I have a nine-year-old son and a sevenyear- old daughter. During the last year,
the boy has been pulling out his eyelashes and eyebrows, and then he began to
pull out hair on the top of his head in a straight line in the middle. It has
created a bald stripe in the middle of his head. I know this is called
trichotillomania, but I don’t know what to do about it. He is very intelligent,
and my wife expects him to excel in his schoolwork. Could it be that this is the
reason for the problem? What can be done about it? We took him to a
psychologist, but we were not impressed that she had done anything to help him.
What should we do?
R.S., Tel Aviv
Prof. Alan Apter, head of the department of
psychological medicine at Schneider Children’s Medical Center in Petah Tikva,
This disorder is in fact trichotillomania.
impulse-control disorder associated with compulsive hair pulling. No one decides
to have it. It can result in a bald patch on the scalp, eyelashes, eyebrows or
another part of the body. Not surprisingly, many individuals with the condition
feel ashamed or embarrassed about how they look, and they often find it
difficult to explain away their hair loss in a way that doesn’t draw more
attention to the problem.
The best treatment is habit-reversal (HR)
therapy, which can be done at our psychosomatic clinic at Schneider’s Children’s
Medical Center or by clinical psychologists who have experience with this
treatment. Habit reversal is a type of behavioral treatment that is used to
reduce repetitive behaviors that may be bothersome and serve no adaptive
function, such as tics, hair-pulling and nervous habits. It was first developed
in the 1970s and has since been used in the treatment of several repetitive
HR is based on the premise that people are often not
aware each time hair pulling, tics or other repetitive behaviors occur and that
repetitive behaviors often follow an urge or feeling of discomfort that is
alleviated only by engaging in the behavior itself. HR works to increase
awareness of one’s behaviors and to provide relief with strategies that replace
the unwanted behavior with a less troublesome behavior.
The patient is
evaluated before the start of treatment, which is explained to the family. When
the unwanted behavior began and its frequency and influences are identified and
described. The family is taught about self-monitoring with a log or record of
each time the behavior occurs. The places and times of day when it occurs are
recorded so the patient can recognize those situations in which the behavior is
more likely to happen. The parent is taught to help with maintaining awareness
of the behavior and to ease record-keeping.
The next step is developing a
competing response – another behavior that the patient may perform instead of
the repetitive behavior. This often utilizes the same muscles used in the
The competing response should be held for at least one
minute, be inconspicuous and strengthen the muscles opposite to the repetitive
In addition, there is a medication called N-Acetyl – Cysteine
(NAC), which is also helpful against trichotillomania.
I am a 42-year-old
man and a former smoker. I would like my teeth to be whiter, but I don’t like
the idea of chemical bleaching and abrasives, as they surely erode the tooth
enamel. Are there any natural foods that one can munch on that make teeth
whiter, such as white cheeses, vegetables or fruits, just by eating them?
Dr. Yuval Wind, director of the advanced aesthetics program, R.E.
Golstein Center for Aesthetic Dentistry and Clinical Research, Prosthodontics
department, Hebrew University- Hadassah Faculty of Dentistry in Jerusalem,
Tooth lightening is a dental treatment that makes it possible to
change the color of the teeth by using material that breaks down the molecules
of pigments found in the enamel and especially the dentin (the internal layer of
the tooth). The treatment is completely safe and does not harm the tooth and
does not require any erosion of the tooth itself. The process makes it possible
to make the color lighter than it was and involves one treatment in the dental
clinic and a number of treatments at the home of the patient.
also a home technique that is slower because it is with more delicate materials;
it takes two to four weeks of an hour a day of the teeth being bathed in the
chemicals in a plastic form worn on the teeth.
There may be some
temporary sideeffects, such as making the teeth sensitive to cold drinks, but
they pass at the end of the treatment.
The lightening does not affect
fillings or crowns – only natural teeth. During the lightening process, patients
should avoid food and drinks with pigments, such as cola, coffee, tea, beets and
the like. The lightening should be repeated two or three times a year by using
the plastic devices for an hour a day over the course of three days.
there is no need to eat certain foods to try to brighten your smile.
for Readers welcomes queries from readers about medical problems.
answer those we find most interesting. Write Rx for Readers, The Jerusalem Post,
POB 81, Jerusalem 91000, fax your question to Judy Siegel-Itzkovich at (02)
538-9527, or e-mail it to email@example.com, giving your initials, age and place