Category Archives: Psychotherapy

Road Rage

“A patient arrived in the office for his psychotherapy appointment. He was visibly agitated, and when I asked him what happened, he reported the following incident: He was driving out of his development. To arrive at my office, it required that he make a left turn onto a highway, not an easy task. He has to cross the south lanes to turn left onto the northern lanes in the office’s direction. Turning left means turning onto the left northern lane and crossing into the right lane. The driver must look carefully that no cars are coming in either direction. My patient, noticing a car coming in the left northerly lane but judging that it was distant enough for him to turn, safely executed the turn and shifted right. Once in the right lane, the other car driver starts loudly honking at him. Unnerved by the blaring sound of the horn, turned his head to see what was happening. He noticed that the car driver was angry and repeatedly gestured at him. “It looked as though he was a raving, spitting, and cursing lunatic,” in his words. Feeling both provoked and angry, he felt tempted to pull over and have a confrontation to “teach that guy a lesson.” Thinking better of it, he allowed the whole incident to pass, except he could not shake his angry feelings or revenge fantasies. He reported he felt rattled, incensed, nervous, and wanted to fight and even pull a gun on that guy. Fortunately, he has no gun and doesn’t know how to use one.

It’s a familiar scene. A person starts the day with a fight with your wife, or your boss gives you a warning, or on the way to work or back home, there is a traffic jam that tries your patience. Under these and similar types of circumstances, you feel frustrated and angry. You could quickly explode if just one more thing happens. Then, one more thing happens when another car weaves in and out of lanes, and you get even angrier.

For too many people, all this pent-up emotion expresses when driving. There is a name for it, Road Rage. It is one of the leading causes of traffic accidents and violent confrontations between angry drivers. Of course, for some people, this has less to do with circumstances and more to do with the fact that they are angry people, always seething and always ready to explode. Whatever may be the factors that enrage one driver, the outward expression of this rage sometimes provokes the ire of another driver who feels he must protect his male ego from humiliation. Of course, drivers tend to blame the other drivers for anything that happens but never themselves.

Road rage can have dire consequences. If there are family and friends in the car, an angry confrontation can be highly embarrassing. Among these are sometimes deadly traffic accidents and fights with others who may even pull a gun and receive a citation from the police. In many states, three or more citations can lead to suspension of the driver’s license and spending an afternoon in jail. In other cases, all of this drama can cause a lawsuit with significant financial damages awarded to the other drivers.

How can these scenarios be prevented? One strategy for those with anger problems is to interrupt their thoughts and ask themselves two things: first, everyone must concentrate on their driving and not the other person. In addition, everyone needs to remind themselves that whatever happens on the road is not personal. 

1) Is it worth it to get out of the car or take some other dangerous action and 

2) What are the consequences of taking action?

If you lose control of yourself in these incidents, it’s essential to seek professional help. Learning to control one’s behavior is essential to a functioning civilization. People should not and must not give in to their impulses.

http://www.allanschwartztherapy.net

Help is available. Contact Dr. Schwartz at. dransphd@aol.com

On Self-Hatred

In my forty years of work as a psychotherapist, I have come across countless people who are extremely unhappy with themselves. Their dissatisfaction varies, but the overall impact is that they feel depressed.

The late Theodore Isaac Rubin, MD, and Psychoanalyst, addressed this self-dissatisfaction in a book entitled Compassion and Self Hate. Dr. Rubin wrote the book “Lisa and David.” which became a Hollywood movie named David and Lisa. It is still a movie worth renting and viewing. 

Dr. Rubin borrows from a great psychoanalyst of the mid-twentieth century, Karen Horney. Horney asserts that we have three selves:

1. Actual Self: Who we are with our physical and emotional abilities and disabilities or limitations.

2. Real Self: Who we could be if we freed ourselves from our self-dislike and unrealistic fears.

3. Despised Self: Self Effacing and very neurotic.

4. Idealized Self: The illusion of glorious goals that are impossible to achieve but that we believe we should achieve.

Dr. Rubin reduces this formula to two selves, the Actual Self and the Real Self.

Actual Self: Who we are with all of our talents, limitations, and illnesses, both physical and psychological.

Real Self: The illusions we believe in about who we should be, being wealthy, powerful, lovable, and independent.

If we hold on to illusions about our Real Self is the extent to which we reject our Actual Self and feel self-hate.

