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“Breaking Free From Society's Chains”

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June 23, 2010 Bad Hair Day

With her blonde hair tied back in a ponytail and dressed in a chic business suit that reeks of Chapel Street, Cassandra Evans looks every bit the successful lawyer that she is.

But as she takes her hair out of her ponytail, it’s obvious that things aren’t quite what they seem. Forget the blonde tumbling mane men often fantasise about. Instead Cassandra’s hair is thinner than most, strands are brittle, and bald patches that were covered up by the ponytail are now evident.

She doesn’t however have Alopeccia, the medical condition that causes sudden hair loss from shock, stress or hormonal balances.

Cassandra has something completely different, something that has caused her to pull out her own hair. She has Trichotillomania or TTM as it’s often called, and she’s not alone. Millions of people all over the world suffer from Trichotillomania, although it is mainly females that suffer from this condition.

Many may be asking right now Tricho what? Deriving from the Greek word Trich (hair) Tillein (to pull) and maniaor frenzy (morbid desire). Trichotillomania is a condition not unknown to doctors. Unfortunately it is one of very little understanding.

Its main characteristic is the compulsive urge to pull one’s hair out, with then an experience of released tension and relief after this is done. Sometimes people even express a degree of pleasure after having performed the act.

It tends to usually start at around five to eight years of age. Although it affects both males and females, by the teenage years and particularly among adults, more women appear to have this disorder, as boys tend to change their behaviour upon adolescence.

There is a ratio of five to ten women to every man. But these figures maybe distorted due to the fact fewer men seek help, and natural balding can disguise hair pulling in men.

Cassandra, herself started pulling out her hair as a child, but it wasn’t until her teen years that her condition got worse.

“I can recall twirling my mother’s hair when I was a baby, and then my own. I think I was about seven when I actually started to pull out my hair. At first it wasn’t a big deal, and I’d just sit there watching television and pulling,” She says.

“But then it became a habit, and when I got into my teens years it got worse. As the pressures of school and just being a teenager increased I’d lock myself in my room, and pull away. I started doing it while I was reading, then before I fell asleep at night. Almost as if it was a source of comfort.”

Although there are only one to two percent of the world’s population that are officially diagnosed with Trichotillomania, the stigma and shame associated with it suggests that an estimated two to three percent more suffer in silence.  Widespread ignorance or misinformation about this disorder-even among Professionals often compounds this.

Shame is something that Cassandra can relate to. More often than not she suffered in silence, hiding her hair pulling from her parents. “My mum used scream at me to stop pulling my hair, so I used to hide it by scooping up the hair once I’d pulled it out and either throwing it away or hiding it under my pillow. I was ashamed of what I’d done, as if I was a naughty child doing something wrong.” She says.

One of the many misconceptions about Trichotillomania is that it is tended to consider it an Obsessive Compulsive Disorder (OCD). While it may have some aspects of an OCD, such as the compulsion to pull, those who do it can not be considered obsessive. It is actually more of an impulse control disorder as are conditions such as compulsive gambling, kleptomania and pyromania.

There is also a tendency among non-Trich sufferers to minimise the problem, particularly among physicians and parents of child hair-pullers. Lack of information and the perception of it being merely a ‘phase she or he will grow out of’ leads to the false impression that Trichotillomania is something that people engage in from time to time.

Margaret Evans, Cassandra’s mother willingly admits that she never understood what her daughter was going through, or even knew that there was a name for it.

“I honestly thought it was something that she would grow out of, that it was no big deal. If I had known that her twirling her hair when she was little would turn into Trichotillomania I would have broken the habit immediately.”

It’s easy to see that Margaret seems to blame herself for Cassandra’s disorder. “How was I to know that she had Trichotillomania? We didn’t even know there was name for her problem until she was about 20. I’d never heard of it, or even heard it spoken of. If I had known it was a disorder perhaps I would have been a little more understanding. But it wasn’t heard of. And it needs to be. Parents need to be made aware of the disorder, and be prepared to deal with the emotional roller-coaster that can come with it. They need to know it’s not something that their child is going to just grow out of.”

