break up dried
   sebum and loosen shedding skin cells from the scalps surface.  Further, it
   aids in helping work sebum beneath the the skin to the surface where it can
   be removed.  Massaging also promotes blood circulation to aid in removing
   toxins and irritates in the scalp tissue, supplying antibodies to combat
   any infection as well as nutrients and oxygen to support the follicles hair
   producing cells.  Massage can also stimulate the nerves of the scalp making
   them less sensitive and likely to itch.
Action: E) Wrap the lathered head in a Turkish towel saturated with water as
   warm as tolerable.  Replace the towel with another after 2 minutes.  Allow
   last towel to remain until it feels tepid, but not cool or around 3 to 5
   minutes.
Rationale: This moist heat is aimed at further softening of surface skin cells
   and keeping the sebum beneath the skin the least viscous as possible to
   bring it to the surface of the scalp.  The elevated temperature and high pH
   of the Cuticura forces water into hair and skin cells carrying with it the
   antiseptic contained in the soap.
Action: F) Rinse the remaining soap from the hair with warm, not hot water.
   After all of the soap has been removed, gradually reduce the rinse water
   temperature over a period of two minutes until it is as cool as can be
   comfortably tolerated.  Allow the hair to remain wet.
Rationale: Reducing the water temperature closes off the pores and seals the
   moisture and antiseptic in the skin and hair cells, pores, and follicles.
   Cooling the skin reduces the activity of the sebaceous glands temporary
   reducing new oil secretion.  The sensitivity of nerve sensors in the skin
   is also reduced to aid in itch reduction.  The hair and scalp are allow to
   remain wet to keep the hair and skin cells saturated with water.

Step 3.

Objective: Reduce the sensitivity of scalp nerves to promote itch control.
   Close the pores and dissolve any remaining sebum left behind.  Reduce the
   scalp temperature, leaving an additional antiseptic residual.
Action: Generously apply Sea Breeze astringent to the scalp and massage in.
   Allow it to remain on scalp for a couple of minutes.
Rationale: Sea Breeze contains alcohol which is a solvent to dissolve any
   dried sebum which had not been washed away.  Through evaporation, the
   alcohol reduces the scalp temperature.  Sea Breeze contains phenol, a
   topical anesthetic, as well as camphor, a potent counterirritant and itch
   suppressant.  Sea Breeze contains an astringent to further promote closing
   of the pores and follicles.  Sea Breeze leaves an antiseptic residual
   behind after it dries.

Step 4.

Objective: Seal the moisture into the hair and scalp.  Provide additional
   protection against irritation and itching.
Action: Apply a small amount of clear pure aloe vera gel onto the wet hair and
   work into scalp.  Comb hair into place.  Allow to dry naturally or with
   heatless drying setting.
Rationale: Removing the sebum strips the hair and scalp of its natural vapor
   barrier.  Without a vapor barrier, the moisture in the hair and scalp would
   quickly evaporate causing the skin and hair to dry out and become brittle
   and irritated. The aloe vera gel seals in the moisture while the hair and
   scalp are still saturated.  The gel is non-greasy, hypo-allergenic, and
   does not promote comedos like natural sebum.  It is not subject to
   bacterial attack as well.  Aloe vera is naturally soothing to the skin and
   also help prevent itching.
 
The aloe vera gel will appear to leave the hair stiff. This is not a problem.
The stiffness completely disappears by simply running a comb through the hair.
The aloe vera gel leaves no visible residual and coats the hair and scalp with
a protective clear film that breaths.  As a side benefit, the aloe vera gels
acts like a styling gel keeping the hair in place eliminating the need for
hairsprays and mousse.  Allowing the gel to dry on the wet hair without
combing after it dries leaves the hair with a wet mousse like look.  Unlike
mousse that gets that appearance with comedogenic oils and lacquers, the wet
look of aloe vera comes from the actual health water held into the hair.

- - - -

So this is the basic protocol.  The products needed are Cuticura soap, Sea
Breeze astringent, and pure clear aloe vera gel.  If you have a problem
locating these in your area, send me an email.  I never sell anything but have
been known to send these things out without charge from time to time.  If it
is for a child or young adult, I always send out a kit upon request.

There are modifications and enhancements for special circumstances.  When the
hair loss is severe and/or the person is shaving, a bentonite slurry clay
masque substantially reduces even more oil as well as extracting excess fluids
and toxin from the scalp.  There are both prescription and over the counter
topical medications that can be used to spot treat sores and particularly
inflamed areas.

