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Your Mental Health

Hair pulling

Have you ever been gripped by an irresistible bad habit – like children who suck their thumbs or those who can’t stop biting their nails?

Many of us have some quirky habit we can’t seem to shake. Something we do when we’re absentmindedly watching TV or when we’re nervous or deep in thought.

For some, a bad habit is really not so simple. Between one and three percent of people experience a compulsion to obsessively pull out their hair, which leaves them with bald patches, stress and feelings of distress.

Trichotillomania is a long and complicated-sounding word to describe an impulse control disorder sometimes also referred to as hair pulling disorder.

Similar to other impulse control conditions such as OCD, kleptomania, pyromania or pathological gambling, trichotillomania involves a recurrent and overwhelming urge to pull out one’s hair. Usually it is the hair on the scalp that is most affected, but other hair such as eyelashes, eyebrows or beard can also be subject to pulling with this condition.

Typically, individuals with this and other conditions like it feel an increasing sense of tension and anxiety immediately before pulling out their hair or when they are really trying to resist the habit. This anxiety dissipates somewhat while the hair is being pulled and then gradually builds up again afterward.

Far from enjoying the experience, those with trichotillomania tend to feel significant distress about their behaviour and also experience difficulties in social, work and other areas of life as a result. Many with this condition avoid intimate relationships and try to hide their hair pulling behaviour.

Although symptoms can begin at any age, trichotillomania usually begins near puberty. It is not understood exactly what causes this condition, but it is believed that both biological and environmental factors play a role.

Sometimes hair pulling can be triggered by a stressful event such as a change of schools, abuse, family conflict or trauma. In other cases, hormonal changes associated with puberty may trigger symptoms.

There is also thought to be a genetic component to trichotillomania as it seems to occur more commonly in those with a family history of anxiety or other psychiatric conditions.

Those experiencing trichotillomania also commonly experience other psychiatric conditions such as obsessive compulsive disorder, anxiety disorders or depression. Other impulse control problems are also common among those who pull out their hair.

Fortunately, there are some effective treatments available that can help those experiencing trichotillomania. Usually, a combination of cognitive behaviour therapy and medication offer the most relief.

In therapy, individuals learn to track their symptoms, increase their awareness of when hair pulling occurs and learn techniques to reverse the habit. These can involve getting the individual to engage in behaviour that is incompatible with hair pulling at times when the pulling is more likely to occur.

Medications that are helpful in treating anxiety and obsessive compulsive disorder also seem to help those with trichotillomania – and combining these with the skills learned in a structured course of therapy can help to manage the condition.

If you or a loved one experience an overwhelming urge to pull out your hair – speak with your doctor about it and get referred to a mental health professional. You don’t need to let this continue to disrupt your life.

Keep learning new things

Did your parents ever tell you to “learn something new every day”? It’s a common little catch phrase with a singsong ring to it that lends itself to being made into a jingle.

As with many phrases that have become cliché, it got that way because of the truth within it.

Although it may not be news, we do know that continuing to learn new things at any stage of life is good for you.

I recently wrote a column about the importance of having purpose in life, and its benefits on cognitive function and protective effects during Alzheimer’s. Continuing to learn new things is similar.

Some research suggests that lifelong learning has beneficial effects for the brain. Some studies show continued learning may slow the progression of Alzheimer’s Disease. We also know it strengthens the area of the brain being used in learning the new task as well as the neighbouring areas.

Studies have also proven the “use it so you don’t lose it” theory treating our brain like a muscle. Learning keeps the brain functioning at a high level.

Not only is learning good for the brain’s circuits, but there are plenty of other great reasons to keep it up. Learning keeps us interested and challenged and wards off boredom. There is no reason life needs to become tedious as we age – there is an unlimited amount of information out there to engage with.

New skills can be helpful in advancing your career making you more employable or versatile. This is particularly useful in a slower economy and in a working world that is forever becoming more specialized.

Continuing to improve yourself is a positive behavior to model for your children. We always like to tell our kids to focus on their schoolwork and truly learn the material and it helps if we show the same level of interest in our own lives.

Learning builds creativity. The more we have to draw on, the more different ways we can look at a subject or discern a solution to a problem.

In our ever changing and technology driven world, continuing to keep up with new information helps us be in touch with those around us and avoid being hopelessly out of date. Thankfully, technology also helps us access an incredible amount of information from the comfort of our own homes. We can do this formally through online courses and tutorials or informally in self-directed study.

The best part of it all is that we can keep finding subjects we enjoy. With such a wealth of topics and information at our disposal, there truly is something for everyone and continuing to learn really should not be a chore but simply our curiosity set free.

I do hope you are able to take hold of the joy of learning something new every day.

Purpose in life good for your brain

Perhaps it goes without saying, but having a strong sense of purpose in life is good for you.

Purpose in life is defined as a psychological tendency to derive meaning from life’s experiences and possess a sense of intentionality and goal directedness.

Many studies have already shown this to be a component of well-being and it is associated with better health, competence, social integration, and participation in the labour force.