For example: 

An individual may cherish the belief that they should be happy. After all, pursuing happiness is guaranteed in the U.S. Constitution. But what is happiness? As Dr. Rubin states, “For me, happiness is feeling good, nothing more… feeling fairly comfortable and relatively tension-free.” 

He then says that we can sustain happiness only for a limited time. Life is not perfect, and moods change. However, the illusion that one should be happy all the time creates self-hate. If someone clings to the illusion that they should be happy all the time, and they are not, they will condemn themselves for not achieving this goal. The problem is that the goal of feeling happy all the time is not achievable.

Perhaps people hold on to unrealistic beliefs about themselves, which explains the epidemic of addiction. Substances offer a temporary that causes a person to feel joyful and omnipotent. When the drug wears out and reality sets in, the self-hate reasserts itself.

To continue the analogy of the drug abuser, the sense of self-hate and wish for joy that propels the addiction also serves as a powerful source of self-punishment. Drug addiction carries with it lots of physical and emotional abuse.

Looking at the dynamic of self-hate in another way, Dr. Rubin talks about the illusions we have about money. There is a commonly held illusion that money can solve all problems. Many patients have told me they would feel free of their problems and suffering if they had enough money. However, real-life tells us a different story.

Lots of people love to play the lottery, hoping to become millionaires. We read about poor or working people winning the lottery and going home fabulously wealthy. Oh, how many of us wish for the same fate? You know the old saying, “Be careful of what you wish for.” It may come true.” The fact is that the lives of many people who won the lottery ended in tragedy. Some of them spent every dollar they won and became bankrupt. Others committed suicide, became addicted to drugs, or suffered an abysmal fate. Money did not solve their problems. Yet, we convince ourselves that it will solve our problems and beat ourselves for not earning or winning a fortune.

The same phenomenon occurs with marriages. Many people enter into marriage with illusionary expectations. These expectations often have perfect bliss, constant sexual fulfillment, and a regular flow of nurturing and love. However, actual life is not this way. Yes, marriage can bring lots of satisfaction, but it also brings many problems and difficulties. Married couples disagree and quarrel, deal with difficult children, and have work and family issues.

The more significant the gap between expectations and reality, the greater sense of disappointment, bitterness, and failure we will experience.

Dr. Rubin states that to be compassionate to others, we must learn to be compassionate to ourselves. The way to be self-compassionate is to learn to accept the Real Self with its limitations.

Accepting who we are instead of wishing for something or someone else is the road to compassion. It means ending self-hatred. Part of the way to end self-hatred is for a person to identify mistaken beliefs and make changes. 

Dogs and Health, a Winning Combination

We know that exercise is good for the heart. We know that having companionship is good for health. But did you know that owning a dog helps relieve stress and lower blood pressure and heart rate? 

Psychology Today Magazine published an article in its April 2006 edition about a research project completed at the State University of New York at Buffalo. In this study, 480 people experienced various stress-inducing tasks. Sometimes, the subject could have their dog present during the task, and in other cases, the dog could not be with its owner. The same was true of the subject’s spouse. Sometimes, the spouse could participate, and the spouse was absent in others. Before, during, and after the experiment, blood pressure and heart rate were carefully monitored and documented. The results of the study were fascinating:

Results:

The tasks required of the subjects were successful in sending heart rates and blood pressure soaring.

When a participant’s spouse was present, blood pressure and heart rate were the highest of all participants, even though the spouse could provide any social support they thought necessary.

Stress response was lowest among those allowed to have their dogs present during and after the task.

It is not surprising that the researchers speculated that those with their dogs present had a better outcome because dogs are comforting and non-critical.

This study coincides with another recent research project, which showed that loneliness and the lack of social support in an individual’s life lead to high blood pressure. A pet, particularly a dog, goes a long way toward providing owners with a sense of responsibility, comfort, and companionship that has real health benefits. 

The mere process of walking a dog leads to the opportunity to speak with people and interact. Children, other adult dog owners, and interested neighbors stop interacting with those walking their dogs. In addition, dogs are always welcoming when their owner returns home from having been elsewhere. This welcome feels very good and reassuring for those who live by themselves and may feel socially isolated.

Financial Problems Impact Mental Health

Not since the great depression have so many people collectively been dealing with financial hardship. The Covid pandemic locked down nations and caused people to lose their livelihoods. It is not surprising that we also see increases in the rates of depression.

