DRAFT of August 1, 2008
A Theory of TTM: Introduction
Here is a general theory of TTM. It comes in three parts. This is
the introduction; the three main parts follow it.
The first part describes in text and diagram how TTMers appear to be
unusually sensitive, in a way that resembles an allergy, to a certain
class of chemicals, the branched long chain fatty acids / alcohols /
aldehydes ("BLCFA3"). These can then lead to both a systemic
agitation ("Urge") in the brain and a topical irritation ("Itch") in
the skin and hair. This first part explains and diagrams how this
biochemical overreaction can be diminished or extinguished altogether
by avoiding its causes. The second part explains and diagrams how
Urge can be partially moderated systemically, by using internal
chemicals ("Drugs") and gross muscular movements ("Struggle") to help
fight against automatic pulling ("Stupor"). The third part explains
in text and diagrams how Itch can be partially moderated topically, by
using external chemicals ("Paints") and finer skin movements
("Fidget") to help fight against focused pulling ("Bites"). So, Urge
and Stupor, and Itch and Bites, can each be addressed in two ways,
biochemical and physical: Drugs and Struggle, Paints and Fidget. For
both Urge and Itch, the countermeasures are arranged in the order of
their effectiveness: avoidance of causes is best, followed by chemical
attack, with physical distractions least.
Fundamentally, this theory posits that TTM (and related skin picking)
is not a behavioral problem, but is rather a protective reaction which
is unfortunately overly exaggerated in TTMers. This scratch-like
response may have been designed to rid the body of local parasites,
and may be related to the observation that many pathogenic bacteria,
gram positive ones in particular, use BLCFA3 in their cell walls. The
TTMer's body appears to recognize and vigorously react to these
chemicals.
But unfortunately these chemicals can also be delivered to the brain
and skin as waxes, oils, and lecithins found in "waxy" foods, airborne
particles, and cosmetics. These BLCFA3 can either directly accumulate
on the body, or be released through digestion (hydrolysis), by
pancreatic enzymes in the gut or yeast enzymes in the skin. In short,
the theory claims that these BLCFA3 annoy the nerves of the brain and
the skin, triggering an Urge to rid the body of what may be an
incipient infection that also causes an Itch. This skin and hair
removal, however, is generally painless, since the same yeasts that
release BLCFA3 also produce chemicals that have an anesthetic quality;
in fact, many of these waxy substances in cosmetics, when tasted by
TTMers, announce themselves by numbing the tongue.
In summary, the theory claims that a TTMer has a genetic
predisposition to experience an unusual Urge (from structures deep in
the brain, possibly the basal ganglia) to remove an unusual Itch (from
pressure sensors in the skin, possibly Merkel cells), but the removal
is unusually painless (from quieted nociceptors in the skin, probably
mechanonociceptors).
DRAFT of August 1, 2008
A Theory of TTM: Urge and Itch
In general, there appear to be four ways to become exposed to these
"bad" BLCFA3 chemicals. The first is from "waxy" foods, which are
eaten. The second is from various lip cosmetics, which are both eaten
and absorbed into the skin. The third is from airborne pollutants of
plant and animal origin, whose waxes collect on the skin, particularly
the lashes and brows. The fourth is from face, hair, and skin care
products, which are absorbed. Many of these "bad" things have both
free BLCFA3, and also other BLCFA3 bound in waxes, oils, and
lecithins, from which they are released through enzymatic action. It
appears that the easiest way to control TTM is to avoid them outright.
This first of three parts identifies what to avoid.
Here is a diagram (best viewed with a fixed font), where the numbers
refer to commentary given below:
= = = =
"WAXY" LIPSTICKS LIPSTICKS DANDER FACE & HAIR
FOODS (1) & BALMS (2) & BALMS (2) & DUST & SKIN
| | | | | | & POLLEN PRODUCTS (4)
| | | | | | & SMOKE | |
| | | | | | & MOLD (3) | |
| | | | | | | | |
| eat | | eat | | apply | collect | apply |
| | | | | | | | |
| v v | | v v v |
| WAXES IN THE GUT | | WAXES IN/ON THE SKIN |
| | | | | |
| hydrolyzed|by | | hydrolyzed|by |
| pancreatic|enzymes | | micro-org |enzymes |
| | | | | |
v v v v v v
BLCFA3 ARE NOW IN THE GUT <-transport-> BLCFA3 ARE NOW IN THE SKIN
| by blood |
| circulate diffuse |
| |
v v
BLCFA3 IN DEEP BRAIN BLCFA3 IN MERKEL AND NOCICEPTORS
| |
| alter membranes local but painless trigger |
| |
v v
URGE ITCH
= = = =
Some general commentary:
- It is not possible to totally separate Urge from Itch. There are
transport proteins in the blood designed to pick up BLCFA3 and carry
them to different places in the body. This means that foods
eventually cause Itch, and cosmetics and airborne waxes eventually
cause Urge. However, the timing and the relative amounts of either
Urge or Itch does seem to depend on the pathway. In particular, most
"waxy" foods take about two days to have an effect, whereas the
fastest TTM response appears to be due to the direct application of
BLCFA3, within hours. In particular, lanolin has both waxes and
BLCFA3, and applying a product with lanolin in it to the hair seems to
trigger some of the fastest and fiercest TTM known.
