Trichotillomania or Hair Pulling Disorder is the compulsive behavior of pulling hair or pulling hair out. This often concerns areas of the head, but can include other areas of the body, such as from the eyebrows, eyelashes, arms, face and legs. The individual may pull their hair in a ritualized manner and some individuals with Hair Pulling Disorder may bite or eat the hair they have pulled. The hair pulling may cause significant distress and is often quite secretive. Areas that show hair damage or loss often cause embarrassment and shame. Individuals with Hair Pulling Disorder often struggle to come forward for treatment and may suffer for years with the condition. It is a commonly occurring condition that responds well to habit reversal training, an sub-therapeutic modality of Cognitive Behaviour (CBT) Therapy sometimes together with medication. The condition occurs slightly more commonly in women than men. Hair pulling behaviour may occur cyclically, where the individual may not pull for weeks or months (sometimes years) and then start pulling again. Stress, as well as boredom often precipitates episodes of hair pulling.
Hair Pulling Disorder used to be considered an impulse control disorder. Predominantly due to some individuals describing pulling urges, proceeded by a reduction in tension and feelings of pleasure. However this has not been widely reported and is no longer considered diagnostically significant. Hair Pulling Disorder is now considered an Obsessive Compulsive Spectrum Disorder (OCSD). The reason for including Hair Pulling Disorder as an OCSD is that it has many common features with OCD. Some of these features include the compulsive activity of hair pulling, similarities with the underlying neuro-cicrcuitry and that both conditions respond well to the same psychiatric treatments.
New developments in the neurosciences and psychiatry are changing the way that we see Obsessive Compulsive Disorder (OCD). OCD may no longer be considered part of the anxiety disorders but rather part of a series of conditions on an obsessive compulsive spectrum. Other diagnoses will likely join OCD on the spectrum as they share many of the features of OCD. Some of these conditions include trichotillomania (Hair Pulling Disorder), Skin Picking Disorder (Dermotillomania), Pathological Gambling, some sexual addictions and hypochondria (Health Anxiety).
These conditions may share common genes, biomarkers, psychological components and brain circuits. The psychiatric and cognitive behavioural therapy treatment of these conditions is also very similar.
For more information about the Obsessive Compulsive Spectrum Disorder visit www.ocdspectrum.com
Body Dysmorphic Disorder (BDD) is a commonly occurring psychological condition that is not easily diagnosed and apparently under diagnosed in South Africa. BDD is considered psychiatrically to be a somatoform disorder, or psychological disorder concerning ones body. However a great body of scientific evidence suggests that it is similar to OCD than other kinds of psychological conditions and should be considered an obsessional spectrum disorder. In other word lying on a continuum of ways in which an individual may develop obsessional thinking or thought processes and how these cause the person emotional distress and impairment in their lives.
An individual who has BDD is concerned with body image, which manifests as excessive concern about and preoccupation with a perceived defect of their physical features. The person may worry about a particular part of their body or face or a few different parts of their body or face. They check their body parts often, such as in mirrors, by feeling, and/or becoming aware of how others may be perceiving their feature(s).
almost 5% of all individuals seeking cosmetic surgery can be diagnosed as having BDD. These figures are also believed to be under reported. Many individuals who may have BDD find it very hard to seek treatment. They may be embarrassed or suffer from social anxiety because of their concerns about their appearance and body image. The individual may then withdraw and can even develop clinical depression.
Contrary to past belief BDD affects both women and men equally. There is effective treatment for this condition through either medication or cognitive behaviour therapy (CBT).
Visit www.ocdtreatment.co.za for more information on treatment for BDD
Children and teenagers are not easily diagnosed with OCD and unfortunately it seems to go unnoticed.
Current research is beginning to shed light on the development of OCD, and it seems that it may have it’s onset slightly earlier than previously speculated. This does not mean that parents should be concerned, it means that we are becoming better at detecting, diagnosing and treating OCD earlier, so that it does not become a problem or difficulty fir a person later in life.