Other studies have also linked depression and anxiety with financial burdens. This study suggests that individuals with depression and anxiety are three times more likely to be in debt.

It’s a Vicious Cycle

Solving any problem requires clear thinking and an ability to take action. When financial burdens cause a person to become anxious and depressed, they live in an emotional state that makes it almost impossible to solve their financial problems.

For instance, when people feel depressed, it is common for them to feel overwhelmed and out of control. They want to avoid problems because they can’t bear the weight of it all. 

Depression and anxiety can also make it hard for people to get proper sleep. The lack of sleep creates a mental fog, making it incredibly hard to figure out a solution to any problem.

Talking to Someone Can Help

No, I’m not talking about a financial planner. I’m talking about speaking with a therapist. A licensed therapist can help you find some calm in the storm. Working with a therapist often brings clarity that can help you heal from depression and anxiety and get your financial life back in order.

There is no reason to be ashamed. At one point, most of us have experienced trouble with our finances and felt depressed and anxious. It is a standard part of living in these modern times when the economy seems to go against us.

If you or a loved one have been having a hard time financially and feeling stressed and overwhelmed, please contact me. I would be happy to help you deal with your current situation.

On Feeling Lonely and Isolated

Loneliness, A Health Hazard

“Its deeply seated in me

The birds are chirping

I can hear the voices

My kids are chatting around

But I feel lonely,

I am a lonely person…… “

Poem by Asma Khan

What is loneliness? How is it defined?

The word lonely, is used here, has nothing to do with being alone. As the poem above states, it’s possible to be surrounded by people, even loved ones, and yet feel lonely.

In reality, loneliness is a state of mind. In that state of mind, people feel empty, alone, and unwanted. Lonely people want human contact. Yet, their state of mind makes it more difficult to form connections with other people. Loneliness is a damaging state of mind. It damages one’s mental and physical health.

For twenty years, John Cacioppo, Ph.D. and clinical psychologist, has studied loneliness. He is the co-author of a recent book, “Loneliness: Human Nature and the Need for Social Connection.” The book’s central theme is that loneliness causes many physical illnesses. For example, studies show that social isolation and loneliness increase the flow of stress hormones. Stress hormones are those that make us alert when danger is present. When someone is lonely, they produce stress hormones with no real threat. As a result, the immune system is damaged, causing a vulnerability to viral diseases. The cardiovascular system rises, leading to stroke and heart attack because blood pressure increases, sleep is disturbed, and the aging process increases. The chronic stress caused by loneliness can even hasten the onset of Alzheimer’s disease.

According to Dr. Cacioppo, some of the adverse effects of loneliness are:

* Depression and suicide

* Cardiovascular disease and stroke

* Increased stress levels

* Decreased memory and learning

* Antisocial behavior

* Poor decision-making

* Alcoholism and drug abuse

* The progression of Alzheimer’s disease

* Altered brain function.”

James J. Lynch, Ph.D., published a brilliant book a few years ago called “A Cry Unheard.” What is significant about the message Dr. Lynch conveys is that loneliness is a failure to communicate, engage in discourse, and be committed to each other and the community. In addition, he clarifies it is not merely talking that makes up communication, but the type of talk that is vitally important to human health. He coins the phrase “toxic talk” to describe a speech that destroys the other person’s self-esteem and well-being. The destruction of that self-esteem leads to loneliness, early heart disease, and death. Criticism, negativity, lack of praise, lack of warm feeling, rejection, and other factors that increase alienation and distance between people characterize toxic talk. According to Dr. Lynch, unwholesome talk increases social isolation and leads to early death.

Listed are a few suggestions that Dr. Cacioppo provides on how to overcome loneliness:

1. Recognize that loneliness is a sign that something needs to change.

2. Understand the effects of loneliness on your physical and mental life.

3. Consider doing community service or another activity that you enjoy. These situations present tremendous opportunities to meet people and cultivate new friendships and social interactions.

4. Focus on developing quality relationships with people who share similar attitudes, interests, and values with you.

5. Expect the best. Lonely people often expect rejection, so instead, focus on positive thoughts and attitudes in your social relationships.

It is important to remember that loneliness is a state of mind linked to wanting human contact but feeling alone. People can be alone and not feel lonely, or they can have contact with people and still experience feelings of isolation.