- Unfortunately, since BLCFA3 are lipids, they can be stored in the
body in the usual form of triglycerides and phospholipids. So, like
any other lipids, it takes a long time to purge the body of these
chemicals. Also for this reason, fasting seems to intensify TTM,
since the body then retrieves lipids, including the BLCFA3, from its
stores.
- The diagram does not appear to have any place for Obsessive
Compulsive Disorder, which has sometimes been linked to TTM. However,
it has been reported by medical researchers that some OCD is
exacerbated after an exposure to strep bacteria. So perhaps both TTM
and OCD are exaggerated responses to certain bacterial chemicals,
although the chemicals that are involved in OCD would appear to be
separate. Some TTMers do have OCD. And, some parents have reported
"TTM by proxy", that is, children pulling out the hair of their
blankets, dolls, or pets. It could be that this latter form of TTM in
particular gets much of its impulse from a co-existing OCD, which
shows up as an urge to make every hairy object in the house nice and
tidy. A few adults have reported wanting to do this to other adults,
too; maybe this is the same phenomenon.
Here is more specific commentary on the pathways, and how to diminish
their effects, using the numbers in the diagram:
(1) "Waxy" foods
The foods to avoid are those that contain the BLCFA3, either in free
form already, or more commonly bound to other chemicals in the form of
waxes or other complex lipids like triglycerides or lecithins. The
amounts of these BLCFA3 may be increased further through an
association of the food with certain bacteria also rich in BLCFA3,
during either food development (the nitrogen-fixing bacteria of
legumes) or food processing (the fermentation bacteria used for cocoa,
coffee, and cola).
Primarily these "bad" foods are legumes such as peanuts, soy, and
beans, and their oils and margarines; egg yolks (from chickens fed a
soy-based diet); lecithin (derived from either soy or egg yolk or
both, commonly found in no-stick pan sprays); most nuts and seeds, but
particularly fermented seeds and their beverages, such as
cocoa/chocolate, coffee, cola; tuna (which is unusual among fish in
having BLCFA3 in its lipids); and the flours, kernels, brans, and
germs of whole grains, including popcorn. Hair roots themselves have
these chemicals and should not be eaten. Some foods combine some of
these undesirable ingredients and are therefore "bad" in multiple
ways, like mayonnaise, or peanut butter cups. Olive oil, or other
oils that are primarily unsaturated, are a good substitute for legume
oils.
A number of other foods are coated with waxes naturally and should
also be avoided altogether, like raisins and dates. Others have waxes
added to them for shipping and appearance, and should be peeled or
carefully washed before eating, or else avoided. These are fruits
like the drupes (nectarines, peaches, plums), and the pomes (apples,
pears), and vegetables like some gourds (cucumber, squashes), the
nightshades (bell peppers, eggplant, tomato), and many root vegetables
(parsnip, rutabaga, sweet potato, turnip, yucca). Some other fruits
and vegetables also have waxes added to them, but their peels are not
generally eaten, such as avocado, most citrus (grapefruit, lemon,
lime, orange, tangerine), some gourds (cantaloupe, honeydew, pumpkin),
and most "tropical" fruits (mango, papaya, passion fruit, pineapple);
however, orange marmalade, and lemon and lime slices in beverages
should be avoided. Very many gums and candies are coated in shiny
waxes as well. They can be "bad" in multiple ways, as many are
made with the waxes of chocolate or nuts already; peanut M&Ms and
chocolate-covered orange peel are two of the worst.
