VOLUME 4 | ISSUE 53 Spring 2009A T L C P U B L I C A T I O N

touchina publication of the trichotillomania learning center

volume 4 | issue 55fall 2009

ForewordRecently, TLC reported via email on the pub-lication of Dr. Jon Grant's study, published in the July issue of the Archives of General Psychiatry, on the effectiveness of N-Acetyl Cysteine (NAC) as a pharmacological treat-ment for trichotillomania, skin picking and nail biting. In his report, Dr. Grant wrote that 56% of the subjects experienced a significant reduction in symptoms of these behaviors.

These findings are exciting for a number of reasons. There is now another readily avail-able tool for treating trichotillomania, skin picking and nail biting. Pharmacology stud-ies for trich and related behaviors are rare, and the results of this study are so promis-ing, it will likely lead to more research in the field. Ideally, larger and more complex studies that test a greater sample of patients for a longer duration will be funded. (Note: in the last issue of In Touch, TLC reported on the funding of a double-blind, placebo-controlled trial of NAC for childhood trichotillomania through TLC's donor-funded Research Grant Program).

This research is also noteworthy because it is one of the first studies of compulsive behaviors to examine the role of glutamate (a chemical that triggers excitement) rather than serotonin, a naturally occurring chemi-cal most commonly linked to compulsive behavior.

What is N-Acetylcysteine?N-Acetylcysteine is an amino acid which can be found at nutrition and health food stores. This supplement affects levels of glutamate in a specific area of the brain, making it eas-ier for patients decrease unwanted behavior.

For that reason, Dr. Grant believes glutamate modulators such as N-Acetylcysteine may be applicable to other disorders, addictions, and compulsive behaviors.

Will it work for me?The study showed that NAC significantly reduced the symptoms of trichotillomania compared to a placebo. 56% of subjects re-ported “much or very much improved” on NAC compared to 16% on placebo (sugar pill or inert substance). Significant improve-ment was initially noted after 9 weeks of treatment.

"This study, the first to our knowledge that examines the efficacy of a glutamatergic agent in the treatment of trichotillomania, found that N-acetylcysteine demonstrated statistically significant reductions in tricho-tillomania symptoms," wrote Dr. Grant. It is important to note that 44% of the partici-pants in this study failed to respond to the amino acid, and that this was a relatively small study.

Inside this issue:

- Workshops & Trainings

- '09 Hands-Down-a-T hon

- Program Updates

- Research Participation

and more...

N-acetylcysteine for Trichotillomania, Skin Picking, and Nail Biting Jon E. Grant, MD, JD, MPHUniversity of Minnesota, Department of PsychiatryTLC Scientific Advisory Board MemberForeword by TLC Staff

504 Plans and IEPs:How Can They Help My Child?Jane Bodine, LCPCNaperville, IL

Editor's Note: Many parents of kids with trich and skin picking notice an increase in these behaviors in the Fall, right when school picks up again. However, not many parents are aware that there are programs in place to help your child cope with the additional stressors of school. Navigating this system can be difficult, and Jane Bodine, LCPC, has outlined the various programs in the follow-ing article. After reading, turn to page 10 for a mother's personal account of how these programs helped her child.

As a former educator of preschool through ninth grade, and an Educational Advocate/Consultant and Licensed Clini-cal Professional Counselor, I can emphati-cally assert both 504 and IEP plans have been essential in most of the hundreds of cases I have had the good fortune to treat.

I will give a brief description, not legalese. I will not speak as a special education representative, but rather as a therapist having advocated for hundreds of chil-dren, adolescents and adults over some twenty-three years of counseling.

A 504 plan is a state-mandated option for children who are experiencing dif-ficulty socially, emotionally or behavior-ally in a manner that interferes with their academic environment and learning. (Ed. Note: The "504" in "504 plan" refers to Section 504 of the Rehabilitation Act and the Ameri-cans with Disabilities Act, which specifies

Continued on page 12

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InTouch is the quarterly publication of the Trichotillomania Learning Center, Inc.

To submit articles or send letters write to:Trichotillomania Learning Center207 McPherson Street, Suite HSanta Cruz, California 95060(831) 457-1004www.trich.orginfo@trich.org Editor: Leslie Lee

copyright © October, 2009All Rights ReservedText deadline next issue: December 5, 2009

Please note that the information in this newsletter is not intended to provide treatment for Trichotillomania or Skin Picking. Appropriate treatment and advice should be obtained directly from a qualified and experienced doctor and/or mental health professional. The opinions expressed are those of the individual authors.

TLC Board of DirectorsJoanna Heitz, PresidentSue Price, SecretaryDeborah M. Kleinman, TreasurerNancy J. Keuthen, Ph.D., Scientific Advisory Board ChairDana Marie FloresDavid PerlmanNancy PerlmanErin Sheepo

StaffJennifer Raikes, Executive DirectorChristina S. Pearson, Founding DirectorAlice M. Kelly, Membership Services; Accounting ManagerLeslie Lee, Program CoordinatorDana Hickerson, Administrative Support

TLC is a 501(c)(3) tax-exempt organization and all con-tributions are tax-deductible. Our Tax ID number is: 77-0266587.

tool tool n. 1. an entity used to interface between two or more domains that facilitates more effective action of one domain upon the other.

2. anything used as a means of ac-complishing a task or purpose.

At TLC, we specialize in tools; Tools for coping, tools for be-havior modification, tools to “take the edge off ”, tools for suc-cess. Finding relief from pulling and picking is not a one-answer solution, it’s more about finding the right combination of “enti-ties” to interface between the body and the mind, to facilitate the “effective action” of relief. This issue of InTouch offers several examples of tools that can be used on the path of recovery.

Our cover story focuses on the recent development of a new “tool” that has garnered a lot of attention. Dr. Jon Grant shares the results of his research into the use of the amino acid N-Ace-tylcysteine as pharmacological treatment for trichotillomania. The results are promising, and Dr. Grant’s article goes a little bit further than the piece originally published in the July issue of Archives of General Psychiatry by discussing the use of NAC for children.

This month’s feature story, 504 Plans and IEPs: How Can They Help My Child? discusses two seldom-used and often misunder-stood tools for parents of trichsters: the Individual Education Plan (IEP) and 504 Plan. Both plans provide legally-backed assistance for kids who face challenges in school: from the mild, such as extended deadlines and shortened assignments, to more involved plans such as special classes and progress reporting measures. This has been a hot-topic of late on the TLC Parent’s Email Sup-port Group, and TLC members Jane Bodine, LCPC and Terry Garcia have provided a thorough overview of what these plans are and how they may help children in public schools.

TLC member and author Gary Hennerberg previews his story of coming out about trichotillomania, and shares with you his three approaches (tools) that changed the way trich affected his life. You can read more on page 4, and learn about his new book, Urges, available online. And the very inspiring Kiran, an-11 year-old, has created his own tools for promoting awareness. See what he’s come up with and learn how you can support him on page 6.

Finally, on pages 8 & 9, we've outlined the tools that YOU have provided to the rest of the TLC community. Many of you may not realize that it is through your membership support, donations and volunteer hours that TLC is able to accomplish as much as it does. These pages illustrate just how much your support “facili-tates effective action”.