Dr. Schwartz is available for consultation or psychotherapy at Email dransphd@aol.com

Grief vs. Depression

Losing a loved one is a jarring and tragic experience. It brings on a period of grief and mourning filled with feelings of sadness, anxiety, guilt, and reliving of the past shared with the deceased going back years. People amid the mourning process have described such feelings as loss of appetite, nausea, tearfulness, restless sleep, guilt about not being able to prevent the death from having occurred, and deep feelings of sadness. Many have described the feelings of grief sweeping over them and then subsiding until the process starts again. 

Reliving and talking about the person who has died can come with laughter, as those grieving remember funny and warm times. However, there is now a controversy over whether grief differs from grieving?

Ultimately, the psychiatrist must use their judgment on whether the patient is grieving or having a major depressive episode. The American Psychiatric Association’s Diagnostic and Statistical Manual shows differences between grief and major depression. Let’s look at the differences and similarities in symptoms of grieving after a loss instead of Major-Depression.

Symptoms of Grief:

1. Sadness, despair, mourning

2. Fatigue or low energy

3. Tears

4. Loss of appetite

5. Poor sleep

6. Poor concentration

7. Happy and sad memories

8. Mild feelings of guilt

Gradually and after an undetermined time, these feelings remain as the individual regains equilibrium as they return to everyday life.

Many of these symptoms are similar to the feeling of people with Major-Depression. Still, significantly different symptoms are part of the profile.

Major Depression:

1. Worthlessness

2. Exaggerated guilt

3. Suicidal thoughts

4. Low self-esteem

5. Powerlessness

6. Helplessness

7. Agitation

8. Loss of interest in pleasurable activities

9. Exaggerated fatigue

In major depression, these feelings are ongoing and carry the real danger of suicide. Daily functioning at work and home is impaired, and the individual feels as if they will never climb out of these feelings.

An essential difference between grief and Major-Depression is that, in major depression, the feelings of loss of the loved one are compensated for by warm memories. One friend recently told me that his beloved childhood people are alive in him as beautiful memories.

The death of a loved one often results in feelings of emptiness. But, for those who suffer from depression, nothing, not even warm memories, compensates for the loss. Freud referred to this in his classic book, “Mourning and Melancholia,” in which he pointed out that the one who is depressed turns their energy into attacking the self rather than integrating loved ones who are now gone.

 Some people hold onto the mistaken belief that mourning last for two weeks. However, who is to say that it takes only two weeks to grieve? The time spent mourning a loved one varies according to each individual. The danger of a mistaken diagnosis is that a physician might prescribe antidepressant medication when none is needed. But, that is where the experience and expertise of the MD are essential. Ultimately, mourning runs its course and resolves itself.

 Of course, where someone has Majord-Depression and is also grieving, the grief process may be complicated by the fact of depression. It is also possible that, for some people, the death of a loved one can turn into a depression.

Diagnosing people with any mental illness is complicated and dangerous if the diagnosis is incorrect.

The reader needs to understand that psychotherapy is always available to help those individuals who are in pain. Help is available.

Contact Dr. Schwartz at dransphd@aol.com.

Please visit his website at http://www.allanschwartztherapy.net.

Journaling and Mental Health

For example:

“You have been through a difficult and traumatizing divorce. When all was over, you felt a sense of relief besides exhaustion and some depression. Several months have passed and you continue to feel the lingering effects of having been through something very stressful. A friend of yours suggests you write about the experience of the divorce as a way of feeling better and putting the episode behind you. You do some investigating and discover that there is solid evidence to support friends’ suggestions.”

Were you among the many young people who kept a diary when you grew up? It’s probably something that more females did as compared to males. Research shows it’s something all of us can benefit from in our adulthood. Rather than a diary, it’s called a journal. Writing a journal can have therapeutic benefits and, perhaps, be a way to change one’s life story or narrative. Clinical Psychologist James Pennebaker, University of Texas, is the leading researcher using physical and mental health journaling. He has completed many controlled research studies documenting the benefits of writing daily. Many other researchers, such as Joshua Smith, Ph.D., and Lauren Smith, Ph.D., have further documented the benefits of writing.

Pam Trachta, owner of Through a Different Lens, a consulting business, reports that “When I journal, or when I teach others to, I strive not to be intellectual and logical and articulate, but to feel the wave, the energy behind an event and to summon images of what that wave feels like, acts like, what it’s saying to me and what I would say to it.” Do not worry about grammar, spelling, or sounding literate. Just write.