According to Dr Catherine Madigan of Anxiety Australia Trich sufferers can not control the impulse to pull out their hair. It can occur in states of relaxation such as watching television, where they are not even aware of their behaviour or in times of stress where hair pulling serves as a release of tension.

However severe, repetitive hair pulling, on a daily basis leads to significant hair loss and potential skin damage.

“Trichotillomania is often associated with depression, lack of impulse control, or a habit disorder and may be precipitated by a stressful event such as a parental divorce, death of a relative or something as simple as studying for a test,“ says Madigan.

“The disorder can also lead to low self-esteem, social insecurities, and even severe depression.”

Dr Madigan is quick to point out that it is unusual for Trich sufferers to be open about their disorder because of the obvious hair loss, and the stigma that is considered abnormal behaviour not only by themselves but by society. She adds that Trichotillomania is very similar to other psychological problems with respect to the silence and social stigma.

“For young adolescents already dealing with peer and social pressures and the normal turbulence of being a teenager, coping with a seemingly uncontrollable ‘weird’ behaviour all by themselves, while attempting to hide it from everyone else, including their family, can be particularly hard.”

Trich sufferers find it hard to deal with some aspects of society. They are so ashamed of their condition that everyday life aspects such as going shopping or even to the hairdressers becomes a burden they are unwilling to face.

“It’s not as if I don’t want to go to the hairdressers, but I’m almost scared to,” Cassandra says, adding, “I find when I do go to the hairdressers they have no idea what TTM is. Not only that but they tend to give me a look of sympathy. I don’t want anyone’s pity. I want them to understand Trichotillomania, and accept it. I don’t want to be treated like a social outcast.”

One of the sad aspects of Trichotillomania is that many of those that suffer from it are unaware that they even have the condition. It is a disorder that is not highly publicised, and it wasn’t until 1989 that it was even mentioned in the media. As a result many Trich sufferers have gone without adequate information about their condition, and some aren’t even aware that there is treatment for it. As a consequence the one symptom Trich sufferers share is shame.

Research into treatment for Trichotillomania has grown steadily over the past ten years. Although there is no treatment that is more effective than the other, with people reacting to treatment differently, a number of those treatment options have shown promise to people with TTM.

These treatments include Cognitive Behaviour Therapy, Pharmaceutical Therapy, Support groups and Alternative Therapy.

Cognitive Behavioural Therapy is a form of therapy that seeks to alter a Trich sufferer’s behaviour by identifying the precise factors that trigger their hair pulling and teaches those who suffer from it learning skills to interrupt and redirect responses to those triggers.

Dr Neomie Da Costa, a therapist specialising in Trichotillomania and a sufferer herself who has been ‘pull-free’ for three years believes strongly in Cognitive Behaviour Therapy. She has used it herself, and beaten TTM because of it.

“Cognitive Behaviour Therapy encourages hair pullers to develop an increased awareness of the time of day it occurs, their emotional states, and other factors that might promote hair pulling.  It’s an important precursor in being able to control the Trich sufferer’s behaviour,” She says.

Some hair pullers have success with simple behavioural devices such as putting bandages on their fingers to interfere with pulling, keeping records of their hair pulling, or changing environmental cues that can trigger pulling.

Cognitive Behavioural Therapy is a fairly popular way to beat Trichotillomania, and it means that Trich sufferers are not being pressured to take medication for their condition.
When Trichotillomania first was diagnosed medication seemed the only alternative for sufferers, and it is still one that is offered to those who don’t believe that Cognitive Behavioural Therapy will help them.

A number of medications have in fact shown promise in reducing the severity of TTM symptoms.  Unfortunately most of them fall under the category of selective Serotinin  Reuptake Inhabitors (SSRIs), the most commonly known of this is Prozac.

Dr Da Costa believes that this can be a dangerous way to deal with TTM, and underlines that the effectiveness of these drugs for hair pulling is not always successful.

“Only a small percentage of people find that these drugs stop hair-pulling completely, while others feel no effect at all. Another problem is that taken for a long period of time these drugs can become an addiction.”