That's all for '09! We'll see you next year... ~Leslie

From the EditorLeslie Lee

Founded in 1991, the Trichotillomania Learning Center is a nationally based nonprofit organization that works to improve the quality of life of children, adolescents and adults with Trichotillomania and related body-focused repetitive behaviors, such as skin picking, through information dissemination, education, out-reach, alliance building and support of research into the causes and treatment of these disorders.

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Upcoming Events & Announcements

Dallas, Texas Afternoon WorkshopPathways to Recovery: Cultivating Behavioral ChangeNovember 14, 20091:30-4:30pm

Join others in the Dallas/Fort Worth area for an educational ses-sion that is also a fundraiser for TLC! This is a volunteer-organized and run event. *Featuring:Mary Kathleen Norris, LPCJennifer McGarry, LPCSusannah West, Dallas Support Group CoordinatoratNorth Lake Community College5001 North MacArthur BoulevardIrving, TX 75038

Cost:$35: adults / $25: children under 16Pre-Registration is REQUIRED prior to November 11. (limited onsite registration may be available if space allows)Register online at www.trich.org or call 831-457-1004.

Information and questions:Contact Susannah at (214) 215-9745 or email dfwtrich@yahoo.com

*You can host events like this in your area! Contact TLC to learn how.

New York City One-Day WorkshopPathways to Recovery: Cultivating Behavioral Change Healing from Compulsive Hair pulling and Skin Picking

November 21, 2009 10:00am - 5:00pmSLC Conference Center

352 7th Street (at 30th) 16th FloorNew York Citywww.slccenters.com

facilitated byChristina PearsonFounding Director, Trichotillomania Learning CenterPre-registration: $105/personRegister online: www.trich.orgor register by phone :831-457-1004

Walk-in registration: $125/person(very limited space available, pre-registration is recommended).

November Support Group Leaders Support CallNovember 17, 20095:30pm PST / 8:30pm ESTTo join the call, dial: 1-218-486-1600 and enter PIN: 745954#.

TLC offers a monthly conference call with Christina Pearson, open to current leaders of peer support groups and individuals who are seeking to form a support group. The purpose of the call is to help new and existing groups grow and flourish by discuss-ing issues and problems that may arise, ideas for staying moti-vated and fresh, ways to increase attendance, and more.The call will take place at 5:30pm PST/8:30pm EST on the third Tuesday of each month, unless it falls on a major holiday. It is not a toll-free call, so you will incur normal evening rates.

2010 TLC ConferenceApril 23-25, 2010Dallas, TX

Block some time on your calendar for the 2010 Annual Confernce. TLC is bringins this 3-day event to Dallas, TX. Early Bird registration will be available later this year. (please note, date has changed).

TLC Brochures available OnlineNow you can order FREE TLC lit-erature directly from our website! Clinicians who'd like brochures for their patients and colleagues, or members working on awareness campaigns and recruitment can now order brochures directly from our site, just visit www.trich.org and click on "TLC Store" from the top of the page. Brochures are listed un-der the "Awareness" section, along

with some other great Awareness-spreading products like brace-lets and bumper stickers. Brochures are free, however a nominal shipping and handling charge is applied at checkout.

TLC is Looking for Kids Making a DifferenceTLC is working on a feature story that will highlight kids with tri-chotillomania or skin picking who are promoting awareness, edu-cating their community and/or fundraising for TLC. If you, or your child, is under 17 years old and working in any of these areas, we want to hear from you!

Contact Leslie at TLC: 831-457-1004 or leslie@trich.org. Thanks!

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I hid my hair pulling secret – that started at age 6 – for nearly 45 years.

As I child, I cried because I couldn’t stop pulling my hair. I prayed, yet that prayer wasn’t answered.

As a teen, I didn’t date, participate in physical activities, or do anything to risk being “outed.”

Sound familiar?

By the time I was a young adult, on my first job out of college, my hair pulling went from bad to worse. I panicked in my of-fice when I saw hair all over my desk and the floor around me. I realized that co-workers were probably seeing me pull clumps of hair every day, and they saw that my scalp had red blotches from the irritation of pulling. And who could miss my rather odd comb-over.

When I was just 21, less than 3 months on my first job, bought a hair replacement. I wore a hair replacement for over 28 years to cover up my weirdly bald head. And while there had to be people who realized I wore a hair piece, virtually no one knew that the reason I wore it was because I pulled my hair.

I was afraid of losing friends if anyone found out. I feared the whispers behind my back from co-workers and that my career would be at risk. I was convinced that my life, as pieced together as I could hold it together, would be ruined if anyone – anyone – discovered that I was a hair puller. Or God help me if they heard that the name of this disorder was called trichotillomania. Only crazy people have something with the word “mania” in it.

Hiding trich was tiring. Caring for my hair replacement was time-consuming. It held me back from things such as going for a walk with my wife on a windy day. Being with my daughters in the swimming pool as they grew up. Going to the gym (although later I would do these things wearing a ball cap).

Then one day I turned 50. I decided soon thereafter that wear-ing a hair replacement needed to come to an end. I was tired of the work required to hide my hair pulling urges. I was tired of spending a half hour soaking, washing, drying, and styling my hair replacement whenever I had an important meeting to go to. If my hair style didn’t look quite right, I’d do it over or obsess with it hoping I could make it look just right. Because of fussing with my hair, I was often late to meetings and would make an excuse about traffic.

I wanted my life back. Actually, I just wanted to live my life. I wasn’t getting it “back.” I never really completely had it after I started to pull my hair. Hair pulling was consuming me, and hiding it was consuming me even more.

A decision to shave my headWithin a few days after my 50th birthday in October of 2006, I made plans to shave my head. Sure, I could just go do it and as a man it would be completely natural to have a shaved head, wouldn’t it? Well no, not really. At least not to me.

I’d be going from a full head of hair (even if many recognized it as a hair replacement) to complete baldness overnight. Many would be shocked and ask why.

I was afraid of what my family would think. Would my business suffer? Would I lose friends? Would they all be scared of someone who – gasp! – had a wire completely loose and pulled his hair out? Would they think I was a mental case? That I should check myself into a center for the mentally ill? Would my life as I had known it completely change for the worse after shaving my head?

These were risks that I was willing to take.

I told my wife of my decision first. She had heard me talk of doing it over the years, but she was surprised when I told her that I had made up my mind and wasn’t going back. I made plans to shave my head on Feb. 1, 2007, giving me about three months to antici-pate it. Lots of planning went into this life-changing step.

I told my teenage daughters with apprehension. They never knew that I was a hair puller, and when they were small children, I swore them to secrecy that they would never tell anyone that I was bald. Before telling them about trich, a big fear of mine was that because of the possible genetic link of passing along this wretched disorder to my daughters, I didn’t want to introduce that idea with them. But they took the revelation in stride and thankfully they aren’t hair pullers.

I also sat down with a handful of family members and friends ahead of time to tell them my story. All were surprised. Some were saddened when they learned that I had hid this mysterious disorder for nearly 45 years and that I felt so alone.