Two specific "foods" deserve special mention: sugar (sucrose; more
particularly, its glucose half), and caffeine. Experimentation with
pure sugar and pure caffeine has shown that they do not trigger
pulling by themselves. However, few people eat pure sugar or pure
caffeine; most regularly these are eaten already mixed with some
"waxy" food, fermented seed beverage, or candy. However, sugar does
has the effect of increasing and extending energy, and caffeine
increases wakefulness and alertness (as do nicotine and ADHD
medications), which can prolong any Urge, particularly at night. This
can result in a glucose- and caffeine-driven trance-like insomniac
state, during which the increased energy and alertness is spent in
marathon pulling. The glucose may also nourish the skin yeasts. For
this reason, foods containing sugar and caffeine should not be
consumed; any cheating should certainly not occur after mid-afternoon,
and probably should be limited to just breakfast only. One of the
very worst things a TTMer can do is to have something sugary and
caffeinated before bedtime. In general, unsweetened tea or
unsweetened decaffeinated coffee (the decaffeination process also
removes most waxes) is a reasonable substitute beverage. In general,
fructose seems to be a much less aggravating sugar that can be
substituted; it is usually available in the dietetic section of larger
supermarkets.
(2) Lipsticks and balms
Lipsticks, lip balms, and lip glosses are a particular problem for
TTMers, in that they are both ingested from the lips and absorbed
through the thin lip skin. Nearly all are made from waxes, BLCFA3, or
both. Their use, together with other cosmetics, which can be nearly
continuous, may help explain why adult TTMers are predominately women
(but gender distribution is more balanced for children), why TTM often
starts at age 12 (when makeup use often first occurs), and why TTM is
often worse in winter (due to heavy application of chapped lip
products). These cosmetics may also contribute to cheek biting and
lip skin picking, where ironically they are then often used to cover
the damage, creating a picking cycle. There have been some scattered
reports that waxed dental floss may also be in this same class of
eaten-and-absorbed cosmetics.
(3) Dander and dust, pollen, smoke, and mold
The skin of many pets and other animals are lubricated and protected
with waxes and other lipids, many of which contain BLCFA3. Dander
from dogs and cats that are kept and handled in close proximity,
particularly if they are slept with, can accumulate on the skin of the
hands, and on the lashes, brows, and other hair of the body. Whether
acquired directly from the animals, or indirectly through dust, these
should be avoided, and the face and hands washed after contact.
Similarly, many plant pollens contain waxes, which also collect on
facial hair; again, washing is helpful. Smoke and mold show up in
surveys as particular problems to lash and brow pullers. However,
"smoke" may be just cigarette smoking, where the nicotine can
contribute to Urge. The impact and significance of mold is not clear.
(4) Face, hair, and skin products
Most cosmetics for the face, hair, and skin contain waxes, BLCFA3, or
both. Eye treatments such as mascaras, liners, and pencils are
basically colored waxes, and most hair conditioners and skin lotions
are based on long chain fatty alcohols (generally listed in
ingredients as a "-yl alcohol", such as stearyl, isostearyl, cetyl,
cetostearyl, cetearyl); these usually contain BLCFA3 as byproducts of
their manufacture. Despite the demands of fashion, all products
containing these ingredients should be avoided; with some careful
shopping, some alternatives can be found. Lanolin is also common in
many of these products, and it is particularly rich in waxes and
BLCFA3. It is probably the most troublesome of the natural cosmetics.
Isostearyl alcohol and its relative, isostearic acid, are probably the
worst of the man-made ones. Unfortunately, they are sometimes used in
baby powders and baby sunscreens; they may be contributing factors to
"baby trich", and may explain why baby trich often remits as the child
ages.
Again, one of the cruel ironies of TTM is that many of the products
used to cover pulling and picking damage to the hair, lashes, brows,
and skin, also appear to cause further Urge and Itch. Aloe vera gel
is a reasonable substitute for hair conditioners, which otherwise
should be avoided. The best shampoos are those that are antidandruff
or antifungal, as they help control skin yeasts, including those near
the eyes.
Three final cultural notes on cosmetics: First, until the mid-1960s,
many American men's hair products were lanolin-based, giving a shiny
look to the hair. Perhaps the move away from the "greasy kid stuff"
has further contributed to the male-female imbalance in TTMers.
Second, the "vacation effect", in which TTM tends to lessen when the
TTMer is away from work or school, may be due in part to a relaxation
in cosmetic use then. Third, stick deodorants (but not necessarily
stick antiperspirants) generally are an exception to the waxy
cosmetics rule, as they usually are based on propylene glycol, which
turns out to be a yeast suppressant, and is therefore actually
beneficial. This adds a further irony to TTM: despite what would be
the often positive cultural advantage of having hairless armpits, few
TTMers focus their pulling on their underarm hair, quite possibly due
to this chemical.