I am always looking for an opportunity to demonstrate this and other
techniques.  I have wanted to do some training-a-trainer things, but have
never been able to put something together.  Perhaps if there is any interest
at the Retreats, I can work something out.  I also would be willing to travel
within a couple of hundred radius of the St. Louis area if that would work out
for anyone.  If several people who were willing to be trainers could get
together in one place, I would be willing to consider traveling a greater
distance, particularly if any of these people were POPs.

Take care.

Mike (TTMParents@aol.com)

= = = = =

A FAVORITE QUOTATION

I have copied below a paragraph from one of the many books I have researched
in.  Of all what I have ever read, it comes closest to what I believe is the
sensible approach to dealing with pulling--or anything else, for that matter.

- - - -

From "The Essential Guide to Psychiatric Drugs", by Jack O'Gorman, MD
(Columbia University College of Physicians and Surgeons):

   A Final Note

   . . . If there is any overriding principle to this book, it is simply that
   the object of psychiatric treatment should always be to make the patient
   better.  That may sound ridiculously obvious, but in fact will be
   challenged by many.  Some feel the object of treatment is to make the
   patient understand more about him or herself, to be better able to 'deal'
   with complex emotions like anger and envy, or to follow societal rules and
   regulations better.  I am not going to argue these points, because that
   would require another book.  But I will bluntly assert that the object of
   psychiatric drug treatment has nothing to do with self-understanding or
   self-realization; it is a medical procedure intended to relieve symptoms
   and sometimes even cure disease.  Thus, a patient can always ask himself a
   simple question when evaluating the usefulness and success of a drug
   treatment:  Do I feel significantly better now than before I started taking
   the medicine?"

= = = = =

    TTM: Trichotillomania Tele-Mailer

Welcome to the Trichotillomania Tele-Mailer, an automatic mailing list for
people involved with trichotillomania.  Trichotillomania ("trich", "TTM") is
an impulse control disorder of uncertain origin characterized by a recurrent
urge to pull out one's own hair.

   PLEASE SAVE THIS FILE FOR FUTURE REFERENCE!

It would be a courtesy to the many existing list members if you would take the
time to read this message in its entirety.  It has five sections: a) basic
information, b) general ground rules, c) general procedures, d) acknowledge-
ments, and e) a Frequently Asked Questions document ("FAQ").


TTM A) BASIC INFORMATION

This mailer will rebroadcast to all the list membership whatever you mail to:
 ttm@lists.cs.columbia.edu 

For more information on how to use this list, including where to read recent
archives on-line, send a message with the subject "help" to:
 ttm-request@lists.cs.columbia.edu

To subscribe to this list so that you receive individual copies of messages,
much like regular email, send a message with the subject "subscribe" to:
 ttm-request@lists.cs.columbia.edu

To subscribe to this list so that you receive batched messages, about a dozen
at a time, send a message consisting of "subscribe digest" to:
 ttm-request@lists.cs.columbia.edu

If you would prefer to converse with a human being, send your email to:
 ttm-owner@lists.cs.columbia.edu

If you are interested in receiving a collection of documents concerning the
control of TTM through nutritional and skin care methods, send an email to:
 ttm-owner@lists.cs.columbia.edu

Please give the FAQ below a read, as it attempts to provide new list members
with a running start on the discussions on the list.  In general, the list
membership is tolerant of "newbies" asking old questions, but will usually
respond privately to such requests, saving the public list for newer issues.


TTM B) GENERAL GROUND RULES

Three design decisions in creating and maintaining this list may affect your
comfort with it:

1) Because of the risk of spam and viruses, this list is moderated.  Your
mailings are rebroadcast to the list membership as soon as the moderator
becomes aware of them and approves them.  This may take anywhere from minutes
to days, depending on the moderator's schedule.

2) To provide some degree of discretion, only members of the list can see the
mail addresses of other members, or retrieve old mailings from the archives.
However, anyone who has heard about the list can join it.

3) Again for speed, and, more importantly, to help develop a sense of
community, the list does not provide for anonymous joining or anonymous
mailing.  Those members wishing to preserve their anonymity can do so by using
a service provider that allows pseudonyms for logon IDs.


