BLOG

trichotillomania

Understanding Trichotillomania

Written by Andrea Potthoff PhD LP
What is trichotillomania?
Trichotillomania (Hair-Pulling Disorder) is characterized by excessive pulling of one’s hair. This can occur anywhere on the body, including hair on the scalp, eyelashes, eyebrows, facial hair, and body hair. Trich is seen more commonly in women, but also occurs in men. Trich occurs in all age groups and is most common in adolescence and early adulthood.
Many people describe the actual act of pulling the hair as very ritualized. They may only do it during certain activities or times of day. Patients also often report being very selective about which hairs they pull, noting that they pull hairs that “don’t feel right” or have a coarser or brittler texture.
It is also common among those that pull hair to ingest the hair they have pulled. This behavior can produce a high degree of shame and embarrassment. Unfortunately, this can also cause a number of medical problems depending on the frequency and amount.
What causes it?
Research suggests a genetic predisposition for trich and it is more common in people with a family history of obsessive-compulsive disorder (OCD). Often times it develops as an anxious coping behavior that then turns into a habit. Sometimes the pulling can be intentional and systematic and other times it can happen with little awareness. Many people find that the habit starts infrequently, but then becomes difficult to stop.
How is it treated?
Many people with trich report that the more they try to resist pulling, the more intense the urge becomes. When others comment on the behavior or notice the loss of hair, this can be an intensely shameful experience. Similarly, children scolded for the behavior continue to pull their hair. Although individuals are motivated to stop pulling, specific tools are needed in order to change the behavior. Reducing shame and guilt about the behavior is often the first step of treatment.
Fortunately, there are effective therapies for trich. The Comprehensive Behavioral Treatment (ComB) is the leading intervention for trich and addresses all aspects of the pulling behavior. There are four phases in ComB that include assessing the frequency and intensity of the pulling, determining causes and reinforcers of the behavior, determining what modalities to target, teaching strategies to reduce or eliminate the hair-pulling, and evaluating and modifying each strategy as needed. When working with children or adolescents, treatment also involves working with parents and caregivers. ComB is an evidence-based treatment, meaning that research has shown it to be effective in the treatment of trich.
Medication is also a treatment option for trich, although current research suggests that behavior therapy is more effective and the FDA has not approved any medication for the specific treatment of trich. It is important to also keep in mind that some medications may increase the frequency of hair-pulling.
If you would like more information about trich or to schedule an appointment please call us at 612-470-4099 or email us at andrea@dendrinospsychology.com.
Self-Improvement

Raising Your Self-Esteem

Written by Dr. Andrea Potthoff PhD LP
Many patients I see in my private practice talk about having low self-esteem. It seems to be an almost universal complaint. It may be difficult to imagine for some, but feeling good about who you are and accepting yourself can change most aspects of your life. Here are some techniques that can help improve your self-esteem:
Domains
One way to start building self-esteem is to start measuring it in different domains. Someone might think of themselves as having low self-esteem, only to find that this really only applies to their romantic life or career. Some key domains to think about are your career/work life, appearance, family relationships, friendships, romantic life, physical health, spiritual health, intellectual pursuits, and hobbies. Once we start breaking down self-esteem, we often find that we have more strengths than we were realizing.
Consider Where It Hurts You
One way to start building self-esteem is to evaluate ways in which your lack of confidence gets in your way. For example, maybe you make less money because you are too anxious about asking for a promotion. Or maybe you are not in a romantic relationship because your negative feelings about yourself make it hard to try dating. Whatever the case may be, take those areas of impairment and turn them into areas of motivation.
Say What You Want
Consider using an affirmation to start changing your level of confidence and self-acceptance. It may feel ridiculous at first, but research shows that there are numerous benefits of using affirmations. Try creating a short affirmation in the present tense. For example, “I am smart.” Repeat it out loud daily and especially during times of self-doubt. It can be difficult to change how you think, but saying what you want out loud is the first step.
Avoid Comparisons
In the age of social media, comparison is an everyday occurrence. It surprises few people that current research shows that social media use is correlated with lower self-esteem and depressive symptoms. In order to improve your self-esteem, do everything you can to limit comparing yourself to others. This might include deactivating your social media accounts, focusing more on what you are proud about, and avoiding social interactions that tend to bring you down.
Practice Self-Compassion
Recent research shows that self-compassion can buffer against the negative effects of low self-esteem. Self-compassion incorporates three main skills: being kind to oneself, acknowledging that failures and disappointment are part of being human, and look at one’s negative thoughts and feelings with neutral awareness. As long as people were rated as high in self-compassion, self-esteem had little effect on one’s mental health. Self-compassion is more like a muscle than it is a personality trait. The more you practice it, the more you have.
If you would like to learn more about ways to increase your self-esteem, please call us at 612-470-4099 or email us at andrea@dendrinospsychology.com.
Pregnancy