DRAFT of August 1, 2008
A Theory of TTM: Drugs and Struggle
TTM is one of several gross physical activities that can help to
counteract the unpleasant feelings of a strong internal agitation, or
Urge, caused by the action of BLCFA3 on the brain. ("Agitation" is a
medical term meaning "restlessness", and it can be one of the signs of
an infection.) This Urge tends to lead to automatic pulling, and the
trance-like state of Stupor.
TTM is therefore helpful as a distracting means of discharging this
agitation, particularly at those times when the combined causes of
internal agitation go up, or when all other helpful distracting
physical activities go down. TTM is more likely, then, during times
of stress (agitation increases) or during times of physical calm
(distraction decreases); in both cases, it provides an an added
physical stimulation to help re-establish a balance between agitation
and whole body activity.
So, although one can reduce TTM either by avoiding circumstances that
promote agitation, or by increasing other physical activities, the
first choice is often unavailable due to the psychological impact of
work and the vicissitudes of chance, and the second choice is often
restricted by the work or home environment. Instead, agitation can be
more directly addressed with a variety of ingested substances. That
is, biochemical systemic Drugs are more effective than physical
musculature Struggle, although neither is as useful as avoidance of
"bad" causes. And, because most of these Drugs appear to work through
some form of sedation, they affect the ability to face the world in an
clear and responsive state of mind, and are therefore best left for
use at bedtime: another reason for favoring avoidance over
tranquilization.
Here is a diagram (best viewed with a fixed font), where the numbers
refer to commentary given below:
= = = =
BIOCHEMICAL: SYSTEMIC PHYSICAL: MUSCULATURE
"bad" foods confinement
"bad" lip cosmetics sedentary acts: phone, drive, TV
sugar: glucose contemplative acts: read, study
stimulants: caffeine, nicotine, sleep-time
medications for ADHD boredom
anxiety/stress
frustration/indecision/tension
Pre-Menstrual Syndrome
^ ^
| |
URGE (1) STUPOR (3)
balanced by balanced by
DRUGS (2) STRUGGLE (4)
| |
v v
"good" foods for vicinal diols: physical exercise
tannins, alpha-hydroxy acids whole body competing responses:
(fruit acids, lactic acid), pacing, stretching
unsaturated fatty acids automatic TTM/picking
"good" supplements of vicinal diols
sedatives: anti-histamines, alcohol,
heavy SSRIs, augmentation drugs
= = = =
Some general commentary:
- It is not possible to totally separate Urge from Stupor; they
typically lead to each other.
- One of the biggest problems with TTM is that nearly all the
sedentary or contemplative activities listed above as Stupor are
unavoidable. Driving, phoning, reading, and studying are all part of
a day's work for most people. And even if one has a very active
physical job, at the end of the day one still has to sleep. This
means that it is unrealistic to address any agitation-activity
mismatch within these circumstances by using Struggle, since it is
often impossible to use whole body physical exercise while working or
trying to fall asleep. Or, in short, the Struggle side of the
mismatch seems to be the one that is the more difficult to use
consistently; Drugs are a much easier way to combat Urge once Urge
starts.
Here is more specific commentary on dealing with Urge, using the
numbers in the diagram:
(1) Urge
The systemic agitation of Urge appears to be triggered by "bad" foods
and "bad" lip cosmetics, which can take up to two full days to make
their effects known, due to the delays in the pathways of digesting
and transporting them to the brain. However, these effects, which
tend to lead to "automatic" Stupor pulling, can be prolonged and
exaggerated by other biochemicals, such as the glucose found in
ordinary sugar, or stimulant "foods" such as caffeine, nicotine, or
the medications taken for ADHD. Disturbing psychological events can
also increase Urge, such as generic "stress" or anxiety, or other
"negative affect" experiences such as frustration, indecision, or
tension. Research has also shown that Pre-Menstrual Syndrome can
increase Urge. These additional intensifiers are often difficult to
avoid, which places an even higher value on the avoidance of "bad"
substances.
(2) Drugs
Although avoidance of "bad" things is the most effective way of
preventing Urge, certain "good" foods, supplements, and outright drugs
can help moderate their effects somewhat. These "good" things fall
into two categories: a certain family of chemicals called vicinal
diols, and a more general group of sedatives.