After I shaved my head, those seeing me for the first time with a bald head were shocked. But I marched forward and told ex-tended family, friends and business associates my story and that trichotillomania wasn’t going to be a secret anymore.If I lost any friends – and I don’t think that I did – then they weren’t really friends.

Three Approaches that Changed My Outlook on Life with TrichotillomaniaBy Gary Hennerberg

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Reliving my childhoodThen I started writing a book, the story of my childhood with tri-chotillomania, with anecdotes of growing up on a farm straddling the Nebraska and Kansas border. Writing my story brought back memories, both positive and painful. In my book, I recount the incident in a farm field that prompted me to start pulling. How my faith in God is an important foundation in my life. And how being in 4-H allowed me to discover gifts and talents I didn’t know that I had.

Intermingled with my story are reflections and intimate personal thoughts and conclusions, all relating to my pain growing up as a hair puller.

I also have written about how I found love along the way. I share a turning point that has enabled me to feel liberated and as a result I now speak openly about having trichotillomania.

The book was written over a two and a half year period, often through tears. It has been a discovery process that has enabled me to realize that despite trich, I have been richly blessed in this life.

Three approaches that have changed my lifeAfter writing my book, and absorbing my own life’s story, I now recognize that there were three overarching approaches that have given me strength and enabled me to move on with my life.

1. Faith

My faith in God and how I was uniquely created has helped me carry on. I visualize my soul as a multi-faceted piece of fabric with threads, and weaves, and colors, and shapes, and frayed edges – all that symbolize the complex person that I was created to be.

I believe we’re all on this earth for a purpose. A few years ago, I started to wonder more and more about my purpose on this earth. I realized that one of a handful of reasons for my existence is to edu-cate the public about tri-chotillomania. Through being a public face, I can show the world that those of us who pull hair are normal people with

families, careers, feelings, hopes and dreams.

I dream of children and teenagers and their parents not feeling isolation or being demonized for having this disorder. It’s my hope that through the words in my book I can inspire hair pullers and others with compulsive disorders to embrace who they are.

2. Self-Acceptance

My second strategy to help me move on with my life has been my ability to accept who I am. Through my faith, I accept that trich is part of being a complex individual. No one can take trichotilloma-nia away from me. And I’m powerless to stop pulling my hair.

This doesn’t mean that I like trich. But having trich has profoundly formed the person who I am today. I like who I am. Once I ac-cepted that trich is one – just one – aspect of my complex fabric, I was able to look at the overall composition of who I am and know that my life isn’t defined by trich. While I don’t like trich, and never will, I would be a different human being today without it.

3. Using My Gifts and Talents

My third step has been to discover and use my God-given gifts and talents. Yes, I pull hair. But I have counter-balancing gifts: A loving family. Talents such as strong communication skills. I sing and perform with a championship choral group. I’m a person of integrity. Loyal. Always wanting good to prevail over bad. Those skills have served me well in my life and when put together are bigger than trichotillomania ever can, or will be.

Hope and inspiration for people with trichotillomaniaMy book is titled Urges, with the subtitle Hope and inspiration for people with trichotillomania and other mysterious compulsive disor-ders. Writing and publishing this book is part of what I consider to be my life’s purpose.

The book includes a touching Foreword by TLC’s Christina Pearson. You can read Christina’s Foreword, the first chapter, a chapter sum-mary, and testimonials from people in the trich community who have read “Urges” at www.Manage-Trich-Urges.com. In addition to my book, I have written and recorded a CD of inspirational mes-sages for people with trich called Doses of Comfort. “Urges” is also available at Amazon.com.

Whatever, and wherever, your journey may be with trich, it is my hope that my words will inspire you to accept yourself, and that you can learn to co-exist with trichotillomania.

Urges

Hope and inspiration for people with

trichotillomania and other mysterious compulsive disorders

Gary Hennerberg

“Urges,” is a new book of hope and inspiration for people with trichotillomania. In this book, Gary Hennerberg shares his childhood story, interspersed with his intimate thoughts and reflections, about life as a hair puller. He shares in his book three approaches he has used to help him accept and move forward with trichotillomania. “Urges” is available at both:www.Manage-Trich-Urges.com or www.Amazon.com.

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Hi, I’m Heidi, the proud mom of an 11 year-old son with trichotillomania. Less than two months ago, I’d never even heard of this disorder. For years I've known that something was different with Kiran, yet his pediatrician dismissed the pulling of his eyelashes and brows as nothing. After an internet search and a new doctor, I had a name for it and a place to go to get help. It’s been a whirlwind ever since!

One evening I was online purchasing homeschool T-shirts and decided to see if there were shirts for kids with TTM. There weren’t any. Disappointed, I casually asked my son, “Do you think we should make a T-shirt or is it not worth the bother?” After an enthusiastic, “Yes!” his brain went into overdrive. I’ll let him take the rest of our story from here.

Hi, I’m Kiran, here to continue where my mom left off. I thought there should be smilies for kids with trichotillomania on T-shirts to make them feel better about themselves, give them a smile, and let them know that somebody understands them. I asked my mom to go into Paint and draw a circle. Then I took over the rest, working really hard to make the smiley faces look natural. The words I used to surround the faces were inspired by my mom who always tries to make me feel good about myself. I thought they would work to make anyone smile.

My online shop is called Kiran’s Little Shop of Smiles and includes smiley, “I am More Than My Hair” t-shirts, stuffed animals, and other products for kids and adults. It can be found here: http://www.cafepress.com/kiranshopsmiles

I hope to raise at least $2,000 or more to help fund TLC’s research projects. I will also be writing to President Obama asking for $25,000 to fund at least one of these studies. Hopefully with all that money, TLC’s research will be years ahead of its cur-rent progress. And hopefully, my T-shirt smiles really will change a nation!

11 year-old opens Trich Awareness Store Online

Support Kiran's efforts: http://www.cafepress.com/kiranshopsmiles

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Patron Sponsorship: $10,000 (1 available) Internet Exposure:

Web presence on TLC site for 5 months • (average 30,000 visits per month) Online link from TLC site to sponsor site for 5 months •

Print Exposure:Full-page advertisement in conference mailing to 10,000+ nationwide •Name and logo in 1 edition of TLC’s quarterly newsletter, •

In Touch, to 2,000+ nationwide

Event Presence:Name and Logo printed in body of conference schedule, •

and half-page advertisement in conference scheduleExhibit space for the duration of the conference•2 complimentary registrations to the conference•Special thank you in Keynote Address during dinner•

Program Track Sponsor: $3,000 (6 available)

Each Program Track Sponsorship funds the sessions offered for a specific audience. These tracks include: Adult Treatment, Adult Personal Growth, Research, Parents, and Kids & Teens . The tracks run for the duration of the conference.