TTM C) GENERAL PROCEDURES

Four items of procedure and policy that frequently come up are the following:

1) The amount of messages that you can expect to receive will vary widely.
There are usually about 300 on the list.  Some days there are no messages; on
a few days there may be over five; in general, there are about two to five per
week.  For reasons that are not understood, the postings seem to go through
cycles of about four weeks long, first with little activity, then with a lot
of activity.  If you aren't getting any messages and you think the system is
broken, send the list owner a private message.  Or just wait a few days.

2) Civil interactions are presumed.  The list owner tends to be a bit lenient,
and is reluctant to interfere with discussions, noting that the list very
often will police itself.  However, if in the opinion of the list owner, a
member persists in doing more harm than good (as evidenced by people sending
private mail stating such, or by a rash of unsubscriptions), uncivil posters
will be unsubscribed--usually, but not necessarily, after a warning.  In the
life the list, since April 1995, six such people have been forcibly removed.

3) The posting or forwarding of chain letters, commercial advertisements,
virus warnings, pleas for locating abducted children, internet hoaxes, urban
legends, etc., even if well-intentioned, is forbidden.  Violators will be
removed from the list immediately and without warning.  Five such posters have
been removed so far.  If you have received an email that is not about TTM but
it causes you concern--including email warnings about viruses--check first
privately with the list owner before you attempt to post it to the mailer.

4) This is a plain text mailer only!  Please do not post using HTML or base64.
Such messages will be returned, and so will any messages longer than 5000
characters.


TTM D) ACKNOWLEDGEMENTS

This list is owned by John R. Kender, a professor of computer science at
Columbia University in New York City, who became a hair puller at age 13, and
who is currently enjoying a remission since July 1992 which he attributes to
nutritional control and skin care measures.  This automatic list was inspired
by the courage and good cheer of both Christina Pearson, the director of the
Trichotillomania Learning Center, and Bill Sweeney, who bravely started it by
hand(!) as a college freshman in 1994.


TTM E) GEOFF DEAN'S TRICH FAQ. [Comment: last updated Spring 2000]

by Geoff H. Dean 

[JRK comment: with some additions and updates by JRK, in square brackets
starting with "JRK" like this one, most recently in 2012.  Original comments
by Geoff are also in square brakets, but are just plain comments, like above.]

Please find enclosed the latest version of the FAQ.  The main section is
essentially the same, but the resources and links section has been extensively
revised. Thanks to everyone who has contributed.

- - - -

The following are the most Frequently Asked Questions by people new to the
mailer.


1 - EXACTLY WHAT IS TRICHOTILLOMANIA?

Trichotillomania is defined as recurrent pulling out of one's hair, resulting
in noticeable hair loss, which is not due to another medical condition.

There is an increasing sense of tension immediately before pulling out the
hair, or when attempting to resist the behavior, and there is pleasure,
gratification, or relief when pulling out the hair.


2 - HOW MANY PEOPLE ARE AFFECTED?

The true prevalence of Trichotillomania is unknown, since people are often
ashamed of their behavior and are consequently reluctant to discuss it, even
with their doctor.  So it is 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.  More recent estimates range from
0.5 to 3.5% of the population, depending on the definition used, and the
nature of the study.


3 - WHERE DO PEOPLE PULL FROM, AND WHAT OTHER THINGS DO THEY DO?

Sufferers as a group pull hair from a wide range of body sites including the
scalp, eyebrows, eyelashes, beard, pubic areas; and, less commonly, underarms,
chest, ears, nose and general body hair.  The sites pulled by particular
people vary widely, and may be restricted to one or two sites.

Associated behaviors include searching for hairs that stand out in some way;
repetitive drawing of hair through the fingers, or over the lips, before or
after pulling; picking of associated skin; careful examination of the hair or
roots; compulsively playing with, or splitting the hair; biting off the roots,
or the hair itself into segments.

The behaviors are also specific to the particular person; some just pull
eyebrows with tweezers, for example, and others just pull from their scalp.
Some pull intensively from particular sites; others try to manage their
appearance by pulling less intensively, but from a wider range of sites.

Some people eat the roots or the whole hair.  Since hair is not digested, but
remains in the stomach, this condition is potentially dangerous and medical
examination should be sought.


4 - WHAT ARE THE CAUSES, AND WHEN DOES IT FIRST START?

There is no known single or obvious cause, and there may be several
contributing factors, such as genetic predisposition, diet and stress.  It is
now commonly regarded as a medical illness, and it may be caused by a
disruption in the system for communication between cells in the brain.

People frequently start compulsive pulling at 12 to 13 years of age, although
commonly at a much younger or older age.  The onset may be associated with
hormonal changes at puberty, although many people recall a significantly
stressful event associated with the onset.


5 - WHY DOES PULLING COMFORT ME?  AM I GOING CRAZY?

During hair pulling episodes, the sufferer frequently pulls from zones of
heightened sensitivity.  It is generally not painful to pull from these areas,
or the pain is mild and the pulling causes great relief, or even comfort.

The pulling can quickly become compulsive, causing relief and comfort on the
one hand, but anxiety and distress at the increasing hair loss on the other.
Sufferers can quickly become greatly distressed at an apparent inability to
control their own behavior, and the continual increase in damage to both their
hair and self-esteem.

Is it any surprise if some sufferers feel they might be going crazy, even
though they are not?


6 - ARE THERE ASSOCIATED ILLNESSES OR CONDITIONS?

There are apparent similarities with the symptoms of Obsessive Compulsive
Disorder (OCD), but only a low minority of Trichotillomania sufferers have OCD
as well; 15% in one study.

Depression has been reported to occur in a majority of people.  However it is
not known if this is due to a direct biological link between the two
conditions, or whether the depression is a consequence of the severe loss of
morale and self-esteem brought on by the hair pulling.

Other behaviors believed to be common include nail biting and skin picking.

Procrastination has been reported as a symptom.  This behavior of putting off
tasks is very frustrating to family and friends, and may be disruptive of
personal relationships.


7 - WHAT TREATMENTS AND SUPPORTS ARE THERE, AND WHAT SUCCESS DO THEY HAVE?

Medications are easy to use, but, used in isolation, are reported to have
limited long term effectiveness for the treatment of Trichotillomania itself.
They have been reported as a useful adjunct to other treatments, and are often
used to reduce the symptoms of associated depression.

Behavior Therapy attempts to stop or control specific undesirable behaviors,
or to replace them with new ones.  Cognitive Therapy usually involves
identifying the thoughts that make pulling more likely, and working on
replacing them with new thought patterns.

These are often combined and / or used in conjunction with specific
medications.  The treatments might include Group Therapy; training in life
skills such as Assertion, Anger and Stress Management, Goal Setting and
Problem Solving; and Relaxation Training.  Programs are usually tailored to
the needs of the individual and, where practicable, involve the family and
supporting persons.

Psychotherapy and Hypnosis have also had some reported success.

Diet control has been widely claimed to contribute to easing or eliminating
pulling behavior.  It is recommended that all sufferers carefully consider the
impact of diet, since some people have reported benefits from even simple
changes.

Skin care has been shown to be important for control of the condition in some
people.  A variety of effective and readily available products has been
identified to relieve intense itching or other associated problems which are
present with some people.

Religion may become a powerful motivating force for healing in some people,
particularly as an adjunct to other treatments.  It can contribute to a sense
of community; improved self-esteem; a strong sense of purpose, and focus on
goals; and an easing of depression.

A sense of community is a powerful force for healing with many people - to
know that you are not alone; to discover after years, or even decades, that
your condition is known to medicine; to share your thoughts and feelings; to
feel understood and accepted; to see people, who share the same affliction,
caring for one another.

There are reports from sufferers that aspects of hygiene may be important for
some people.  Specifically, those who pull from eyebrows or lashes may benefit
from avoiding furry pets and frequent washing of the hands and eye area with
soap and water.

We should also consider what we regard as success, as so eloquently stated by
a parent, "Improvement tends to be incremental rather than total or complete,
and must be viewed in a broad perspective [rather] than simply the reduction
or cessation of the hair pulling behavior itself.  Rarely can a given course
or therapy be viewed in such absolutes as success or failure, but rather as a
process of continuous improvement in all aspects of the child's overall
quality of life." (M.J.Grant, TTM mailer, 5 Aug 99)


8 - HOW CAN I MEET OTHER SUFFERERS?

There are two broad ways to interact with fellow sufferers: via support groups
in your own locality, and via the various internet networks.

There should be a Mental Health organization in your own area who can put you
in contact with local support groups.  In any case, the Trichotillomania
Learning Center attempts to maintain a comprehensive listing of support
groups.

For those who have an internet connection, there are support groups using
email which are knowledgeable, helpful and provide a safe environment for
interaction and learning.

Options for contacts include email networks (e.g. the TTM mailer); the
Fairlite Bulletin board; online chat groups; private email with users met via
these groups; and private web pages featuring contacts and links.

Some groups organize, or facilitate activities, such as retreats, picnics, an
International Day, and a bracelet symbolic of unity within the trich
community.


9 - WHAT CAN I DO FOR SUFFERERS?

The best way to help sufferers with Trichotillomania is to care about them, to
try to understand them, and to help them to learn more about their condition,
and how to manage it.

Sufferers commonly express enormous relief to discover that they are not
alone; to find that the condition has a name; and to be reassured that they
are not weird or crazy.  It can be a profound experience for a sufferer to
describe their behavior and associated feelings to others people, and for this
to be accepted.

Parents of sufferers have often sought guidance about what is a helpful
approach toward their children, and specific information and contacts are
available for parents.


10 - WHERE CAN I FIND MORE INFORMATION?

Please note that this is not intended to be a comprehensive list of
information sources.  Readers are referred to the pages below with the comment
"resources and links".


BOOKS

Dan Stein, Gary Christenson, Eric Hollander, "Trichotillomania", 1999,
American Psychiatric Press, 344 pages, ISBN: 0880487593, Price: US$45,
Publisher phone in the US, (202) 682-6262.  Also in online bookstores

Jeffrey L. Anders, James W. Jefferson, "Trichotillomania - A Guide", 45 pages,
by the Madison Institute of Medicine, 1989, ISBN: 189080214X Price: $4.95.
Postal address: Information Centers, Madison Institute of Medicine, P O Box
628365, Middleton, WI 53562-8365; or by phone in the US, on (608) 827-2470.
This is online at http://www.trichotillomania.ab.ca/rwpeta/Aguide.html.

Cheryn Salazar, "You Are Not Alone: Compulsive Hair Pulling, the Enemy
Within", 1995, Cheryn Intl., 262 pages, ISBN: 0965067009, Price: US$14.95,
Web: http://www.cheryn.com/book.html. Also in online bookstores.

Jack M. Gorman, M.D., "The Essential Guide to Psychiatric Drugs", Revised
edition December 1998, paperback, US$6.99, St Martins Mass Market Paper, 416
pages.  In online bookstores.
[Comment: Expert but non-technical information on psychiatric drugs]

WEB RESOURCES

TLC (Trichotillomania learning Center)
   http://www.trich.org/
   trichster@aol.com
[Comment: Key site for resources and information; non-profit, subscription]

TTM Mailer library web site
   http://www.irishlace.net/trichlibrary/
[Comment: Aims to make available select material from the mailer]
[JRK comment: Site expired sometime around 2011.  Some of its content is
   avaialble at: http://www.geocities.ws/ttmlarchive]

Parent Group
You can subscribe by sending a message to:
   parents_ttm-subscribe@yahoogroups.com 
containing only the word subscribe.  The group is also online at
   http://groups.yahoo.com/group/parents_ttm
This will require a free registration.
[Comment: An forum to share ideas, hopes and concerns with other parents of
   pullers]
[JRK comment: Still exists, but inactive since June 2009]
[JRK comment: YouTube has many teen-oriented videos.  One good place
   to start: http://www.youtube.com/watch?v=CiBIXMBEqgE

Online full text articles.
   http://mblcommunications.com/trichotillomania.html
[Comment: Medical information about Trichotillomania - drug treatments;
   Behavior Therapy; Classification; Trichotillomania in Children and
   Adolescents; etc.]
[JRK comment: website expired about 2006]
[JRK addition: Use Pubmed: http://www.ncbi.nlm.nih.gov/pubmed/]

JK Diet Pages
   http://jkdietpage.tripod.com
   http://soul4ce.home.texas.net
[Comment: Information on dietary control of Trichotillomania]
[JRK comment: not JRK's own web pages, but web sites set up by some other
   people who have had success with nutritional approaches to TTM.]
[JRK comment: both websites expired about 2011]

Amanda's Trich Web Guide
   http://www.jly2.com/ttm
[Comment: Excellent private site, resources and links]
[JRK comment: Site moved to http://www.home.intekom.com/jly2]

Stephanie's FAQ
   http://www.geocities.com/~modularforms/trich/FAQ.html
[Comment: Excellent and extensive FAQ]
[JRK comment: Site expired when Yahoo shut down Geocities in 2009]

Open Directory Project
   http://search.dmoz.org/cgi-bin/search?search=trichotillomania
[Comment: Useful links]