According to Pennebaker, developing a deeper understanding of an event and the emotions it generates helps the brain digest the information. Pennebaker thinks that your brain turns it into a more easily stored story when you analyze a traumatic event. “Storytelling simplifies a complex experience,” he says. Turning the memory into a story can be painful at first. It can take weeks or months to notice an improvement. Smyth and Pennebaker report that patients often feel worse when they journal. 

Here are some suggestions for how to journal:

1. Write for yourself

2. Write about all the emotions associated with the event.

3. Set aside 30 minutes at a regular time for three or four days in a row when you won’t be disturbed.

4. Explore how the topic relates to other aspects of your life, such as your childhood and relationships.

5. Write continuously and don’t think about spelling or grammar.

Journal writing about traumatic events can be difficult, time-consuming, and careful. Writing about the worst events of your life can dredge up solid emotions, and healing doesn’t follow. For example, journaling therapy doesn’t seem to work by itself with people who are severely depressed or who have post-traumatic stress disorder. Smyth suggests notifying either your health care professional or someone close to you before attempting this exercise. Let them judge if it’s helping or hurting you.

Also, keep your healing journal private. It’s okay to tear up the pages or burn them once you’ve written about the event. Showing them to anyone who isn’t a therapist or healthcare professional could make matters worse–it could be hazardous for a battered woman to show the pages to her spouse.

Some therapists integrate journaling into their therapeutic practice. Journaling is something you can look for in a therapist if interested. You can certainly do something while in therapy to discuss with your therapist if you are experiencing difficult emotions. Remember, one does not have to be in therapy to write a journal.

Psychotherapy help is available. Email Dr. Schwartz at dransphd@aol.com

Teenagers, Depression and Suicide

Teenagers and Depression and Suicide

Most of us remember our teenage years as being very difficult. I have heard many adults, friends, family members, clients, and others unequivocally state that they would never want to revisit those days. Among the many problems adolescents face are feeling accepted by peers, believing that they are attractive, getting along with parents and siblings. Then there is also coping with school and adjusting to the rapid physical changes brought on by hormones, rapid growth in height, powerful sexual urges, and dealing with the pressure to use drugs and alcohol. It is not surprising that many of these teenagers feel anxiety and depression.

Adolescence is when young people join social groups of males and females. There are parties and the first experience of dating and sexual play. The Covid pandemic has brought these experiences to a halt. Many schools are closed, and most people wear masks to prevent the spread of the virus. These factors are not conducive to socialization. Perhaps, with the pandemic declining, everyone will resume their everyday lives.

Today, adolescents have the added pressure of social media. At least some teens are the targets of these insults and rumors who experience terrible feelings of despair. Sadly, it is easy for bullies of either gender to beat up each other by posting horrible things about youngsters they dislike. The result is shocking reports of suicides committed by these unfortunate youngsters.

During the past two years, teens have struggled with the Covid pandemic. Isolated at home and enduring internet learning, more young people, commit suicide. The quote is from the Baylor College of Medicine:

“During the COVID pandemic, I, along with most pediatricians, have seen an exponential rise in teenagers admitted to the hospital with suicidal thoughts and attempts. Some had been lonely and contemplating suicide for a while. Some made rash decisions and cried of regret when recounting their actions.”

“When a child tries to commit suicide by firearm, they are likely to succeed.”

“The pandemic uniquely affected adolescents. Social isolation, constant uncertainty, stress, and fear have plagued their lives. According to the CDC, teenage emergency room visits for suicide attempts increased significantly during the pandemic, with a 50% rise in cases in females and an almost 4% increase in males. Suicidality among teens in Texas was on the rise before the pandemic. However, most suicidal attempts are not fatal except for guns.”

“In Texas, guns are the second leading cause of death among children and adolescents. Suicide is also the second leading cause of death among American youth.”

Teenagers depend upon parental cooperation for psychotherapy. For example, they need to be driven to appointments and be provided with money to pay for sessions. Because of their age, parental involvement is essential for the therapeutic process to succeed. Parental involvement means that there will be joint sessions with the therapist and separate meetings with parents. Many parents are reluctant to get involved because they fear blaming their child’s problems.