Internet Exposure:Web presence on TLC site for 3 months • (average 30,000 visits per month) Online link from TLC site to sponsor site for 3 months•

Print Exposure:Name and logo printed in the conference program (mailed to 10,000 •

nationwide) and schedule (distributed to all attendees)Name and logo in 1 edition of TLC’s quarterly newsletter, •

In Touch, to 2,000+ nationwideEvent Presence:

Sponsor supplied Banner/Signage displayed during all track sessions•

Kids’ Kick Back Corner: $2,500 each (2 available) The Kids’ Kick Back Corner is a “get-away” space for our younger attendees that offers staffed arts and crafts, video games and refreshments just for kids.

Internet Exposure:Web presence on TLC site for 2 months • (average 30,000 visits per month) Online link from TLC site to sponsor site for 2 months•

Print Exposure:Name and logo printed in body of conference schedule•Name and logo in 1 edition of TLC’s quarterly newsletter, •

In Touch, to 2,000+ nationwide

Event Presence:Sponsor Banner/Signage displayed in Kids’ Kick Back Corner•2 complimentary registrations to the conference•

Exhibitor: $500 Internet Exposure:

Web presence on TLC site for 1 month • (average 30,000 visits per month) Online link from TLC site to sponsor site for 1 month•

Print Exposure:Name printed in body of conference schedule•Name printed in 1 edition of TLC’s quarterly newsletter, •

In Touch, to 2,000+ nationwideEvent Presence:

Exhibit space (6ft. table) for the duration of the conference•One free registration to the conference. •

Literature Table $200 Display your brochures, coupons, or other literature on a display table at the TLC Book-store. Literature tables are fully accessible to any conference attendee. TLC Staff will make sure your literature remains stocked for the duration of the conference.

Event Presence:Display space up to 8 1/2 x 11inches on tables at the TLC Bookstore, •

centrally-located for the duration of the conference.

Advertising Opportunities TLC offers select members and service providers the opportunity to include an advertisement in this National Conference Catalog (mailed to 10,000 individuals throughout the country) and/or in the Event Schedule distributed to conference at-tendees. Rates are as follows:

Contact Leslie@trich.org for ad specifications

Custom Sponsorship Have another idea on how you or your business can participate? We’ll work with you to customize a sponsorship tailored to meet your needs and marketing objectives.

Voice your support for TLC and the TTM community, while promot-ing your services. Sign up for a conference sponsorship today: Contact Leslie Lee, at Leslie@trich.org or call 831-457-1004, x2.

2010 TLC Conference . April 23-25, 2010 . Dallas, TX

get involved. show you care. become a sponsor

The Trichotillomania Learning Center Annual Conference offers a comprehensive schedule of seminars by the world’s leading experts in this field, pro-viding education and inspiration to hundreds of sufferers of all ages, researchers and treatment professionals. Reach out to this vibrant community by becoming a Conference Sponsor today! Sponsorships are not limited to businesses; past sponsors have included support groups and individuals who simply want to show they care.

Get Involved. Show You Care. Become a Sponsor. Act now: opportunities are limited and the Conference Program print deadline is December 10, 2009.

Contact Leslie Lee at 831-457-1004 x2, or email leslie@trich.org for more information.

National Conference Catalog (full color included) Full page: $7501/2 page: $5001/4 page: $2501/8 page: $175

Submit by 12/10/2009

Event Schedule (black and white printing)Full page: $4001/2 page: $2501/4 page: $150 1/8 page: $50 Submit by 2/25/2010

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2009 in Review: TLC Members Make a Difference!

Education and Outreach

www.trich.org

TLC's main gateway of information was redesigned in late 2008, going live on Christmas Eve of last year. Since then, 175,000 people have discovered trich.org: and that's just the NEW visitors to the website! The website has seen nearly ONE MILLION page views in the past year.

TLC is currently entering the second phase of our web redesign. The staff and Web Committee has taken your feedback and cre-ated a wishlist of new features we'd like to add to the site later this year. Some of these features include interactive social networking tools, webinars and live chat sessions, as well as further content development and streamlined data processing.

Free Information Packets

TLC has always offered free information to anyone who requests it (last year we mailed over 1200 packets). With the launch of the new website, we added a Free Information Request Form, and number of requests increased exponentially! As a result of this huge increase in postage costs, workload for staff, and an orga-nizational goal to cut postal costs and paper usage, TLC went digital with our responses in June. Since then, an average of 400 packets per month have been emailed (that's 2000 emails sent since June). Each email comes with some a personalized re-sponse, and general information about trich and/or skin picking. In addition, we developed a "Getting Started" guide that helps newcomers understand how to access the information, support groups and online resources available on trich.org.

The phone is ringing off the hook; literally!

Since last October, 2150 people phoned TLC for information, help, or just to talk to someone who understands.

349 people attended the 17th Annual TLC Conference in Boston. During the height of the recession, a record number of attendees met other pullers and pickers for the first time, learned new coping skills and strategies, studied the latest research de-velopments, and realized they are NOT alone. The largest gather-ing of pullers, pickers, kids, parents, and professionals convenes in Dallas for 2010. Take advantage of the lower travel costs and book your tickets now; this conference is sure to be one of the largest ever.

110 people experienced a retreat at Pema Osel Ling. 2009 may be the last Pema Osel Ling retreat for a few years, as it is time to give East Coast attendees a break on travel expenses. A record number of retreatants flew out to California to experience the transformative environment of this retreat center. We've found what we hope will be an equally unique location for 2010, just outside of Baltimore, MD. The new location will accommodate many more people; in fact, we'd like to see twice as many, so keep an eye out for date and registration announcements.

TLC held a record number of workshops and fundraising events this year: seven so far, with two coming up in November. Christina Pearson led four of them, in Chicago, San Francisco, Bal-timore and New Jersey. We also held a meet-up in Charlotte, NC (which developed into the new Charlotte-Area Support group, which thankfully is now providing support to a very under-served area), and two fundraising events in Los Angeles. 356 people, total, attended these events.

What's even more impressive is that both the New Jersey work-shop and the pending Dallas workshop were organized by vol-unteers. TLC produced a PowerPoint presentation and accompa-nying handbook titled: "A Brief Overview of Trichotillomania," that enables anyone to give an informed and accurate presentation on trichotillomania. If you would like information o how to host a mini-workshop in your area, contact TLC at info@trich.org.

National Trichotillomania Awareness Week is currently underway, so we cannot report on final numbers at this time. However, we do know that, so far, 365 people have become "fans" of TLC on the social networking website, Facebook. And, the Hands-Down-a-Thon, which involves soliciting donations from friends and family, has 26 participants who have collectively raised $7000 so far!

Treatment and Recovery

28 treatment providers graduated from the 2009 Profes-sional Training Institute (PTI). The PTI, an annual training pro-gram facilitated by Charles Mansueto, PhD, Fred Penzel, PhD and Ruth Goldfinger Golomb, MEd, LCPC, provides training in current cognitive-behavioral treatment approaches for both trich and ski picking. This year's class had attendees from across the United States, and even South Korea!

Speaking of the PTI, TLC and the esteemed PTI faculty have

Take a moment to pat yourself on the back. Really! You deserve it. You have made an amazing difference in people's lives by supporting TLC with your membership and contributions. Here's a peak at the amazing things your support has accomplished in the past year:

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wrapped filming of a "virtual PTI." This new DVD-training module will allow treatment providers to take the PTI course independent-ly. Look for the release of this program in Spring 2010.