Purpose in life is also shown to have positive effects on cognitive and psychological health in the elderly, a reduced risk of Alzheimer’s Disease, reduced cognitive impairment, less disability and even reduced risk of death.

One study examined the connection between purpose in life and Alzheimer’s Disease. Results showed that individuals with higher levels of purpose in life experienced better cognitive function in spite of advanced age and even Alzheimer’s.

In this longitudinal study of aging, 246 community-based seniors were assessed over time. Volunteers’ levels of purpose in life were assessed via structured interviews, cognitive function was measured each year and brain autopsies performed after death.

Researchers hoped to learn about the neurobiologic basis of the protective effect purpose of life has on our brains. What they found was that having purpose in life provides a protective reserve by reducing the effects of brain changes on actual cognitive function.

Although purpose in life didn’t seem to prevent tissue damage in the brain, individuals with higher levels of purpose showed better functioning even at more severe levels of damage to brain tissue.

With an aging population, Alzheimer’s is a condition that is affecting more and more Canadians. We have yet to discover any effective cure or even treatment to slow its progression and research into potentially protective or preventive measures we can take is important.

Alzheimer’s has a long phase during which individuals continue to function and live independently. Damage to the brain accumulates and cognitive function declines gradually – so it is very helpful to identify factors such as purpose that can protect against harmful effects of the disease.

Although it is helpful to know that having a sense of purpose in life can improve our odds when it comes to Alzheimer’s, is that sense of purpose something we can learn? Or is it simply a trait we are born with?

Some evidence suggests purpose in life can be modified or possibly learned – making this a potential treatment target. Of course more research is needed to fully develop this theory.

A few useful steps toward living with a sense of purpose might include setting measurable goals and working toward them and remaining engaged in activities and pursuits that interest you regardless of your age. Continue learning new things and consider getting involved in a cause that is meaningful to you.

I often meet people in my practice who have retired from the workforce and then seem to simply be waiting to die. I have always believed it is critical to keep the mind active at every stage of life.

Get the most out of psychiatric care

It’s not easy to get an appointment to see a psychiatrist. With current shortages patients are often faced with a wait time of many months which can feel like a very long time when struggling with a mental health issue.

Here are a few simple tips that will help you get the most from your psychiatrist and will also make it easier for your psychiatrist to help you.


1. Be able and willing to talk openly about the problem or issue for which you’re seeking advice.

As you may have guessed, your doctor cannot be expected to read your mind. If you truly want help, you have to be willing to talk.


2. Bring a list with the names and doses of all current medications.

This information is very important to get an accurate picture of your medical history and is essential before your psychiatrist can recommend an action plan going forward.


3. Bring a list of medications and other therapies you have already tried.

For the same reasons as above, it is very helpful to know what treatments you may have tried and why they were discontinued.


4. Find out if anyone else among your biological relatives has a psychiatric condition including suicide and drug abuse.

Most psychiatric conditions do have a strong genetic component and it helps to know a family history.


5. Bring relevant past records if possible or know where these can be obtained.

Again, the more complete a picture you are able to provide, the more accurately your psychiatrist will be able to diagnose and recommend next steps. If you don’t have your medical records, it is still helpful to provide the names of previous doctors where information could be found.


6. If you have had lab work done (eg: blood, urine, brain scans etc.), bring the results or have your doctor forward them to the psychiatrist.


7. Complete any pre-interview questionnaires.

Some psychiatrists will ask you to complete detailed questionnaires prior to your first interview. Although they might seem lengthy, these provide important background information and help to give an idea of potential issues at the outset of a working relationship.


8. Be prepared to stop smoking cannabis, drinking excessively or using other non-prescription drugs.

If you are serious about receiving treatment for a mental health issue, drug and alcohol abuse are only going to be barriers for you. If you’re not willing to stop, it will be difficult for a psychiatrist to help you.


9. Be prepared to meet without children, spouses, friends, other counselors or lawyers in the room.

In order for an effective doctor/patient relationship to be built, there needs to be an atmosphere of calm and trust without interruptions. Psychiatric interviews often include discussion of topics that are very personal and can be inappropriate for children or friends.

If you are interested in family or couples therapy, this should be discussed with your psychiatrist ahead of time.


10. Be sure to arrive for your appointment on time.

Aside from being courteous, arriving on time will help ensure you receive your full interview in an unhurried manner.

Read more Mental Health articles


About the author...

Paul Latimer has over 25 years experience in clinical practice, research and administration. After obtaining his medical degree from Queen's University in Kingston, Ontario, he did psychiatric training at Queen's, Oxford and Temple Universities. After his residency he did a doctorate in medical science at McMaster University where he was also a Medical Research Council of Canada Scholar. Since 1983 he has been practicing psychiatry in Kelowna, BC where he has held many administrative positions and has done numerous clinical trials. He has published many scientific papers and one book on the psychophysiology of the functional bowel disorders. He is an avid photographer, skier and outdoorsman.


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The views expressed are strictly those of the author and not necessarily those of Castanet. Castanet presents its columns "as is" and does not warrant the contents.

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