The first group of Drugs, characterized by a chemistry of vicinal
diols (two or more adjacent carbons each with a hydroxyl group),
appears to interrupt the conversion of waxes into free BLCFA3,
probably at the step of hydrolysis of these waxes by pancreatic
enzymes. There are a lot of these, which is fortunate, because most
of them take about three hours to work, and then they last only until
about eight hours from ingestion. This means some member of this
family has to be taken several times a day. Additionally, their
signature effect is that they tend to be tranquilizing, which is
sometimes not desirable. This mild sedative effect always appears to
be in direct proportion to the amount ingested, although some are more
potent sedatives than others. However, both the lengthy delay and the
tranquilization can be inconvenient: yet another argument for avoiding
"bad" substances directly.
The vicinal diol family of "good" chemicals can be found in both foods
and in supplements. Taken in foods, there are three major varieties:
the tannins, the AHAs, and the UFAs. The first variety, the tannins,
recognized by their mouth puckering action, are found in (unsweetened)
tea and in dry red wine. The second variety, the AHAs, alpha hydroxyl
acids, are also sometimes called fruit acids, although they are not
just in fruit. Most acidic fruits, like apples, pineapples, kiwi, and
the citrus fruits have one or more of these acids. However these
fruits should not be eaten with their waxy peels, which is why grapes
are not recommended, even though they contain one of the most
effective AHAs, tartaric acid. Another AHA is lactic acid, found as a
result of fermentation in cottage cheese, unsweetened yogurt and
kefir, sour cream, buttermilk, sauerkraut, kimchi, or hard sausages.
The third variety, the UFAs, unsaturated fatty acids, do not actually
contain vicinal diols immediately, but can be converted into them by
the body's enzymatic epoxidation and hydration. These include the
"fish oils" EPA and DHA, various refined special seed oils like borage
oil that contain GLA and its relatives, and those cooking oils
consisting principally of unsaturated fatty acids such as olive oil.
Vicinal diols can also be taken in supplements: choline bitartrate,
vitamin C, and even cream of tartar. Two additional supplements in
this family have had some current or past advocates: inositol and the
gluconates. The second of these two was mistakenly called
"potassium"; experimentation with potassium salts other than potassium
gluconate shows no benefit. However, potassium gluconate is probably
not the most satisfying of the many gluconates to take; magnesium is
probably the best and is sold as "chelated magnesium". These
supplements all have differing potencies and side effects, principally
gastrointestinal, so caution is advised.
The second group of Drugs, a more generic collection, appears to fight
Urge by straightforward brute force sedation, although sometimes this
is not their intended effect. Among the most effective, cheapest, and
most readily available are the over-the-counter first generation
antihistamines such as diphenhydramine (Benadryl) or chlorpheniramine
(Chlor-Trimeton), which are also marketed as sleeping aids (Sominex).
Standard alcohol works, too, although its side effects are well known.
Other powerful prescription drugs taken in heavy doses often cause
sedation. Among these are the SSRIs, which may explain why their
dosages often must be continually increased as the body adapts, and
why the maximal dosages of these antidepressants often end up being
used for TTM. Similarly, the augmentation of SSRIs with
antipsychotics may also depend on the sedating side effects of the
latters' off-label use. In general, this second group of Drugs can
not be recommended for continuous use.
Three final comments on "good" foods: First, some foods combine some
of these desirable ingredients and are therefore "good" in multiple
ways, like (unsweetened) pineapple cottage cheese or (unsweetened)
fruit yogurt (both have malic and citric acids, plus lactic acid), or
dry red wine (which has tannins, plus tartaric and lactic acids).
Likewise for the generally available combination supplement of
inositol and choline bitartrate. Second, foods or beverages sweetened
with pure fructose (which is different from high fructose corn syrup)
generally are less aggravating. Homemade lemonade made from lemon
juice and fructose, or especially a fake non-alcoholic wine made from
cream of tartar and fructose, have been found to be a satisfying way
to ingest AHAs, although overindulgence in any of the AHAs can lead to
an acid stomach. Third, it is reassuring to observe that one of the
most helpful foods, yogurt, is produced by bacteria that do not seem
to generate any BLCFA3 of their own. That is, they really are "good"
bacteria, despite the fact that at least one of them is even in the
streptococcus genus. Nevertheless, it is not clear whether taking
probiotics is positively helpful to TTMers.