41 treatment providers joined TLC's ever-growing list of Pro-fessional Members, bringing the new total to 171 (an impressive number, but one we’d like to see quadruple in the next couple years). Their information is now available on our website.

10 service providers (including cosmetologists and retail ven-dors) joined TLC this past year. That’s in addition to the 25 salons, cosmetologists and retail referrals that were already listed on www.trich.org.

TLC staff exhibited at the American Counselor's Association Con-ference, introducing these behaviors to 4000 counselors from across the country. Our presence was so well received by the Licensed Counselors in attendance that TLC Board Member Sue Price, MS, NCC and Founding Board Member Joan Kaylor, MSEd, LPC, NCC, will present, "The Experience and Treatment of Trichotil-lomania," at the 2010 ACA conference.

Research

Once again, Founding Director Christina Pearson attended 2 Alli-ance for Research meetings in Washington DC. These meetings give trich and skin picking a voice at the table with 25 other na-tional non-profit organization, ( such as the Anxiety Disorders As-sociation of America, Tourette Syndrome Association and National Alliance of Mental Illness, to name a few), and top staff of the Na-tional Institute of Mental Health (NIMH). These meetings provide a platform for advocacy and developing future policy. TLC's con-tinued presence at these meetings mean the hair pulling and skin picking HAVE a voice in the national mental health arena.

The TLC Research Grant Program funded a seed grant to recipi-ent Michael Bloch, MD, for a pharmacological study on the use of N-acetylcysteine (NAC) for pediatric trichotillomania. TLC's Executive Board, on the recommendation of the TLC Scientific Ad-visory Board, approved this study based on the results of afore-mentioned study completed by Dr. Jon Grant, which focused on NAC as a potential treatment for adult trichotillomania. Through this study, the investigators seek to demonstrate the efficacy of NAC in the treatment of childhood trichotillomania.

TLC's Scientific Advisory Board has made tremendous progress in their respective fields. In addition to the research and ensuing publication of Dr. Jon Grant’s NAC study (as reported on page 1), Dr. Douglas Woods became the second SAB member to receive a federally-funded grant from the National Institute of Mental Health. You may recall that Dr. Martin Franklin received a grant late last year that has funded a study of pediatric trichotillomania be-havioral treatment outcomes.

The Pilot Study for the International Genetics Consortium was successfully led by Nancy Keuthen, Ph.D. and David Pauls, Ph.D. In addition to her work with the Genetics Consortium, Dr. Keuthen received benefactor funding to launch a two-site treatment study in collaboration with consulting SAB-member Dr. Barbara Roth-baum, of Emory University Medical Center. Building upon existing research findings, Keuthen and Rothbaum designed an “evidence-based” treatment protocol that, in addition to habit reversal train-ing, teaches emotion regulation and distress tolerance techniques as well as mindfulness and relapse prevention strategies to opti-mize recovery from setbacks.

Dr. Dan Stein is leading the team of SAB members advocating for important changes to the way trichotillomania and skin picking are classified in The Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Currently under revision, the DSM-V is the most common reference manual for mental health disorders, As reported in the last issue of InTouch, these changes are critical to the efforts to accurately diagnose, and treat, pulling and picking behaviors.

Finally, the SAB has been collaborating on a manual of their own, Current practices in the Treatment of Trichotillomania. Through a multi-level process that included interviews, surveys and data-analysis, the SAB is near completion of a comprehensive docu-ment that will replace our current Clinician’s Guides.

No one wishes for trichotillomania, there is no one who is grateful that they pick their skin. To have such dedication, love and support from a community of unwilling participants is truly amazing. The TLC Executive Board, Scientific Advisory Board and staff are all very grateful of your support and efforts. Each year, progress is made, shame subsides, treatment becomes more accessible and more and more sufferers learn that they are not alone...and for that, YOU should be very proud!

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Dealing with the personal and social hardships a child with tri-chotillomania may face is a challenge in and of itself. My daugh-ter graduated from high school with the class of 2009, and is now a freshman at American University in Washington, D.C. Our battle with trichotillomania began in second grade, when I first noticed my daughter was pulling her hair. After more than a year of meetings with doctors, therapists, psychologists and psychiatrists I finally found what she was suffering from had a name: Trichotillomania.

By then, my daughter was near the end of third grade in Catho-lic school. It had become apparent that she would need help in school so that she would not fall behind academically. When I first approached her principal and teachers in hope of educat-ing them on trichotillomania, I realized that the Catholic school she was attending did not have the resources to fully assist her. I moved her to public school and soon realized the challenges I would face, and eventually overcome, in dealing with the public school system. The following are some steps I took, and I hope that sharing these steps will assist you with your child.

First, get the school to test your child. The school may be hesi-tant since testing can be costly - be insistent if you suspect your child may have problems. My daughter would have difficulty staying on task when she was pulling her hair, yet the school did not want to test her because she was not failing her classes. I am a teacher and my husband is an attorney, yet we still had dif-ficulty with the school. Be insistent! If the school is still not help-ing you, seek assistance from a Special Education Advocate. This is a person who is versed in Special Education laws and assists parents in getting help for their child. Once I had an advocate, the school began to do everything I requested.

My daughter did not have learning disabilities, but she did have some emotional issues and was diagnosed with ADD, both of which got in the way of her ability to do her work. The ADD di-agnosis helped get her classified under Special Education. Chil-dren with trichotillomania can come under OHI (other handi-capping impairment) Special Education (IDEA) or 504. If your child loses focus while pulling make sure you stress that point. Loss of focus or “zoning out” in class while pulling can be the key to receiving assistance. I suggest you do some research and learn about both and the differences because it can be confus-ing. I found this website to be very helpful:http://school.familyeducation.com/special-education/ada/38439.html

Once my daughter was classified under Special Education, she was eligible for shortened assignments, extra time to complete her assignments and small group testing. We even received spe-cial permission to allow her to wear a cap to school. The schools may also provide sessions on campus with a school psycholo-gist. Although most school psychologists are not experienced with trichotillomania, they are someone your child can talk to.

Also, work with the school counselor to schedule your child with teachers who are open to his/her unique needs. Before the school year started, I would email the teachers and give them

information about trichotillomania (contact TLC for a copies of the Brochure for Educators). I would talk to friends and neighbors who had children a grade or so ahead of mine, so I could get a feel for which teachers were friendly and caring. Build a good relationship with the counselors and they will help place your child with teachers who are more understanding.

I also had to adjust my expectations of my daughter. As a parent, I expected her to complete her work, but if she had a difficult day at school, I would let her shorten her assignments. You have to be careful; do not enable your child, but be understanding of what an obstacle trichotillomania can be. I made sure she par-ticipated in extracurricular activities, such as sports, so that she could release the stress of her day. As long as she was learning and progressing, I didn’t stress about her making straight A’s.