 Experience with teenagers shows that parental attitude and cooperation make a big difference in whether the treatment is successful.

There are several ways parents can sabotage psychotherapy:

1. Failure to make the car available to the teen or drive them to the appointment.

 2. Failure to pay for sessions.

 3. Refusal to attend family sessions.

 4. Defensiveness for fear of being blamed.

 5. hostility blaming the teenager for everything.

 6. Rejecting depression as a real medical problem and blaming the teenager.

 7. Attempting to hide a history of child abuse.

All parents must know the importance of teenage depression and the need for psychotherapy. Multiple factors can cause our teens to become depressed, and many of them have nothing to do with the family. Today, children are growing up in a complex, dangerous, and uncertain world. In addition, they’re learning to cope with the opposite sex can become complicated. Breaking up with a boy or girlfriend can cause grief and depression. It is a mistake not to take this seriously.

Dr. Schwartz is available for consultation. He is available at dransphd@aol.com

Trauma and Gaslighting

Gaslighting Quotes That Capture This Emotional Manipulation

  1. “Gaslighting is mind control to make victims doubt their reality.” — Tracy Malone.
  2. “Gaslighting is a subtle form of emotional manipulation that often results in the recipient doubting their own perception of reality and their sanity. In addition, gaslighting is a method of manipulation by toxic people to gain power over you. The worst part about gaslighting is that it undermines your self-worth to the point where you’re second-guessing everything.” — Dana Arcuri.
  3. “It frightens me because I feel vulnerable to attacks, an easy target for gaslighting. Phrases like ‘No, I didn’t say that!’, ‘You don’t remember,’ and ‘You must have forgotten,’ start rattling my brain and making me jittery.” — Ankita Sahani

There are many times of childhood trauma, where family members state it happened a long time ago, and it’s time to get over it. The same people who say that engage in gaslighting the survivor of childhood trauma.

What is meant by gaslighting?

Gaslighting refers to the act of undermining another person’s reality by denying facts, the surrounding environment, or their feelings and memories. Ultimately, the target of gaslighting may doubt their sanity.

The trauma of childhood abuse can have long-lasting repercussions that affect your understanding of yourself and the world around you. For many, the effects of abuse show up in dysfunctional interpersonal relationships resulting from attachment disruptions at pivotal points of childhood development. By examining the impact of childhood abuse on interpersonal relationships and the role of therapy in healing, people can better understand their experiences and the possibilities for recovery.

One result of childhood trauma can be dissociative disorders:

Dissociative disorders involve the inability to distinguish between thoughts, memories, surroundings, actions, and identity. People with dissociative disorders escape reality in involuntary and unhealthy ways and cause problems with functioning in everyday life. In one case, a patient dissociated when she had to move from her apartment after many years. Any stress can set off this disorder. 

The Impact of Childhood Abuse on Interpersonal Relationships

In the absence of secure attachments, survivors of childhood abuse often develop dysfunctional attachment styles that disrupt your ability to interact with others in healthy ways. Emotional abuse, neglect, and sexual abuse are more strongly associated with interpersonal distress in adulthood than physical abuse. However, it is essential to remember that any abuse survivor can experience profound interpersonal difficulties, including:

  • An inability to trust: The ability to trust others is a critical part of forming and maintaining healthy relationships. However, when someone has experienced childhood abuse, that ability is often diminished or even removed altogether. As a result, you may be reluctant to engage in honest and open relationships for fear that you will be betrayed or harmed. Staying closed off, guarded, or hypervigilant can make it difficult for others to feel close to you, and you deny yourself the opportunity to form healthy and meaningful bonds. The lack of trust also affects all insecure attachment styles.
  • Avoidant attachment: Some people who do not experience the benefit of secure attachment in childhood must avoid attachment to others altogether. Avoidant people are unable to trust others. It also arises due to extreme self-reliance. Many abuse survivors learned that they could not rely on others to meet their attachment needs early. Those with an avoidant attachment may decide to ignore those needs or attempt to meet them yourself. In adulthood, this typically translates to social avoidance or the formation of emotionally distant relationships in which you remain unresponsive to the needs of others.
  • Ambivalent attachment: Survivors of childhood abuse develop a weak attachment style. People with an ambivalent attachment style desire intimacy. However, they are ever watchful of change in the relationship, sometimes to the point of paranoia, “frustrated and resentful, particularly if you feel misunderstood or vulnerable.
  • Disorganized attachment: People who experience this style are deeply fearful of relationships. However, they crave emotional closeness. You are at once afraid of intimacy and of being alone. As a result, you may lash out if you feel ignored or unloved while being reluctant to show affection for others. These patterns create significant barriers to forming and maintaining healthy relationships. 

