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T H E H A I R- P U L L I N G P R O B L E M Beware as long as you live, of judging people by appearances — Jean de la Fontaine The Hair-Pulling Problem A Complete Guide to Trichotillomania FRED PENZEL, PH.D. 2003 Also by Fred Penzel Obsessive-Compulsive Disorders: A Complete Guide To Getting Well And Staying Well Oxford New York Auckland Bangkok Buenos Aires Cape Town Chennai Dar es Salaam Delhi Hong Kong Istanbul Karachi Kolkata Kuala Lumpur Madrid Melbourne Mexico City Mumbai Nairobi São Paulo Shanghai Taipei Tokyo Toronto Copyright © 2003 by Fred Penzel Published by Oxford University Press, Inc. 198 Madison Avenue, New York, New York 10016 www.oup.com Oxford is a registered trademark of Oxford University Press All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Oxford University Press. Library of Congress Cataloging-in-Publication Data Penzel, Fred. The hair-pulling problem : a complete guide to trichotillomania / Fred Penzel. p. cm. Includes index. ISBN 0-19-514942-4 (cloth : alk. paper) 1. Compulsive hair pulling. I. title. RC569.5 .H34 P466 2003 616.85'84—dc21 2002012721 135798642 Printed in the United States of America on acid-free paper This book is dedicated to all those brave and beautiful people who also happen to pull their hair. This page intentionally left blank Acknowledgements A fter writing all the acknowledgements for my last book, I thought I had managed to thank just about everyone I knew, but it seems that I have gone and collected a whole new group. Before I get around to them, let me thank the host of people who are becoming regulars. My greatest thanks would be to my wife, Dr. Wendy Penzel, now my professional colleague, who has never failed to give of her wise advice, moral support, and time. I must admit that without her help, these books would simply never have happened. Next, I would like to thank my son Joe, who has taught me more about being a person, a father, and a psychologist than any other teacher I have ever encountered. He is a pure human being in the best sense of the word, and has always generously given of his time with me so that I could help others. He has also, without realizing it, helped me to have a clearer view of the complexities of the subject of this book. He is the best person I know. I must also thank Christina Pearson, founder of the Trichotillomania Learning Center, who happens to be one of the wisest, most inspiring, and most compassionate people it has ever been my pleasure to meet. I have probably learned more about the realities of Trichotillomania from simply being around her and listening, than through any other teacher or experience I have encountered. Also, she is a friend. I would certainly be remiss if I did not thank my colleague, Dr. Charles Mansueto, of Silver Springs, Maryland. On a professional level, he has probably been one of my greatest influences and his thinking on the subject of hair pulling has very strongly shaped my own. I should add that in addition to being extremely knowledgeable and producing sharp, and intriguing insights, Dr. Mansueto happens to be one of the best natured, most humorous, and caring psychologists one could ever hope to meet. I count him as a friend. I must also extend my appreciation to Ruth Golumb and Sherri Vavrichek, therapist colleagues of Dr. Mansueto’s, whose excellent self-help book for kids and views about hair pulling have also been real influences on my work. Of course, I could not forget my editor and agent, Barbara Bergstrom, who has polished my writing, valued my work, and placed it in an appropriate setting. She guides me through the maze that is book pu