In high school, we faced another obstacle. Although my daugh-ter was eligible for advanced placement classes, the teachers and school did not want to make accommodations for her. They felt that if she could not keep up she should be in regular classes. I made the argument that she had the mental capability to do the work but just need extra time on assignments if she felt overwhelmed. Once I pointed out that they were breaking the law, they agreed to allow accommodations for her in advanced placement classes. Once a student is receiving accommodations at school, that status will apply to state testing and college en-trance exams such as the PSAT, SAT & ACT. (Our daughter received extra time on these tests and was tested in a small group). These accommodations will also apply once a student is in college.

Another important issue to deal with in school is that of bullying and teasing. In elementary and middle school our daughter ex-perienced a lot of bullying. Every time this occurred we made it a point to tell the administrators and counselor so that it was documented. The schools were helpful most of the time, and spoke to the students who were involved and usually got them to stop bullying. There was one incident when a counselor told me that, "At some point your daughter will have to get use to the teasing." I quickly corrected her and said, “No, the other stu-dents need to stop teasing. My child has a right to go to school and not be bullied.” I was once told that if they had to accom-modate my daughter, they would have to do the same for oth-ers. I responded by saying not all kids have trichotillomania; it is their responsibility to accommodate kids in these situations!

Finally, use the Trichotillomania Learning Center (TLC). They have a wealth of information and have always been there for support. Make an effort to attend a retreat with your child. Through the retreats our daughter has made many friends whom she com-municates with on a regular basis through email and other so-cial networking sites. TLC has helped our daughter cope with the issues brought on by trichotillomania and adjust to live a happy normal life. We are not alone.

Theresa welcomes your questions or comments: terrymazuca@gmail.com

How a 504 Plan Helped My Daughter Theresa Garcia San Antonio. TX

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that “no one with a disability can be excluded from participating in federally funded programs or activities, including elementary, second-ary or postsecondary schooling). A meeting can be convened, of-ten with a school social worker, school psychologist, or guidance counselor, to address the issue at hand initially. Often one or both parents are present and, depending on the age of the child, they might be present as well. I am often invited by parents as an advocate, especially if the school does not under-stand how trichotillomania and associat-ed disorders may interfere with learning. I might provide data and specific instances of ways learning has been impacted by their diagnosis/diagnoses.

For some individuals, 504 plans are easily implemented without even necessitating a formal meeting. For example, recently a client was having trepidation about an upcoming swim class because her hair was full of bald patches and she might feel ashamed and embarrassed and face potential teasing. I wrote a let-ter to the school social worker and asked that her class be changed to a later term. It was done immediately, so she was able to obtain relief and change her schedule before she had to encounter exces-sive anxiety about trichotillomania. Another time I requested Velcro be attached under school desks so the student could play with a manipulative inconspicuously. 504 plans are great for children who can be successful by using some carefully placed accommodations. A 504 plan seeks to level the playing field so that those students with learning challenges (such as focusing issues due to hair pull-ing) can safely pursue the same opportunities as everyone else.

An Individualized Education Plan (IEP) is the "next step" of a least restrictive environment or plan for the student. I have participated in these planning sessions, one lasting a total of four hours, as each group had their respective representative to protect their status. First, a child will need to be deemed eligible for an IEP. This process entails determining if there is a learning, social/emotional, behav-ioral or other health impairment which deems a comprehensive process of assessment, observation, data collecting, and behavior plan as a result. An advantage of an IEP is a more extensive paper trail to monitor and provide services to a child. There are annual reviews of the progress being made, or need for changes to the plan once initiated. The assessment process can take 3-4 months as parents are interviewed, reports from doctors and therapists are requested, medication regimens are reviewed, etc.

After the testing and observations are completed, and the data is collected, there is a meeting to share the results. It is a beautiful

process in which all the school personnel, and parents and treat-ing therapists, if present, are able to share feedback regarding the student. I have had meetings in which, if I had not been present, a child would have been sent to a school for children with behavior

problems when, in actuality, the child suf-fered from comorbid disorders with exces-sive anxiety and depression, and needed a therapeutic environment. Another posi-tive about IEPs is that the teachers become informed and are often a part of the IEP meeting, allowing them to give feedback.

Students eligible for an IEP generally re-quire more than a level playing field -- they require significant remediation and assis-tance, and are more likely to work on their own level at their own pace even in an inclusive classroom. Only certain classifica-tions of disability are eligible for an IEP, and students who do not meet those classifi-cations, but still require some assistance to be able to participate fully in school, would

be candidates for a 504 plan.

What other advantages are included in these accommoda-tion plans?

Students are often allowed to use manipulatives, which can help with habit reversal. The stress of school is often a trigger for pulling and picking. Having a squishy toy, putty, a rubber band, a string, or being able to replace the urges or behavior with an object is es-sential to improve trichotillomania and compulsive skin picking.

Students are less likely to be negatively consequenced if there is a plan that explains why the child is constantly fiddling and picking or pulling at their body and/or hair.

A plan can institute breaks, if needed—a trip to the social worker if a child is experiencing excessive anxiety or restlessness—or can help teachers understand why a child is not able to do the school work as in the past. Assignments can be reduced or modified in many plans, if needed.

Some children may have to have late start times if too depressed to get up in the morning, or half-day school days if riddled with panic, or alternate school environments if social/emotional impediments result in an inability to learn in the regular environment.

A plan might assist a child in avoiding unnecessary teasing. For ex-ample, in one classroom recently, a child was teased because he

504 Plans and IEPs: How Can They Help My Child?Continued from page 1

Students are less

likely to be negatively

consequenced if there is a

plan that explains why the

child is constantly

fiddling and picking or

pulling at their

body and/or hair.

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As the researchers note, "Cognitive Behavior Therapy has shown benefit for trichotillomania and should be considered in conjunction with pharmacotherapies."

While N-acetylcysteine was well tolerated by participants in this study, it is always important to discuss taking dietary sup-plements with your own physician. Please refer to the article for more specific information about the use of this supple-ment.

What's next?Dr. Grant and his team hope their study will lead to further research into the effectiveness of N-acetylcysteine at higher dosages, studies of its use in the long-term treatment of tricho-tillomania, and its effectiveness in treating patients with vari-ous manifestations of the disorder. "As effective treatments for hair pulling emerge, it becomes increasingly important that physicians and mental-health care providers screen for tricho-tillomania to provide timely treatment," they wrote in their report.

Read more from Dr. Grant:Why is this study significant?Although behavioral therapy has shown benefit for trichotillo-mania, the use of medications has generally been disappoint-ing. One possible reason is that all of the medications previ-ously studied (clomipramine [Analfranil], fluozetine [Prozac]) work largely by affecting the neurochemical serotonin. The findings from this study suggest that using medication that tar-gets the neurochemical glutamate may prove more beneficial in controlling the symptoms of trichotillomania.

Limitations of the study?Although it was the largest randomized, controlled clinical tri-al performed on trichotillomania, with 50 people, it is still an incredibly small number of people. Also, people pull for many different reasons and may have different biological aspects to their pulling. NAC helped in just about half of the people and so it is hardly a magical pill. The study did not combine NAC with behavioral therapy and it is strongly suggested that any-one taking NAC also use behavioral therapy. In addition, the study was only 12 weeks in duration so it is not clear how long people need to take NAC if it is helpful.