Another alternative to beating Trichotillomania is with support groups. Many hair pullers not only feel shame at what they are doing, but feel alone. Hiding their condition can make it harder to focus on ways to reduce pulling and even beating it. Joining a support group can help them to erase shame and makes people with Trichotillomania feel ‘normal’ again. Many of the support groups are online, as it adds an anonymity to those who wish it and gives Trich sufferers a sense of comfort in being able to talk to others from their own personal space.

Another alternative to those who don’t feel comfortable with support groups, Cognitive Behavioural Therapy or using Pharmaceutical medicines is always the alternative of using alternative therapies.

Dr Da Costa says of alternative therapies “There have been reports that several therapies such as hypnosis, biofeedback or even just changing your diet and exercising can be helpful to some sufferers.”

Beating Trichotillomania is not easy and even harder when dealing with the stigmas dealt to them by society.

Dr Da Costa says she knows of one young girl that suffers from Trichotillomania, but her parents refuse to believe that her baldness is caused through hair pulling.

“She’s admitted to me that she pulls her hair, but her parent’s can’t accept it. I explained the situation to them, and they stood up and walked out in complete denial. This means that this young girl is going to have to go through this alone. And that’s not right.”

More often than not those who stop pulling hair will eventually resume it.

Cassandra thought she had completely beaten the disorder after not pulling her hair for a year, but only recently started up again.

“I tried honestly to stop, but found myself doing it again. But I’m determined to beat this. I will beat this.”

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January 10, 2010 The Perfect Image

 

Britney Spears, sex, and the ‘perfect’ image-These all seem to be the things that pop to mind when one thinks of the media. In recent years the media has turned the ‘perfect’ image into something that can now be considered crass, crude, and overtly sexual.

Open up any big name magazine like Cosmopolitan, Seventeen, or even Dolly and you’re guaranteed to find a half-naked woman lying on top of some man dressed in Versace, clutching a half-full glass of scotch in one hand and a cigar in the other. And if not that then something very close to it.

Flip a few more pages into that magazine and you’ll see pop icons acting overtly sexual, only in panties and a beaded necklace.

It seems that this or even the sight of a bikini-clad model lying on a shiny, red sports car is considered by the media to be a norm.

This is a scary thought to most. But Britney Spears and those like her, gyrating, and singing in revealing, low-cut clothing are a part of today’s society. And they get paid for it. The problem with this is that millions of very young, and very impressionable girls are buying their albums, and mimicking that very look and those very sexy dance movements.

It is these girls that are growing up assuming that they should look, act, and dress like their favourite pop icons, actresses, or the models they see in magazines.

This is a concern to Dr Katharina Dulckeit, who believes that the media is to blame for how children and teenagers act and perceive how they should be in today’s society.

“We live in a society where children have become accustomed to these blatant displays of sexuality, and this can’t be blamed on them but the media, as it is the media that has accepted it as a norm.”

Dulckeit believes the media has brainwashed people into seeing only outward appearances over other qualities such as intelligence and personality.

“Sadly a person’s individual intelligence, character, and moral worth play not the slightest role in whether they should be made into a role model. The media is more concerned about the amount of skin that is bared, and the more the better.”

The treatment of women as sex objects has never been so blatant these days, especially with magazines like FHM, and Ralph. These magazines bill women alongside toys, sex and cars as entertainment for men. This objectifies women and reduces them to nothing more than something that men can play with and discard whenever they feel like it.

Unfortunately it is not only just men’s magazines that are doing this. Cosmopolitan claims to be a magazine that empowers women, and is supposed to be a women’s magazine written by real women.

Yet it write articles like ‘man manual’ and ‘how to please your man in 50 different ways’; articles that treat women as if they are sex objects, put on this earth only to please a man.

Every day we see these pop stars, models and actresses adorning magazine covers. We, as a society revere them for their natural beauty, and what we perceive to be the ‘perfect’ image.

According to Sydney makeup artist Lila McGuiness what we’re not seeing is the hours that are taken to make these women look flawless.