Also although OCD does have a strong genetic component or predisposition, it does not mean that if a parent has OCD or other anxiety difficulty their child will definitely develop it. It seems that many individuals also need certain circumstances in order for OCD to develop. We are not yet fully aware if exactly what all these circumstances are yet, but many include early life trauma, stress and or fear learning or modeling.
If you suspect your child may be suffering from OCD, there are a lot of really good resources. These can be found at
There are a number of Apps that I have found particularly useful in helping my clients manage OCD, carry out exposure and response prevention therapy (ERP) and ultinately reduce the symptoms of OCD.
Many of these Apps are unfortunately only available at the moment to iphone, ipad users.
OCD Manager is a fantastic App that has some very important basic information to help you develop the right attitude and approach in managing and treating your OCD. It allows you to set exposure challenges and reminders on when to engage in a particular exposure challenge. The app also has an integrated OCD coach, where mindfulness and acceptance exercises are built in (in a procedure called ARC). This is probably one of the most useful OCD apps available. If you cannot afford individual CBT and ERP for your OCD, this can certainly help you. Even if you do have a therapist, this will provide you with great structure and tools to keep you working on and developing your skills in managing OCD and the associated anxiety.
This App has a sliding thermometer or rating scale to evaluate the difficulty of resisting obsessions and giving into compulsions. When you are about to give in, the app provides a number of skills and Cognitive Behavior Therapy Techniques to help you manage through a response prevention.
This is a fantastic App that can help you in doing good Cognitive Therapy, in the process of cognitive restructuring. It is a step by step process of looking at your situation, cognitive (thought) triggers, emotions and behaviorally responses and then identifying thinking errors and eventually changing your thinking. It is a great way to keep on practicing cognitive challenges and restructuring. Also highly recommended for anyone managing their OCD or any other anxiety condition or depression.
For more info on OCD treatment visit www.ocdtreatment.co.za
Here is an absolutely fantastic tip on managing OCD
More can be found on his youtube link
To individuals who are considering embarking on the difficult process of cognitive behavioral therapy (CBT) for Obsessive Compulsive Disorder (OCD) which includes exposure and response prevention (ERP), it is strongly recommended that therapy should not be taken in small doses; ambivalence and looking for a quick fix are not a winning formula.
CBT is a time limited intervention aimed at reducing the symptoms of OCD. It is an evidenced based treatment and the current scientific evidence suggests that it is most effective form of treatment for OCD. Some studies suggests between a 60% and an 80% effectiveness in reducing symptoms and improving the quality of life of individuals suffering from OCD. CBT briefly involves challenging thought processes and behaviours that support a high frequency, intensity and duration of negative emotional states.
Exposure and response prevention (ERP) has been firmly established as the treatment of choice, as a sub-treatment of CBT, for obsessive-compulsive disorder (OCD). ERP involves systematically confronting images, thoughts, circumstances, objects and situations that trigger or involve OCD symptoms. This is done to help the client’s brain to re-learn and habituate to these fear or distressing triggers.
However, the dropout rates in doing ERP, have required reconsideration of other additional techniques. It can be very difficult for someone to do ERP, as it initially can produce high levels of anxiety. In the short to medium term it does eventually reduce discomfort, build mastery and improve self efficacy. Most individuals doing ERP receive a benefit.
However for some of those people who do receive benefit, a portion of the presenting OC symptoms remain, often necessitating further treatment. Newer cognitive-behavioral approaches that focus on challenging OCD appraisals and beliefs have been proposed as additions to traditional ERP. These appear to compliment and enhance the effectiveness of ERP. One such CBT treatment that is being used with ERP is mindfulness . Mindfulness techniques teach the client to manage and cope better with the negative intrusive thoughts and uncomfortable negative emotional states.
For more information on CBT treatments for OCD visit:
More to come in OCD treatments….
Obsessive Compulsive Disorder (OCD) has often been described as a secret illness. Individuals often find their obsessions and compulsions embarrassing and very difficult to talk about. Being in a group offers a means to normalize these uncomfortable feelings and emotions. The group can provide a safe environment to explore and discuss obsessions and fears and learn from others how to manage their difficulties. The group can also be a great place to practice exposures and can be a therapeutic environment as well as a supportive environment.
For more information on the OCD support group in Cape Town visit: