While finals week causes distress for all students, only those with nail biting, hair pulling and skin picking habits can boast about the physical damage the end of every semester brings for them.
Counselors see no rush to quit these habits if they have no effects on a student’s life. Such tics, however, could be signs of an Obsessive Compulsive Disorder, anxiety, or depression.
“What I tell people is, if you pull hair, count the hairs. If it’s more than a hundred in a day, you need to see someone. Your hair probably won’t be replaced as fast,” said Dr. Trent Holmberg, psychiatric resident at the U Counseling Center.
Pulling hair to the point that significant hair loss is evident is a disease called Trichotillomania?where the individual feels a sense of relief by pulling hair from the scalp or body areas. The most common sites are the scalp, eyebrows and eyelashes.
Usually Trichotillomania is accompanied by another problem, such as anxiety.
“It is not common for people to come in [with Trichotillomania] being their primary complaint,” Holmberg said.
However, in every primary interview, Holmberg asks the patient if he or she has any tics.
The most common way compulsive skin-pulling or hair- pulling begins, according to Holmberg, is people picking at their skin?taking away irregularities?until they begin to pull at their skin with no reason.
“It comes to a point where anxiety increases until they pull, and it has nothing to do with the skin,” Holmberg explained.
“I started pulling on my eyebrows in junior high, probably because I had bushy eyebrows,” said Danya Allen, a freshman in exercise physiology.
Allen now plucks her eyebrows, but her habit of pulling her eyebrow hair along with the habit of rubbing her skin remains.
Allen’s family was irritated with her habit before she moved out of the house. Now, it irritates her boyfriend.
“He says I’m obsessive compulsive,” she said.
However, Allen has never made any attempt to stop.
“When I pull, most of the time nothing comes out, so I never worry about it,” she said.
For Trichotillomania, or any tic, Holmberg’s guidelines for treatment is “life functioning.”
“If it’s distressing their life, we treat it,” he said. “It depends on how they are experiencing it. Someone who cracks knuckles and believes it causes arthritis will have distress.”
Holmberg explained that if a person does not believe knuckle-cracking will harm him or her?and isn’t concerned about other people’s reactions?that person does not need to quit.
“Incidentally, cracking knuckles has been studied and doesn’t have any long-term effects,” he added.
For Lauren Weitzman, counseling psychologist at the Counseling Center, what distinguishes a habit being a result of OCD from being a result of stress or anxiety is the frequency with which it occurs.
“A student might bite their nails when studying for an exam, but for knuckle cracking, they might have to go through a ritual before going on to the next thing they’re doing,” Weitzman said.
“As a clinician, it is more worrying when people hurt themselves,” she continued.
If someone decides to stop a habit, there are medications or non-medication methods to help the person stop.
For Holmberg, straight will power can be enough in some cases, but not always. Holmberg compares the urge for a nervous habit to an itch, and the response to a scratch.
“There is a certain amount of will power you can exert over something that itches,” Holmberg said.
A non-medication method for treating Trichotillomania is talk therapy, a form of Cognitive Behavioral Therapy, which requires a professional therapist. The patient and therapist try to find psychological factors causing the hair pulling. Afterward, they can disconnect the train of thought that tells them to pull their hair when they feel anxious.
Holmberg gives an example of a woman who pulls her eyebrows after an argument with her boyfriend. The woman and therapist figure that she feels depressed after the fight, and does not have a good view of herself.
When the woman looks at herself in the mirror, she notices things that are wrong with her eyebrows, pulls out a few to fix, and after a while, she realizes she has pulled out more than several eyebrow hairs. This process develops into a habit.
“Once people know it doesn’t make sense?fighting with the boyfriend is not going to be helped with pulling eyebrows?they usually stop,” he said.
Talk therapy does not always work. When it does work, the patient stops for several years, or for a lifetime, according to Holmberg.
“Some people can see it clearly doesn’t make sense. Some people don’t think?when the urge comes, they pull,” Holmberg said.
In that case, anti depressants or anti-psychotic medicines are used.
The first treatment is CBT. In case of failure, a psychiatrist prescribes just medication, or medication along with CBT.
“The maximized chance, of course, is doing both,” Holmberg said.
According to Weitzman, treatment in the category of “behavioral interventions” is common. Behavioral intervention method is to substitute a different behavior for the tic, such as tying a rubber band around the wrist, or squeezing a stress ball.
“Something that has the same purpose, but not so much the negative consequences,” she explained.
Weitzman added that another step is to identify the cause of the habit and when it occurs. She compares the process of quitting a habit to the process of quitting alcohol: figuring out what causes drinking and what would serve the same purpose.
“I wouldn’t call it an addiction, but I would say there are some similarities,” Weitzman said.
Julie Prince, a freshman in pre-pharmacy, bites her lip?sometimes until it starts bleeding. She has tried to stop several times, but she always starts again.
“I put a lot of lipstick or chapstick on my lips, so I won’t bite them, but I do it anyway,” she said.
Prince said her habit started when she began dancing. She bit her lips when concentrating or worrying about a performance.
Kristina Chen, a freshman in pre-med, does not bite her lip until it bleeds, but it frequently hurts.
“I don’t notice I’m doing it until I realize, ‘Ow, it hurts,'” she said.
Chen has made no attempts to stop.
Kiersten Horne, a sophomore in modern dance, bites her lip and nails. She claims she doesn’t bite as much when she is less stressed.
“If I catch myself doing it, I’ll stop, but it’s no big deal to me.” Horne said.
Holmberg believes there is a range of severity for every behavior.
“Are there health consequences? Does it affect your relationships with other people?” he said. If it does, according to Holmberg, you might want to stop.