The long-term outcomes of breast implants studied

The largest study of breast implants to date provides women with some important information regarding rare but serious adverse outcomes.

What are the long-term risks of breast impant surgery?

A breast implant is a prosthesis used to change the size or shape of a woman's breast.

Some women use breast implants to feel more comfortable in their bodies, whereas others choose breast reconstruction to recreate a natural-looking breast after a mastectomy.

A surgeon performs a mastectomy to remove breast cancer tumors.

The two most popular and Food and Drug Administration (FDA)-approved breast implants (defined by their filler material) are the saline solution and the silicone gel.

The saline implant uses a silicone shell filled with a sterile saline solution during surgery, while the silicone implant uses a silicone shell prefilled with viscous silicone gel.

The regulatory history of breast implants

The FDA have not always been in favor of silicone breast implants. In 1992, the FDA concluded that the data available at the time were not sufficient to support approval.

The decision did not impact gel-filled breast implants for patients undergoing breast reconstruction; people considered these implants to be investigational medical devices, to be further analyzed and clinically studied.

In the early 2000s, the FDA approved saline-filled breast implants for augmentation in women who are aged 18 and older and for reconstruction in women of any age.

The approval for silicone gel-filled breast implants, instead, was valid for a limited number of augmentation, reconstruction, and revision patients at a limited number of sites.

What is aseptic technique?

Healthcare professionals use aseptic technique to protect patients from infection.

Then, in 2006, the FDA approved silicone gel-filled implants from two manufacturers. For the first time, silicone gel-filled breast implants were available for augmentation, as well as reconstruction and revision. Manufacturers must conduct postapproval studies to verify safety and effectiveness.

In 2011, the FDA issued a Safety Communication regarding the link between breast implants and anaplastic large cell lymphoma, a rare type of lymphoma (a cancer of the lymphatic system).

Based on a review of the clinical studies, the FDA believed that women with breast implants may be at risk of developing the disease.

Uncovering adverse outcomes

After the approval of silicone breast implants, the discussion into safety remained open. The FDA conducted several large postapproval studies to follow a number of people with breast implants, but up until now, nobody had thoroughly analyzed the database.

"We are sharing critical information on complication rates and rare associations with systemic harms. This data gives women important safety information about silicone breast implants to have real expectations and to help them choose what is right for them," explains Dr. Mark W. Clemens and colleagues, of the University of Texas MD Anderson Cancer Center in Houston.

Scientists analyzed data on about 100,000 people enrolled in large postapproval studies in 2007–2010. Around 80,000 of these patients received silicone implants, and the rest had implants filled with a sterile saline solution. The results are now published in the journal Annals of Surgery.

Thanks to this large database, the scientists were able to assess the risk of rare harms for women with breast implants.

Around 72 percent had breast augmentation, around 15 percent had revision augmentation, 10 percent had breast reconstruction, and 3 percent had revision reconstruction procedures.

The team found that women with silicone implants had a higher risk of rare adverse outcomes, including sclerodermia, rheumatoid arthritis, and Sjogren's syndrome.

The risk of developing these conditions was around six to eight times higher than in the rest of the population. Silicone implants were also associated with the risk of stillbirth and skin cancer.

The scientists also found that women with silicone implants may be at higher risk of some surgical complications, including capsular contracture (scarring around the implant), compared with saline-filled implants.

It is important to note that, while certain rare harms seemed to be more common in women with silicone implants, "absolute rates of these outcomes were low." The authors conclude:

"To resolve the remaining uncertainty in the evidence base, it is important that this data be analyzed in an unbiased manner. It remains the plastic surgery community's duty to provide definitive evidence for the risks associated with breast implants."

Source: MedicalNewsToday

How to protect your mental well-being this festive season

A perfect world sees the holiday season filled with love, warmth, and happiness. However, more often, it is crammed with stress, exhaustion, and panic. Here, we offer some advice on how to bring a little calm back to the festive season.

How can we avoid the stress of the festive season?

I know it seems hard to believe, but we are, once again, fast approaching the holiday season.

Although millions of people across the United States and beyond are looking forward to the festivities, it can sometimes leave people feeling jaded and exhausted.