“Actually the look isn’t all that natural when you think about it. If you look at any of these photo shoots you’ll see that this so-called natural beauty, is controlled by lighting, perfect positioning, stylists who find the most flattering outfit and then makeup.”

In most cases Lila says that the photos are then digitally enhanced with all blemishes, scars, wrinkles and discoloration’s erased. And it doesn’t even stop there.

“It also means that breasts can be lifted, and enlarged, skin enhanced with a glow, cheeks blushed, stomach muscles added and fat cropped out. They can even change the outfit, as they did with Meg Ryan, if they don’t like the result. Anything is possible. And it’s the norm.” says Lila.

The media, when portraying the ‘perfect’ woman doesn’t take into consideration how ‘normal’ women and teenage girls feel when they see this image, or how they see themselves. More often then not they are made to feel self-conscious even if they have nothing to be self-conscious about.

Through the media, advertising agencies and fashion designers have helped to breed insecurity and self-abuse by suggesting that only the wasted look is desirable. But this isn’t a new situation. The visual aspects of the media can influence from an early age. And it all started with Barbie.

One of the biggest dilemmas facing Barbie is that the current figure is setting a negative stereotype for children in society.

Not only does Barbie depict what society considers the perfect figure but she also has everything that a little girl might dream of. However her body sends the message that if you’ve got the body you get the guy, the beach house and the pink corvette.

This is a problem, when 90 percent of the Western girls aged between three and eleven own Barbie dolls and live in a world where Barbie and fairytale princesses are their main role models.

 They play with them unaware of the underlying messages that these figures contain.

Raising Women editor Debi Stagg says it is Barbie, with her ridiculously tiny waist, enormous breasts, and long, slender legs that is sending out the wrong message to young girls about what is the perfect image.

“It’s not just Barbie but fairytale characters that are relying on their looks to attract a handsome mate because they believe that they need a man to take care of them. Take Sleeping Beauty for example, she goes to sleep, doesn’t age and doesn’t wake until Prince Charming kisses her. It’s all sexual and giving children the wrong message. It says I’m a helpless dumb woman, who needs a man to make her life complete.” Debi says.

But even before females reach their teenage years, many of them have forsaken Barbie and fairytales and are instead absorbing highly sexualised images that surround them.

“In a sense they are trading the ideal messages sent by Barbie dolls for the sexual images that display real-life Barbie dolls and models as their ideals. It’s sick. Because when many young girls hit puberty they are scared of gaining weight and not being ‘perfect’ ” says Debi.

Advertisers play a major role in this. They often emphasise sexuality and the importance of physical attractiveness in attempt to sell their products but this is a growing concern because of the pressure that is placed on not only women but also men to focus on their appearance.

Advertising agencies may adversely impact women’s body image, which can lead to unhealthy behaviour in women and girls striving for the ultra-thin body idealised by the media.

In an International Poll done by advertising agency Saatchi and Saatchi it was found that 27% of young women believe that the media pressures them to have the perfect body and it was found that ads made women fear that they were too unattractive and old.

On average women see 400-600 advertisements per day, and by the time a woman is 17 years old she has received over 250,000 commercial messages through the media.

Only Nine percent of those messages have a direct statement about beauty but many more emphasise the importance of beauty.

This constant exposure to female-orientated advertisements can influence girls to become self-conscious about their bodies and obsess over their physical appearance as a measure of their worth.

Advertisements emphasise thinness as a standard of female beauty, and the bodies idealised in the media are frequently atypical of normal, healthy women.

Statistics show that today’s fashion model weighs 23% less than the average female and young women between the ages of 18-34 have a seven percent chance of being as slim as a catwalk model and a one percent chance of being as thin as a supermodel.

This same study shows that magazine models influence 69% of teenage girls’ ideas of what is the perfect body shape, and the pervasive acceptance of this unrealistic body type creates an impractical standard for the majority of women.

Women frequently compare their bodies to those they see around them, and researchers have found that exposure to idealised body images lowers women’s satisfaction in their own appearance.