(3) Stupor
Generally, this happens when exercise is not possible due to some sort
of confinement, and it can be prolonged with various energizers, some
of which are deliberately used for related but non-TTM purposes (for
example, coffee or energy drinks to extend studying). Sedentary
activities such as phoning, driving, or TV watching, and contemplative
activities such as reading or studying, enable such "automatic"
pulling, particularly if these activities are unavoidable. TTMers are
well aware that preparing for sleep is a particularly dangerous time,
as it combines confinement with another Stupor inducer, boredom.
(4) Struggle
Activities that involve whole body physical movements include aerobic
exercises, and large scale competing responses, such as pacing while
phoning, or stretching while driving, reading, or studying. (There is
little good to say about TV watching!) Because these activities
appear to bring about systemic biochemical changes, they do not act
instantly, but on the other hand their effects can persist for some
time afterward. TTM and skin picking, which can often involve the
full body when pulling or picking from areas below the neck, can be
seen as a last resort (or, for TTMers, a first response) that involves
musculature movement.
DRAFT of August 1, 2008
A Theory of TTM: Paints and Fidget
TTM also consists of hand and arm activities that are directed to
local skin and hair irritation, or Itch, caused by the action of
BLCFA3 in the skin. This Itch tends to lead to focused pulling, and
sometimes to an unusual sensation some pullers have referred to as
Bites.
TTM is therefore helpful as a deliberate means of addressing the local
causes of irritation, the "fat root", the "one specific hair", or the
"crusty scab" which TTMers and skin pickers seek. More generally, it
also is a means of providing a general counterirritant to the affected
skin area, particularly at those times when local and environmental
irritants go up (especially for lash and brow pullers who appear very
sensitive to airborne allergens), or when fine motor activities go
down (especially when using modern devices: car, phone, computer
mouse, TV remote). TTM is more likely, then, during times of
allergy-like reactions (irritation increases) or during times when the
hands are employed elsewhere (counterirritation decreases); in both
cases, it provides an added physical stimulation to help re-establish
a balance between irritation and skin-targeted activity.
So, although one can reduce TTM either by avoiding circumstances that
promote irritation, or by increasing other fine motor activities, the
first choice is sometimes unavailable due to the demands of cosmetic
fashion or workplace air quality, and the second choice is often
restricted by the necessity for concentrated mental activity.
Instead, irritation can be more directly addressed with a variety of
applied substances. That is, biochemical Paints are more effective
than physical skin Fidget, although neither is as useful as avoidance
of "bad" causes. And, because most of these Paints have limited
impact and work for only short durations at a time, they are often
impractical to keep re-applying, and are best left for use in at-home
emergencies: another reason for favoring avoidance over
counterirritation.
Here is a diagram (best viewed with a fixed font), where the numbers
refer to commentary given below:
= = = =
BIOCHEMICAL: TOPICAL PHYSICAL: SKIN
"bad" cosmetics oily skin and hair
airborne waxes hot humid air
depression tight itchy clothing or wigs
anger wearing cosmetics to bed
hands in use: reading, writing,
surfing, driving
^ ^
| |
ITCH (1) BITES (3)
balanced by balanced by
PAINTS (2) FIDGET (4)
| |
v v
hot sudsy showers, spot treatments, ice
shaving pain: rubber band snaps,
antimicrobial shampoos, soaps, pulsation sticks
cleansers, creams competing responses of the hand
other antimicrobials: chlorine, sun hand and finger toys
counterirritants: terpenes, ginger focused TTM/picking
extreme hair: bleach, perm, relax
= = = =
Some general commentary:
- Itch is usually felt as simply a local sensation demanding some
physical attention, but in the extreme it sometimes manifests itself
in a strange phenomenon, Bites. These are sharp, small, localized
pains without any apparent physical cause, seemingly occurring within
the skin itself near a hair follicle. They tend to occur most often
during hot weather, and may be related to a skin yeast.
- It is not possible to totally separate Itch from Bites; they
typically lead to each other.
- A big problem with TTM is that Fidget does not work very well unless
it is used nearly continuously, and is therefore socially unattractive
except at home. This means that it is unrealistic to address any
irritation-activity mismatch within these circumstances by using
Fidget since it is often impossible to use these distractors while
otherwise socially engaged. Or, in short, the Fidget side of the
mismatch seems to be the one that is the more difficult to use
consistently; Paints are a much easier way to combat Itch once Itch
starts.
Here is more specific commentary on dealing with Itch,
using the numbers in the diagram:
(1) Itch
The local irritation of Itch appears to be triggered by the action of
BLCFA3 on the nerves of the skin and hair follicles, which often can
be felt nearly immediately if BLCFA3 are directly applied, or up to
two days later if they result from the digestion of waxes. These
BLCFA3 can be deposited directly through cosmetics containing them,
through blood transport of digested food waxes, or indirectly through
the digestion in the skin of deliberately applied or inadvertently
collected waxes; this skin digestion appears to be by the enzymes of
skin micro-organisms, most probably and most commonly by Malassezia
yeasts. These effects tend to lead to "focused" Bites pulling. The
principal sources of BLCFA3 in and on the skin are waxy cosmetics,
namely conditioners, hand and body lotions, and lip products; and eye
products that contain waxes, "-yl alcohols", lanolin, and sometimes
lecithin.
A more subtle source are airborne allergens containing waxes,
principally animal dander, pollen, and dust; these mostly affect
lashes and brows, where they collect. Disturbing psychological events
can also increase Itch, particularly the "negative affect" experiences
of depression and anger. These additional intensifiers are often
difficult to avoid, which places an even higher value on the avoidance
of "bad" substances.
(2) Paints
Although avoidance of "bad" things is the most effective way of
preventing Itch, certain "good" surface chemicals can help moderate
their effects somewhat. Because these chemicals are applied
externally and tend not to be absorbed, they work very quickly, but
they last for only short periods of time. These "good" things fall
into several categories: simple soaps and solvents for removing BLCFA3
and waxes; antimicrobial shampoos, soaps, cleansers, creams, and other
antimicrobial means for killing off skin micro-organisms that
hydrolyze waxes into BLCFA3; various short-term counterirritants to
overwhelm Itch with other chemically induced sensations; and extreme
sterilizing hair care measures.
The first group of Paints should probably be called paint removers
instead, as they fight Itch by washing away BLCFA3. Probably the most
helpful is to take long hot sudsy showers to clean the skin and hair
all over; this has the added benefit that the heat helps liquefy the
BLCFA3 and move them up out of the follicles. A number of TTMers have
found that showering twice a day, in the morning and immediately after
work, to be most effective.
Similarly, hands should washed before touching the hair or the eye
area, especially after close contact with pets, and the face should be
washed after any unavoidable pet nuzzling. Of less value but useful
as a quick removal treatment for "hot spots", Itch can be temporarily
soothed by removing some of the BLCFA3 by washing the area with 91%
isopropyl alcohol (or, better, with propylene glycol, which has
vicinal diols), followed by an application of any number of other
short term counterirritants or itch relievers listed below, with the
antimicrobial aloe vera gel probably being the best.
The most thorough way to remove surface BLCFA3, but often impractical
on the scalp, is to shave the skin. This combines the benefits of
local heat, antiseptic soap, and surface removal through deep
scraping. Additionally, on the scalp it has a continued benefit: a
bald head does not continue to use conditioners. One should be
careful, though, since some shaving soaps themselves contain waxes and
BLCFA3 (isostearic acid in particular), as do some after-shave lotions
(lanolin in particular).
The second group of Paints diminishes Itch over time by attacking skin
micro-organisms, primarily Malassezia skin yeasts, that convert waxes
into BLCFA3. Anti-dandruff shampoos appear to have the greatest and
longest effect: those with ketoconazole (Nizoral), selenium sulfide
(Selsun Blue), or zinc pyrithione (Zincon, Head & Shoulders). Other
shampoo ingredients with antifungal properties, such as ethoxy
diglycol, cocamidopropyl betaine, or iodopropynyl butylcarbamate are
also helpful, but these sometime ingredients of standard non-medicated
shampoos seem to change frequently, so no brands can be recommended.
For the hands, an antimicrobial soap such as Cuticura, or ZNP, or
possibly any pure castile soap have been reported to be useful. For
the brows, lashes, and lids, there are good antimicrobial cleansers
like Ocusoft Plus or Sterilid, although their carrier detergent can
leak through the eyes into the gut, causing a pronounced laxative
effect, so caution is advised. For the same reason, baby shampoo,
which has the same detergent carrier and is not antimicrobial anyway,
is not recommended for eyelid cleansing.
For persistent hot spots, the twice daily application of antifungal
creams like miconazole nitrate (Micatin, Monistat) often helps; in a
pinch similar application of a triple antibiotic (Neosporin) often
helps, too. A good, cheap, homemade antifungal wash can be made from
2% boric acid with 2% acetic acid (essentially, eyewash and weak
vinegar); veterinarians use it for Malassezia infections. A few other
antimicrobials, which are not actually "applied", have been reported
by TTMers to be helpful: the chlorine (bleach, really) in swimming
pools, the salts in sea water, and the UV rays of sunshine. These
make a day at the pool or the ocean beneficial, particularly without a
bathing cap.
The third group of Paints gives quick, but short-lasting, relief to
Itch. It consists of counterirritants, chemicals that create a
stronger different sensation in the sensory nerves of the skin.
Principal among these are the terpenes, a chemical family that is
generally antimicrobial, that contributes the pungency to spices such
as mint, clove, wintergreen, and thyme, and that temporarily fools the
cold receptors. There are many commercial preparations containing
them: Sea Breeze Sensitive Skin, Listerine, Vick's Vap-o-Rub, Band-Aid
Anti-Itch Gel (which contains camphor, the very first medication
attempted to stop TTM, applied by Hallopeau himself to a TTMer in
1894!), and preparations made with tea tree oil or lavender oil or
chamomile oil.
For those who can stand it, another chemical family is also
antimicrobial, but fools the heat receptors instead, and is based on
the capsaisins in chili peppers. These are found in commercial
preparations like Zostrix. However, a much friendlier chemical
relative to these, gingerol, is more useful, and is very easily
available by simply cutting into a piece of ginger to release some
juice to rub directly; TTMers have found that it is even mild enough
to apply to the brows and lashes. Still other antimicrobial
counterirritants with no clear mechanism of action include witch hazel
(but its real extract is hard to find), and the very useful and
pleasant aloe vera gel.
The final group of Paints are weapons of mass destruction against
micro-organisms, to be used against scalp Itch only in emergency.
Bleaching, coloring, perming, or relaxing the hair subjects the skin
to prolonged and intense chemical bombardment, rendering it nearly
sterile, an effect that lasts days or weeks before the micro-organisms
can recover. It is more likely this biochemical action, rather than
the commonly voiced "decision to stop pulling" after a visit to the
salon (in order to keep from destroying the hairdresser's effects),
that accounts for many TTMers' observations of their effectiveness. A
less extreme form of these antiseptics treats local hot spots with
benzoyl peroxide, which is effective but also bleaches.
Some final comments on Paints: Generally, since Itch is neither an
inflammation nor a pain, neither anti-inflammatory topicals such as
hydrocortisone nor local anesthetics such as benzocaine seem to do
very much good. Some TTMers report that eating antifungal foods such
as onions, garlic, or ginger, or drinking ginger tea, has an effect on
Itch too, although the effect seems to be in the skin rather than the
gut. There also have been scattered reports that mustard family
vegetables work similarly. There is some evidence that the common
skin mite, demodex, serves as a vector transporting micro-organisms
from one hair follicle to another, so it may be that the application
of acaricides such as permethrin (Nix, Rid) can slow down the spread
of hot spots. Some topical biochemicals combine some of these
desirable ingredients and are therefore "good" in multiple ways, like
antimicrobial shampoos (they remove and disinfect), or terpenes (they
cool and disinfect).
(3) Bites
Generally, this happens when the skin is additionally irritated by its
immediate environment, primarily when the skin and hair need to be
washed and BLCFA3 have built up; TTMers are well aware that pulling
increases with an increasing feeling of "oiliness". However, hot
humid air exaggerates these topical irritations, as does constricting
clothing, or itchy clothing (particularly wool, which may carry
residual lanolin), or hot wigs. Cosmetics left on the face for
extended periods also contribute, particularly if they have not been
removed before bedtime. Extended one-handed activities such as
writing, mousing, or cell phoning enable such "focused" pulling,
particularly if they are unavoidable. TTMers are well aware that
preparing for sleep is a particularly dangerous time, as it allows
added awareness of skin and hair condition.
(4) Fidget
Activities that involve the physical counterirritation of the skin and
hair include: a sharp numbing change of temperature by applying ice;
the deliberate infliction of local pain by wrist rubber band snaps or
electrical "pulsation sticks" (quartz crystal ignition devices for
sparking gas backyard barbecues, modified with hand grips); various
learned competing responses for hands such as fist clenching; and the
use of fiddle toys for the hands and fingers. Because these
activities do not appear to work through systemic biochemical changes,
they can act nearly instantly, but on the other hand, their effects
only persist for short periods of time. TTM and skin picking, which
are primarily hand and finger activities, can been seen as a last
resort (or, for TTMers, a first response) that involves fine motor
movement.