There are gifts to buy, family to visit, meals to cook, and events to plan and attend. Time is limited, money is tight, and the children won't stop crying.

Many people have stressful lives before the added pressures of the holiday season; sometimes, the extra cognitive weight can make them buckle.

A survey conducted by the American Psychological Association found that people in the U.S. are likely to feel more stressed around the holidays rather than less.

In this Spotlight, we cover seven simple tips that might help a person keep their mental well-being intact across this year's festive season.

1. A family affair

If you find your family challenging to be around, you are not alone. Make sure you set boundaries early on — stay for 1 night instead of two or three, for instance.

Instead of busting a gut trying to visit every relative across multiple states, limit who you go to see. Make apologies in advance to those who you might miss, and save yourself that 12-hour round trip.

You can visit great uncle Gordon in Alaska in the Spring; the weather will be more clement then, anyway.

This goes for all aspects of holiday planning: be realistic. Don't take on more than is comfortable. Not even a super hero could plan the office party, a family party, and the school Christmas play; then cook Thanksgiving dinner and Christmas dinner, buy gifts for everyone, and still be smiling.

Don't be afraid to say "no" to some people; they probably won't mind — they might even be relieved.

If you do have to travel long distances, build in some wriggle room with the timings— if you expect delays, they won't seem quite as stressful in the likely event that they crop up.

2. Planning cash flow

It is very difficult to avoid spending too much money during Thanksgiving and Christmas. Gifts, food, drink, outings, guests, more food, more gifts; it quickly mounts up.

Although many people know they are likely to overspend during the holiday period, very few make sensible plans in advance.

This year, try to set a reasonable budget that you think you can stick to. Wherever possible, only spend cash or use a debit card. Credit cards might seem like a good idea when you are in full festive flow, but we all know they can come back to haunt us in the doldrums of January.

3. Alcohol overload

There are many opportunities to drink alcohol over the holidays. Before the festivities begin, remind yourself that you do not have to drink alcohol at every single event.

Saying "no" can be tough but rewarding.

Try to make a plan before you arrive; decide what you will drink and when, and stick to it.

Perhaps decide to make every other drink a nonalcoholic drink. Pace yourself. This can be more difficult than it sounds, but it is worth it.

Excess alcohol often causes interpersonal problems that wouldn't have arisen otherwise, especially when people are feeling more stressed than usual.

During the aftermath of a night out, dealing with relatives or making plans might be much more challenging and stressful than they would have been otherwise.

Alcohol feels like it reduces stress at the time but, in the long run, it might make things worse.

4. Calorie overload

There is no point pretending that we are going to stick to a pure and healthful eating regime for the entire holiday period. Anyone who can maintain dietary goals throughout the season receives a gold star but, for most people, it's just not a reasonable ask.

Don't put too much pressure on yourself to eat healthfully for the duration of the holidays. At the same time, make solid attempts to moderate yourself. Choose the more healthful option now and again, and don't go back for second helpings.

What are the best diets for 2018?

A panel of health experts — on behalf of U.S. News & World Report — reveal the top-rated diets for 2018.

The guilt of falling off the wagon can really dent our happiness and confidence. Attempting to minimize this guilt will help your sense of mental well-being both during the holidays and well into the days and weeks that follow.

5. Don't let it all slide

Exercise routines tend to go out of the window, too. This, to a certain extent, is both understandable and acceptable.

We all need to take our foot off of the gas at some point during the year, so it may as well be while the weather is awful and there are plenty of good movies on the television.

Just being in nature can lift your spirits.

That said, exercise is a great way to sharpen the mind and lift a person's mood.

This is the time of year when we most need a boost, yet most of us cut out physical activities entirely.

Be sure to cut yourself some slack, but also make sure to get some exercise when you can. Even light exercise, such as walking, can be enough to stave off the festive blues.

If you can, get out into nature; so-called green exercise has been shown to boost self-esteem and improve mood.

6. Approaching loneliness and loss

Not everyone struggles with an overly busy calendar during the holidays. For some people, it can be a lonely, isolated time.

To beat this, planning is necessary. There are plenty of things to do; it is just a matter of looking around and diving in. You could join a group, start a new hobby, or, even better, volunteer for a local charity.

