Do you find yourself dwelling on thoughts about how things will turn out poorly? That you won’t be able to handle things? 38 % of people say that they worry every day. Some people say that they have been a worrier all their lives. You may also notice that you have difficulty sleeping, you feel tense, and you have difficulty remembering and concentrating. You may worry about more than just a couple of things—work, relationships, health, what people think, unfinished tasks, finances, the safety of family members, or your future in general. This is called Generalized Anxiety Disorder (GAD) which is also associated at times with alcohol misuse, depression, chronic pain, and inflammatory bowel disease. Between 4 to 7 % of people suffer from GAD during their lifetime.

How do worried people think? Do any of the following describe you? 1) If something bad could happen, I need to worry about it; 2) If I can imagine a bad outcome, it is more likely to happen; 3) Uncertainty is hard to tolerate and I equate it with a bad outcome; 4) I need the answer immediately—I cannot wait; 5) My worry is out of control and I try to stop it; 6) But, I need to worry to feel safe and responsible; 7) My worry can make me sick. You feel that you are trapped by your negative thoughts, but you also sometimes think that you need to pay attention to them. Since you are focused so much on your thinking, you are not fully present, you cannot relax and wake up worried about whatever pops into your head.

You probably see yourself or someone you know in this list. Here is the good news. In research done at Penn State University, 91 % of things that people worry about have a neutral or positive outcome. Even when there is a negative outcome, 78% of the time worriers say they handle things better than they thought they would. In other words, worriers are better at coping with real problems than they think they are. The problem is that they “create” more imaginary problems than they can handle.

Cognitive behavioral therapy can help you cope more effectively with these unwanted intrusive thoughts. I have described a detailed set of strategies and techniques that you can use in my book, The Worry Cure: Seven Steps to Stop Worry from Stopping You. Our therapists can help you regain control over your life so that you are not hijacked by the noise from your thoughts.

Is it Trichotillomania?

By Melissa Horowitz, PsyD

Trichotillomania (TTM), also known as hair-pulling disorder, is a type of body-focused repetitive behavior. TTM tends to be more common in females than in males, and can develop in childhood or early adolescence, with a prevalence rate of roughly 1-3%.

The symptoms include: 

• Repeatedly pulling one’s hair 
• The location can be the same or vary across one’s body - e.g., scalp, eye brows, eye lashes, on face or pubic area 
• Hair loss or baldness can occur in the locations where the hair is pulled
• Unsuccessful attempts to resist pulling one’s hair 
• It is distressing to the person 
• It can impair a person’s ability to function in their everyday routine 
• The pulling behavior can vary from a few months to years, with or without dormant periods in between 
• The recurring pulling is not due to a medical condition or another mental health condition 

Emotional distress such as anxiety, depression, embarrassment and loneliness can occur following thinning or broken hairs or bald spots. Additionally, lowered self-confidence, belief that one has no control over one’s behavior and concerns that others will not understand or may impose judgments, can also occur. 

Even though it is included on the obsessive compulsive disorder spectrum, the symptom presentation and treatment approach for TTM is different from that of obsessive compulsive disorder. Unlike obsessive compulsive disorder, the repeated pulling of one’s body hair does not occur following an obsessive thought. Hair pulling is also a relieving experience and is reinforced by the reduction of tension or the pleasure derived from the behavior. Often this is out of conscious awareness, sometimes occurring spontaneously.

Unfortunately at this time there is no cure for this condition; however, relief can be obtained by learning about the condition and ways to manage the chronic nature of the symptoms. Habit reversal treatment (HRT) is often combined with other cognitive behavior therapy approaches to create a comprehensive treatment. 



If you are unsure if you meet criteria for this condition, these steps may help you begin the process of collecting information to determine if it makes sense to be evaluated for TTM.  

Step 1: Keep a daily record of any hair pulling, even if only for a single week and include these categories: 

• The date 
• Time of day the hair pulling behavior occurred 
• Your physical location 
• Generally what was going on at the time 
• Where the hair was pulled 
• How many hairs were pulled 
• How long the episode lasted 
• Possible or known reasons the hair pulling behavior eventually subsided

Step 2: Review the daily record to see how aware you are of any hair pulling behavior and its effect on your thinking, emotional state, daily routine, and generally how you are feeling about yourself. 

Step 3: If you suspect your hair pulling is having a negative impact in general or in specific ways on your life, consider whether it is time to schedule a consultation with a qualified professional. 

If you are interested in scheduling a consultation with one of the psychologists on our staff with expertise in TTM, our office can be contacted by phone at 212-308-2440 or by email at intake@cognitivetherapynyc.com.