Are there side effects or other problems with NAC?The subjects in our study did not have problems on NAC. We used a capsule form of NAC. There is a liquid available from pharmacies but it causes significant side effects and should not be used for this purpose. Side effects reported in the literature have included: nausea, indigestion, headache and abdominal pain. Other issues with NAC include that it should not be used in people with asthma as it may worsen that condition (this is interesting given that it actually helps people with bronchi-tis). Also, because of the way NAC works in the body, many people recommend supplemental zinc, copper and other trace minerals and as well as taking two to three times the typical

amount of vitamin C. These recommendations are based on people taking NAC over an “extended period” and because the scientific literature is unclear what that actually means, it is probably best to take NAC with a multiple vitamin plus vitamin C.

People should be cautioned that although NAC is an amino acid and thereby appears safe, people should always ask their doctors before starting the supplement. In addition, just be-cause something may be good for you in small doses does not mean that more is better or safe.

Could the results apply to skin picking and nail biting?In my opinion they can. We published a small case series de-scribing the benefits of NAC in people with skin picking and nail biting. Having said that, we have not yet conducted a con-trolled study of these behaviors using NAC.

What is the optimal dose of NAC and when during the day should people take it?These are still unclear. For our study, we examined dosing be-tween 1200mg and 2400mg per day. I think some people could benefit from higher doses, up to 3600mg per day, but this has not yet been studied in a controlled manner.

In terms of when to take it, I advise people to divide the dose and take it twice a day, perhaps even closer to the times of day when people pull or pick. For some people, it is probably out of the system in 3-5 hours.

Where does someone get NAC?For our study, we bought the product online from a company named Swanson’s in Fargo, North Dakota. I am not endors-ing that company and they did not provide us any discounts or funding for our research. They were able, however, to provide us with documentation of the quality of their product. From my perspective, this is a problem in doing research in this area. Which are the reputable companies and which are not? I don’t know enough about makers of nutraceutical products to recommend particular companies. I would suggest asking your doctors or other clinicians about products and suppliers in your areas or online.

Is NAC helpful and safe for children?The study we conducted was done only on adults with tricho-tillomania. I know many people want to be able to help their children who suffer from trichotillomania. A study addressing this question is currently being conducted at Yale University and sponsored by a research grant from TLC. A definitive answer is still pending.

I have used NAC in some adolescents with trichotillomania or skin picking (who have failed to respond to behavior therapy), and have ultimately used the same doses we studied in the controlled trial (1200-2400mg). It appears safe in these young people.

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was constantly picking at his hair. Students accused him of having lice. Perhaps bullying children can be separated from the student (when class schedules are set up), and a child can be assigned as an advocate for the student who needs extra help. Students are less likely to be discriminated against because of behaviors and appearance.

Teachers can be used as potential aides in the classroom to cue a child when they are picking or pulling. This is only with the par-ents’ and student’s permission and needs to be carefully outlined so as to assist the student, not cause embarrassment.

Parents get more feedback from school personnel, are able to feel less overwhelmed and part of a team to help their child. School personnel often set up regular email or phone feedback with par-ents, if needed. I welcome this feedback as well, as it helps my treatment become more targeted to problems encountered on a daily basis.

Teachers can be further educated aboutpulling and picking to lessen the stigma and increase compassion for all involved.

Individuals can choose if they want to participate in advanced placements or not. Perhaps it would increase pulling and picking and isn’t worth the risk at present.

Social workers can enhance toleration and flexibility toward tri-chotillomania and skin picking sufferers. Guest speakers can be ar-ranged to come to class, videos like “Bad Hair Life” can be shared.

The whole child is looked at with these plans: their emotional, social and academic selves. The student is given equal footing in which to learn as others without neurological disorders.

My personal belief is that a child can’t learn optimally if there isn’t a sense of connection and community. Both of these plans can cre-ate more cohesion and decrease the isolation so many individuals with these disorders feel.

I love getting the word out about trichotillomania, compulsive skin picking, and OCD. These meetings are a forum to educate, elevate and increase growth for all involved. Secrecy is not the best option for most individuals; it just lets the emotions and feelings of shame fester. Solutions are discovered, and individuals learn that these disorders are just that—dis-order, and highly treatable.

Last, it is normal to pull with trich, to pick with compulsive skin picking, and to obsess and ritualize with OCD. What we need to learn are improved ways of eliminating and reducing symptoms once they are recognized and diagnosed. I believe 504s and IEPs are tools to help guide the way.

Jane Bodine, LCPC, is the clinician/owner of a practice in Naperville, Illinois, specializing in the treatment of OCD/OC Spectrum disorders, providing individual, family, group therapy, educational advocacy, home and office visits, phone and soon to offer webcam sessions for people out of the area with no access to therapists with expertise. Email: janeoctric@yahoo.com; phone 630-416-3146.

Should it be used in little children? I would always recommend first trying behavioral therapy and if that is not successful or only partially successful, then I would talk to the child’s pediatrician before starting NAC. Some research studies in children have based the dose on body weight - often trying to reach a target dose of 60mg/kg/day. Of course, it should be started at a lower dose, say 300mg or 600mg per day. I think discussing this with your pediatrician would be potentially helpful.

Final thoughts:The interest this study has generated has told me that too many people are struggling with this problem and have seen too little improvement from available treatments. Although this study offers hope for better treatments, keep in mind that about half of the people did not respond. The encouraging message from this study is that perhaps we are learning more about what is happening in the brain of people who pull their hair and that we can and will have even better treatments down the road.

Jon Grant, MD, JD, MPH, is an Associate Professor of Psychiatry at the University of Minnesota, and co-directs a clinic for Impulse Control Disorders at the University of Minnesota Medical Center in Minneapolis, MN. Dr. Grant completed an undergraduate degree at the University of Michigan, a master's degree at the University of Chicago, a law degree from Cornell University, a medical degree from Brown University, and a masters degree in public health from Har-vard University. Dr. Grant is a board-certified psychiatrist.

Dr. Grant has written over 100 peer-reviewed articles and book chap-ters on the phenomenology and pharmacological management of impulse control disorders, particularly pathological gambling, klepto-mania, and grooming disorders. He is the author of Stop Me Because I Can't Stop Myself, a book on impulse control disorders published by McGraw-Hill (2002) (co-authored with Dr. Suck Won Kim), and co-editor (along with Marc Potenza) of two books published by the American Psychiatric Association: Pathological Gambling: A Clini-cal Guide to Treatment (2004) and A Textbook of Men's Mental Health (in press). Dr. Grant's research is funded by the National In-stitutes of Mental Health.

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I love this community. A couple of weeks ago, I flew to Portland for an evening to see an old elementary school friend. After picking me up at the airport, we went to din-ner at a Lebanese restaurant (a first for me, and the food was marvelous). While wait-ing at the front for a table,

two women suddenly rushed up with beaming faces, to wrap me in tremendous hugs. As the dust settled, I realized they were both longtime TLC members, and that we had met several times over the years at different events and get-togethers.