How Pregnancy Affects Your Mental Health

Written by Dr. Andrea Potthoff PhD LP
Most of us have heard of the “baby blues,” but few of us realize the ways in which all stages of pregnancy can affect mental health. In the midst of all the congratulations, it can feel difficult to talk about and seek support for pregnancy-related mental health issues. Below are some of the most common mental health issues associated with having a baby.
Fertility Challenges
Before becoming pregnant, many women find that struggles with trying to get pregnant take a significant toll on their mood and their relationships. Fertility challenges can cause depression and anxiety. Unfortunately, stress and anxiety can reduce a woman’s chance of becoming pregnant. Relaxation and stress management are crucial skills when dealing with infertility issues.
Unexpected pregnancies can also be a source of anxiety, stress, and relationship difficulties. Even if this is a welcomed surprise, the adjustment of having a child unexpectedly can exacerbate mental health symptoms.
Pregnancy Difficulties
Once becoming pregnant, many women report a change in their psychological health. For example, while pregnant, many women experience an increase in anxiety. This is especially true if they have previously experienced pregnancy loss. Some women find that they cannot control their worries related to the pregnancy, while others report that their overall level of anxiety has increased.
A number of factors can affect mental health during pregnancy including the number of children a woman has, whether or not the pregnancy was planned, and her previous history of mental health symptoms. Some women decide to stop certain psychiatric medications during pregnancy and this can cause increased concern over mental health symptoms. Social support can be a key component for managing these symptoms during pregnancy.
Many women find that mental health symptoms start during pregnancy and continue postpartum. Monitoring your symptoms and reporting them to your physician can help you better understand how your brain reacts to pregnancy and a new baby.
Postpartum Issues
After having a baby, it takes time for your body to recuperate and this includes your mental health. With fluctuating hormones, comes a wave of possible mental health symptoms. Depressive symptoms, including low mood and loss of interest, affects 10-15% of women and can affect the mother’s wellbeing and child’s development. Despite the prevalence of mental health issues after pregnancy, screenings for depressive symptoms usually occur only once. It is not uncommon to experience suicidal thoughts during this time and suicide is actually the leading cause of maternal death.
Research also tells us that the time right after a child is born is one of the more difficult times for couples. Little sleep, new stressors, and constantly changing hormones can make navigating your romantic relationship challenging. Preparing your relationship for this change can help keep both partners on the same page.
Unfortunately, expectations around motherhood and stigma around mental health can make it hard to have conversations about how you are struggling. Seeking help from a professional is one option to consider. Therapy can offer support and skills for managing pregnancy-related mental health or relationship concerns. Please call us at 612-470-4099 or email us at andrea@dendrinospsychology.com to learn more.

 

Self-Improvement

Res-Illusions?