People who experience childhood abuse are vulnerable to developing mental health disorders that compromise emotional and behavioral stability, including depression, anxiety, PTSD, and borderline personality disorder. These illnesses present additional challenges to engaging in healthy interpersonal relationships, leading to re-traumatization that creates further emotional damage.

Contact Dr. Schwartz at

dransphd@aol.com

It’s Enough to Make You Pull Your Hair Out

Do you remember a time when you were reading or studying for a school exam or writing a term paper and were quite unconsciously twirling, twisting, and pulling your hair until the strands fell out?

I have worked with people with Trichotillomania. They are also known as “trichsters,” but nothing is humorous about this disorder. It is a disorder also known as hair-pulling. “Trichotillomania is repetitive twisting and twirling of the hair. The hair loss is usually in a well-defined area with shortened, broken-off hairs and early regrowth of hair. The scalp is the most commonly involved site, but eyelashes and eyebrows may also be involved. The hair loss can also be patchy and poorly defined.”*

Some 2.5 million Americans experience this disorder. Hair pulling often begins during childhood or adolescence. For example, studies show that boys who pull out their hair start around the age of 8, while girls begin around twelve years of age or with the onset of puberty. By far, the highest percentages of people with this disorder are women, and they are 4 times more likely than males to engage in hair-pulling.

The ancient origins of the word, Trichotillomania come from Greek root terms meaning “hair,” “pulling,” and “mania,” or madness. Actually, there is nothing mad or crazy about this little-understood disorder. Today, psychiatry and medicine define it as an impulse control disorder. The implications are that it is medical in nature and specifically neurological in origin.

*Symptoms:

  • Constant tugging, pulling, or twisting of hair
  • An increasing sense of tension is present before the hair pulling
  • Sense of relief, pleasure, or gratification is reported after the hair pulling
  • Hair pulling leads to an uneven appearance
  • Bare patches or diffuse (all across) loss of hair
  • Hair regrowth in the bare spots feels like stubble
  • Some individuals may develop a bowel obstruction if they eat the hair they pull out
  • Other self-injury behaviors may be present
  • People suffering from this disorder often deny pulling out their hair

*(Information is from U.S. National Library of Medicine)

Many mental health specialists define this disorder as impulse control because those with this disorder cannot resist the urge to pull their hair. The impulse to tear one’s hair is so overpowering that it cannot be controlled. Once the habit has reached those dimensions, there is no way to resist the urge. The result is that bald spots emerge on the scalp. 

The presence of these bald spots becomes a source of great distress, particularly for teenage girls when they are at the height of concern about their appearance. In fact, the impact on one’s appearance and its social consequences have the most significant impact on the social and emotional adjustment of people with this disorder.

One of the most essential facts for sufferers and their loved ones to know about this behavioral disorder is that it is not a bad habit. People can learn to control or alter patterns with little difficulty. The overwhelming urge to pull hair places it outside of the category of a learned and bad habit.

It is said that there are two types of Trichotillomania: one in which the individual is aware that they want to pull their hair and another: in which the person is so involved and absorbed in an activity that they are unaware of what they are doing.

Among those who know they want to pull their hair, there is a feeling of extreme distress, depression, and anxiety, leading them to pull their hair out. The result is a feeling of relief or an end to the emotional numbness experienced by these individuals. However, there is no awareness that they have started to pull their hair for other people. Among the second group, the process of hair-pulling seems to be much less open to attention much of the time, until sometime after it has started. In all cases, once the person attempts to stop the behavior, the worse it becomes.

Reports about the prognosis of this disorder are that most children will outgrow it within a year. However, if this does not happen, it can and does last into adulthood.

There is no one accepted and proven treatment for this disorder. The commonly tried treatments are medication for depression, psychodynamic psychotherapy, cognitive-behavioral therapy, and behavior modification. One form of behavior modification is referred to as reverse habit conditioning. The patient is made aware of the behavior and when it will happen and then explores alternative coping mechanisms to the hair-pulling.