This is a growing concern, as the health industry believes that the depiction of thin models may lead teen girls into unhealthy weight control habits because the image they seek to copy is one that is not only unattainable but also unhealthy for many girls. A study found that 47% of girls were influenced by magazine pictures to want to lose weight but only 26% of these girls were actually overweight. Research has also found that stringent dieting to achieve the ‘perfect’ body can play a key role in triggering eating disorders.

According to Dr Katharina Dulckeit girls who are dissatisfied with their bodies show more dieting, anxiety and bulimic symptoms after prolonged exposure to fashion and advertising images in a teen girl magazine. And this can cause women in their teens and twenties to begin smoking in order to control their appetites.

“It’s very difficult for teens to develop healthy attitudes towards sexuality and body image when much of the advertising aimed at them is filled with images of impossibly, thin, fit, beautiful and highly sexualised young people. The underlying market message is there is a link between physical beauty and sex appeal, popularity and material success.”

Fashion marketers like Calvin Klein, and Guess use provocative marketing campaigns featuring young models. These ads sell more clothing to teens but in the process are also selling adult sexuality and the thin look.

Everywhere women go they are bombarded by the media’s idea of the perfect body. This unrealistic stereotype is portrayed in music videos, movies, magazines, and on television. They kept banging out the same message, to teen girls especially, that they are not thin enough, or pretty enough. Millions of dollars each year are spent on diet regimes, supplements and exercise equipment. These are purchases made mainly by healthy girls who are plagued with feelings of inferiority.

Messages that imply that young girls are not good enough the way they are, and that they have to have the product being sold to fit in, can cause various eating disorders, suicide and drug use in young girls and women. That is because they then feel that they struggle to measure up to that image.

Louise* is one young woman that understands the effects of advertising and the constant portrayal of the ‘perfect’ image.

Diagnosed with anorexia at 18, she says it all started through not feeling beautiful enough, and then not thin enough. She truly believed that for her to be beautiful she had to be thinner. At only 55 Kilograms this was a danger to her already slender body, as she constantly refused to believe that she was thin.

“There are ads that tell you how you should dress and what you should look like and then they say ‘but we respect people for what they choose to be like.’ Okay, but which one do I do first?”

Louise says that almost every magazine she picked up had the ideal female body and face selling their product. They focused constantly on diets and other beauty enhancing products, and every time she read them she felt inferior.

“Reading articles on how to apply the perfect make-up and what to do to make myself look gorgeous made me wonder what was wrong with my hair, my body and my skin. I just felt abnormal and ugly.”

Vivian Hanson-Meehan, Founder of the National Association of Anorexia Nervosa and Other Associated Disorders says that advertisers make money off women’s insecurities without thinking of the consequences of it at all.

“Magazines reflect images of thinness and beauty, and link them to other symbols of happiness, love and success for women, and this can be a real danger. Unfortunately this advertising works because women and girls never feel that they are perfect, especially after they see the ‘perfect’ image for so long, and feel that in order to be beautiful, popular or fashionable they have to fit this image.”

She says that young women are tired of feeling second rate because they can’t match the ‘perfect’ image seen so often in the media, that to obtain the ultra thin look many young women restrict their food intake.  Sometimes they take drastic measures and in doing so disorders can develop, such as Anorexia Nervosa and Bulimia Nervosa.

“Anorexia Nervosa generally starts between 12-18 years, and is characterised by restrictive food intake, weight loss and excessive exercise. Up to one percent of adolescent girls develop it. Another eating disorder is Bulimia Nervosa, which is the binge/purge syndrome. It typically can develop between 16-20 years of age. Three percent of teenage girls develop this disorder.”

Hanson-Meehan concedes that it’s not just the media but also a young woman’s immediate surroundings such as her family and friends that can trigger Anorexia and Bulimia but believes that the media contributes to a large part of this.

She believes that the media and other prosaic sources, including the weight loss industry, have a responsibility to redefine the parameters of external beauty, and to represent every body type.

“Promoting healthy eating and self-acceptance is a much more positive and a constructive message to convey to the world rather than sexuality and thinness. We need to convey that external attractiveness is skin deep and that we should all look within our souls to discover our real true beauty.”

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