Written by Dr. Andrea Potthoff PhD LP
We are two weeks into the new year. How are your resolutions coming? Odds are not too well. Researchers estimate that 80% of New Year’s resolutions will fail by February. We find that people’s motivation drops quickly within the first month of the year. With goals to lose weight, improve relationships, start something new, or get rid of a bad habit, our chances of succeeding are low. The most common resolutions revolve around healthy eating and weight loss, but rarely last. In fact, February 4th is the biggest day for fast food visits (now creatively known as the “fatty solstice”) and gym visits seem to tank around the same time of year. So, if we are serious about changing, what can we do about it?
Why do resolutions fail?
Looking at what derails you from meeting your goals is a helpful place to start. Here is a great example of how changing your thinking can change your behavior. When you do make a slip-up (which is bound to happen), do not view it as a failure and scrap the rest of the day. Get back to your goal as soon as you can. Eleven o’clock at night is not too late to start eating healthy again.
When you do work towards your goal, how have you been rewarding yourself? Humans respond remarkably well to reinforcement, but many of us neglect to reward ourselves. Develop incentives that will help motivate you to meet your goal. A beneficial reinforcer occurs frequently enough to maintain motivation and not too often that its value diminishes quickly. I often encourage patients to develop a list of possible reinforcers (e.g., coffee with a friend, buying a book) to choose from in case motivation changes over time.
Sometimes we make the simple error of moving the goal line. Let’s say you want to go to the gym three times a week, but once you’ve accomplished that, you set the goal of going every day. Stick to the original goal or you may find your motivation decreases quickly.
What can you do to keep your resolution?
Recent research shows that postponement of something is more successful than total restriction of it. Instead of eliminating your vice, consider postponing it and reducing its frequency overtime. Scientists have found that we tend to desire and consume products more if we try to restrict them entirely.
Accountability and partnership can be enormously beneficial when we are working towards a new goal. Find someone who can participate in the goal with you. Having someone to go to the gym with or participate in a new hobby with can help provide you with motivation when you are not feeling motivated on your own.
Sometimes a professional can help you work toward a new goal. This might be a personal trainer, dietician, financial advisor, or even a psychologist. If you would like more information about getting professional support for your goal, call us at 612-470-4099 or email us at andrea@dendrinospsychology.com.
Tic Disorders

Tic Disorders 101

Written by Dr. Andrea Potthoff PhD LP

What is a Tic Disorder?

Chances are you have observed them in yourself or others, but may not have realized what you were seeing. A tic is a involuntary and repetitive movement or urge. Common tics include repetitive eye blinking, hand movements, and throat clearing. Tics are surprisingly common. In fact, 12-18% of school-aged children have tics and tics usually peak in intensity between ages 10-11. Tics are more common in boys and typically decrease in severity in adulthood. Tic disorders are a class of neurobehavioral disorders that are characterized by vocal and/or motor tics. Tourette syndrome is one example. It is also important to know that individuals with a tic disorder are more likely to show signs of Attention-Deficit/Hyperactivity Disorder and Obsessive Compulsive Disorder.

Is my child in control of his or her tics?

This is one of the most common questions I hear from parents and the answer is no. Tics are involuntary and often go unnoticed by the individual. However, there are changes that can be made at home and at school to substantially reduce the frequency and intensity of tics. Parents often worry that pointing out a child’s tics will make them worse. Research shows that addressing tics in treatment does not increase their frequency. However, we often encourage parents to ignore tics and focus on how well your child is addressing a tic when he or she notices it has happened. Shame and embarrassment often follow tics, especially in older individuals, and this can make them worse over time.

How is it treated?

A thorough assessment is important for understanding how to address each individual tic. Fortunately, researchers in this area have developed an intervention, knows as comprehensive behavioral intervention for tics (CBIT), that is evidence-based and known to be effective. In fact, it has met the American Psychological Association’s criteria for a well-established intervention. CBIT can be used with children, adolescents, and adults. In addition, medication is often considered for more severe cases of Tourette Syndrome.

CBIT combines parent/social support strategies, function-based assessment, and habit reversal training. CBIT is highly structured and typically lasts 8-10 sessions. Most tics are preceded by a premonitory urge, often described as specific muscle tension, an itch, or feeling of anxiety or pressure. CBIT helps individuals identity the signs they are about to tic and then assists them in developing a competing response in order to stop the tic from occurring.

How can I get help?

Dendrinos Psychology specializes in CBIT for the treatment for tic disorders. Dr. Andrea Potthoff is trained in CBIT and relies on evidence-based techniques to treat tic disorders as effectively as possible. After conducting a comprehensive assessment, an individualized treatment is developed. We provide a supportive environment that helps individuals and families address both verbal and nonverbal tics. If you would like more information or to schedule an initial appointment, please contact us at 612-470-4099 or email us at andrea@dendrinospsychology.com.