For many of us, the holiday season can be a reminder of loved ones we have lost. Starting new traditions can be a useful way to turn this into a positive. Perhaps consider incorporating that particular loved ones' interests into the new tradition to help keep their memory alive.

It's also a good idea to seek out people who are going through a similar experience; they will understand and might be able to offer advice, or simply a listening ear.

7. Manage your expectations

When we daydream about the holiday season, we might picture a harmonious, well-dressed, gleeful family sitting at a beautiful oak table, a huge Christmas tree, and a roaring open fire. That, sadly, is unlikely to match reality.

Before the celebrations begin, be realistic. Mental well-being can take a substantial hit if the reality doesn't match up with our preconceived ideas. However, if we have realistic expectations, we are much more likely to be happy with the results.

We do not live in a movie; we inhabit the real world — a messy, unpredictable world; expect less and roll with the punches.

The take-home message

Sadly, as is often the case, moderation is key. When approaching food and drink, exercise some reserve; when people expect too much from you, push back; if being with family stresses you out, limit the time you spend with them.

All of the above are simple in theory but can be difficult in practice. Setting yourself some guidelines ahead of time might do a world of good. Happy holidays!

 Source: MedicalNewsToday

Strength training tied to better heart health than aerobic

Exercises that build strength can benefit the heart more than aerobic activities, such as walking and cycling, according to recent research.

New research suggests that strength training is the best exercise for heart health.

A survey of 4,000 adults revealed that static activity, such as strength training, had stronger links to reduced risk of cardiovascular diseases than dynamic activity, such as walking and cycling.

The researchers point out, however, that any amount of either kind of exercise brings benefits, and that it is probably better to do both than to increase either.

"Both strength training and aerobic activity appeared to be heart healthy, even in small amounts, at the population level," says Dr. Maia P. Smith, who is an assistant professor in the Department of Public Health and Preventive Medicine at St. George's University in Grenada.

She explains, however, that while "static activity appeared more beneficial than dynamic," the findings also revealed that those who engaged in both kinds of activity "fared better" than those who just increased the amount of only one type.

The study featured at the 2018 American College of Cardiology Latin America Conference that took place last week in Lima, Peru.

Recommended amounts and type of exercise

According to the American Heart Association (AHA), guidelines recommend that adults in the United States should be physically active for at least 150 minutes each week.

This activity should consist of at least 150 minutes of moderate-intensity or 75 minutes per week of vigorous-intensity aerobic exercise, or a combination. It is better to spread the exercise across the week than complete it all in 1 or 2 days.

The guidelines also advise doing exercise that strengthens the muscles, such as resistance or weight training. People should do this on at least 2 days per week.

Even greater benefits accrue from 300 minutes of exercise per week, say the AHA. They also recommend breaking up prolonged bouts of sitting — even getting up and doing some light activity is better than just sitting, they add.

The Go4Life program from the National Institute of Aging (NIA), which is one of the National Institutes of Health (NIH), advises older adults to do four types of exercise:

·         Endurance, or aerobic, exercises that increase breathing and raise heart rate.

·         Strength, or resistance, exercises that strengthen major muscle groups in the upper and lower body and improve their function.

·         Balance exercises to reduce the risk of falls and the disabilities that they can cause.

·         Flexibility exercises that stretch the body and increase a person's range of movement.

Aerobic activity includes walking, jogging, cycling, swimming, gardening and all forms of sports, such as golf, tennis, and volleyball.

Push-ups, static rowing, resistance training, dips, arm and leg raises, and hand grips are all examples of strength-building exercises.

Practicing Tai Chi and yoga can improve balance and flexibility as can simple exercises that involve the use the body or everyday objects, such as a chair.

Types of exercise and cardiovascular risk

Dr. Smith and her colleagues used data from the 2005-2006 National Health and Nutrition Examination Survey on 4,086 adults in the U.S.

This included information that individuals gave about types of physical activity and the presence of cardiovascular risk factors, including high blood pressure, being overweight, having high cholesterol, and having diabetes.

The team analyzed the cardiovascular risk factors against the type of activity in terms of whether it was static, such as weight training, or dynamic, such as walking or cycling.

How exercise affects metabolic hormones

Cycling and other forms of endurance training impact metabolic hormones differently to resistance or strength training.