I introduced everyone, without giving particulars, as there were dif-ferent groupings among us. When I finally got to my table, my dear friend Gail said, “They must be really great friends. The love was so evident! How long have you known them?” (Here’s an aside: Gail is from my eighth grade class that graduated in 1970 – we recon-nected after 35 years of no contact.)

It was a profound moment for me. I felt as close or closer to those two women as I ever had with family, loved ones, or lifelong friends. Because we connect deeply - outside the parameters of blood, so-cio-economics, religion, politics and race. We connect on an experi-ential level in the heart, which sees no separation. The joy between us was vitalizing and rejuvenating – to see and be seen. To know and to honor. To share and understand. And all without words. I mean, we had words, but not about the connection between us. For me it was a watershed moment that came out of the moments of my life, doing this work, reaching constantly for my own recovery and the recovery of others.

I smiled and said that I knew them through work, and how wonder-ful it was to see them. Then we moved on to other subjects. The next day I flew home as it was just a quick visit. But I had been deep-ly moved by the whole experience and pondered on it quite a bit. Perhaps that it was so unexpected, spontaneous, 1,500 miles out of my way, in a place I had never been.

To be so flooded with love, acknowledged with unconditional warmth and joy, to stand for a moment in the sheer power of the truth of our community. Please realize: I had only spent a few hours over a fif-teen-year period with these women. Yet we were deeply connected through the shared struggle with hair pulling and skin picking. It was both renewing and energizing, and let me tell you why.

I have spent the past few weeks working to develop outlines for next year’s new TLC programs, and it has been both exciting and also frustrating, as without funding we cannot do them all. But this chance encounter reminded me who and what these programs are

meant to serve, and why they are needed, and suddenly I am on fire with enthusiasm.

Here’s the interesting thing – IF we get the ten or twelve new pro-grams up and running in 2010, TLC will have 38 simultaneous pro-grams running, from the quarterly newsletter to the Professional Training Institute, from educating cosmetologists to developing a genetics research consortium – from strengthening in-person sup-port groups to hosting social networking… the list goes on and on!

And… it is all because of you, me, and all of us. Whether grandmoth-er, therapist, sufferer or parent. Whether husband, wife, or child or good friend – whether it is because you yourself have these prob-lems in your own nervous system or you love or care for someone else who does, it is for you. All these wonderful programs are for each and every one of you. And me too. Why? Because the need is there, and our collective heart recognizes this.

TLC will need your help to make them happen, will need both your financial and volunteer support. So, I am asking you to remember this when you open a TLC fundraising letter, get a phone call from me or Jennifer, or just suddenly decide on your own to sponsor a project. (At some point we’ll have the whole list drawn up – then you can pick one to get involved with!)

An important item to remember in these difficult economic times is to use your money wisely, funding things that will culminate in ben-eficial returns. Investing in TLC does just this, having profound impact on individuals, families, professionals, and others, not to mention the world at large. As Dr. Douglas Woods has stated – an investment of $6000 by TLC in a seminal research project culminated in a million dollar grant being awarded from NIMH. And that $6000 was made up of little donations, mostly ranging from $10 - $50 in size.

Two days ago, a member told me she was doubling her monthly contribution. I was ecstatic in response, and she said. “Really Chris-tina, it’s only $25 a month, nothing to get so excited over.” I pointed out to her that this WAS important, and would bring TLC the ability to apply it to a useful project.

Guess what? If every member of TLC was able to donate regularly even $15 per month, that would bring in more than a quarter of a million dollars annually. And some can do more, far more – so let’s say how about $30, $50, or $100? We all want a cure – we just need to work together to access it.

Remember that WE CAN do this – we CAN relieve suffering, and we HAVE the organization in position to do this. That’s TLC. You and me. We are everywhere. Finally. So let’s get busy!

Love, Christina

Founding Director's Report...(Musings from Christina)Christina PearsonSanta Cruz, CA

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It is amazing how the emo-tions of back-to-school season stick with you into adulthood. Far more than on New Years Day, it is Sep-tember when I feel the mix of nervousness and excite-ment of a new start and new projects ahead. It is mostly

a good feeling: energized and ready to dive in. But we all know that school, work, and the normal stress of our busy lives pose special challenges to those of us with trich and skin picking. Pre-paring to meet those challenges needs to be part of our Autumn plans, too.

That’s why the timing of the Hands-Down-A-Thon in the fall is perfect. It focuses participants on helping themselves during this busy time, providing an extra dose of motivation, community support, and tools to curb our impulses to pick and pull. For those of you participating this year, congratulations! I hope it has been a good experience. We all thank you for the sponsorship dona-tions you raised for TLC.

If you didn’t participate this year, you may want to think about how to use goals, support networks (like the TLC email groups, a local support group, friends or a family member) and tools – from bandaids to behavior therapy – to help you get through your most challenging times. Maybe it hits you in December?

The Holidays are a challenging time for many – shopping and cooking and travel, high expectations, the good and bad of family visits. If all this usually triggers picking or pulling for you, now’s the time to start planning to help yourself through the next few months in whatever ways work best for you. Is it time to treat

yourself to some new fiddle toys? Have you been meaning to try StopPulling.com? Is that a bottle of NAC I see peeking out of your Christmas stocking?

It is easy for this to become a very insular season, as we all buckle down and just try to get through our long to-do lists. But the joy of the holidays comes from the special importance given to coming together for a meal, and the love expressed through giv-ing and receiving – in other words, through community, my very favorite theme. It doesn’t take much.

The other day, I was feeding my daughter Audrey (picture oat-meal all over high chair, toddler and mommy) and I looked out the window to see a young girl crouched down in my driveway, taking a cell phone photo of my car’s bumper. Of course, it was my “www.trich.org” bumper sticker she was interested in. I ran out and handed her a TLC brochure. “Thanks. I have a friend with this,” she said, and walked on. Connections can be very simple. And you can even reach out to others passively, just by parking your car near the sidewalk.

So prepare yourself for the difficult times, give and receive sup-port however you can, and enjoy the seasons.

Much love, Jennifer Raikes

Executive Director's Report...Jennifer RaikesLos Angeles, CAJennifer@trich.org

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___ I understand that I will receive a receipt from TLC each year for my tax records.

I would like to pay by:

___ Check

___ Electronic funds transfer (please enclose a voided check, if possible)

___ Credit card (see below)

___ Appreciated securities (TLC will contact me)

Please select your payment method:Check or money order enclosed (US funds only) mCharge my credit card: (we accept all credit cards) Amount to be charged: ___________________________________________________ m

Card number:___________________________________________________Exp. Date:_______________3-Digit Security code __________(from the back of the card. American Express users, please provide the 4-digit number from the front of the card)

Cardholder’s Name: ____________________________________Authorization Signature:______________________

TLC is a 501(c)(3) tax-exempt organization and all contributions are tax deductible. Our TAX ID number is 77-0266587.

Thank you for helping TLC become all it can be...Your support makes all the difference!Mail completed form to:

TLC • 207 McPherson Street, Suite H • Santa Cruz, CA 95060 or fax to 831-426-4383831-457-1004 • www.trich.org • info@trich.org