After adjusting the results for age, gender, ethnicity, and smoking status, they looked at the results in two age groups: 21-44 years (younger adults) and over 45 years (older adults).

These revealed that 36 percent of the younger adults compared with 25 percent of the older adults reported doing static exercise.

For dynamic exercise, 28 percent of the younger adults compared with 21 percent of the older adults said that they engaged in this type.

'Both activity types were beneficial'

Doing either type of exercise was linked to a lowering of cardiovascular risk factors of between 30 and 70 percent. The link was strongest for younger adults and doing static exercises.

Dr. Smith suggests that future studies should do more to differentiate between the two types of exercise so that scientists can see their separate effects on health more clearly.

Only around 1 in 5 adults and teens in the U.S. meet the recommended 150 minutes per week of "heart-pumping" activity, say the AHA.

With this in mind, perhaps the more pressing message of the recent study, as Dr. Smith concludes, is that – since "both activity types were beneficial" – clinicians should encourage people to "exercise regardless."

"The important thing is to make sure they are engaging in physical activity."

Source : MedicalNewsToday

Why a low-gluten diet may benefit everyone

New research, published in the journal Nature Communications,finds that a diet low in gluten may also benefit the health of people who are not allergic to it. However, the benefits are not down to the mere absence of gluten.

A low-gluten diet may have unexpected health benefits, provided that it also contains high-quality fiber.

People living with celiac disease or gluten intolerance opt for a low-gluten or gluten-free diet to manage their symptoms.

In autoimmune conditions, such as celiac disease, for instance, the body's immune system reacts to gluten by targeting the small intestine.

Those with gluten intolerance, or gluten sensitivity, report that the protein triggers gastrointestinal symptoms, even in the absence of celiac disease.

However, an increasing number of people are adopting a gluten-free diet, even if they do not have celiac disease or gluten allergy. But some recent studies have suggested that doing so may have adverse health consequences, such as raising the risk of developing type 2 diabetes.

Researchers, led by professor Oluf Pedersen, of the Novo Nordisk Foundation Center for Basic Metabolic Research at the University of Copenhagen in Denmark, set out to investigate whether a diet low in gluten is beneficial for people who are not allergic to it.

Comparing low- and high-gluten diets

Prof. Pedersen and colleagues carried out a randomized trial of 60 healthy Danish adults aged between 22 and 65 years old who did not have celiac disease, diabetes, or any other disorders.

The participants adhered to an 8-week-long low-gluten diet and an 8-week-long high-gluten diet, respectively, with a 6-week washout period in between.

The low-gluten diet consisted of 2 grams (g) of gluten per day, while the one high in gluten comprised 18 g of gluten per day. The washout period involved a regular diet with 12 g of gluten daily.

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New research explains how gut inflammation occurs.

The two diets were similar regarding the number of calories and the quality of the nutrients they contained. However, the composition of fiber differed: the low-gluten diet also contained less fiber from wheat, rye, and barley, as these are primary sources of gluten.

The researchers examined the changes in intestinal fermentation by performing the metabolic profiling of urine samples and monitoring diet-related changes in the participants' gut microbiome.

Overall, the study found that a low-gluten diet changed the participants' gut microbiome, reduced their gastrointestinal discomfort, and resulted in a small weight loss. The researchers think the digestive changes, such as reduced bloating, are caused by the alterations in gut bacteria and function.

Prof. Pedersen further details the findings, saying, "We demonstrate that, in comparison with a high-gluten diet, a low-gluten, fiber-rich diet induces changes in the structure and function of the complex intestinal ecosystem of bacteria, reduces hydrogen exhalation, and leads to improvements in self-reported bloating."

"Moreover, we observed a modest weight loss, likely due to increased body combustion triggered by the altered gut bacterial functions," the leading researcher adds.

Dietary fibers are key

So, is a gluten-free diet good for you? It might be, say the researchers. But the health benefits found in this study seem to hinge more on the quality of the fiber in the diet, not merely the absence of gluten.

"More long-term studies are definitely needed before any public health advice can be given to the general population. Especially, because we find dietary fibers — not the absence of gluten alone — to be the primary cause of the changes in intestinal discomfort and body weight," says Prof. Pedersen.

"By now we think that our study is a wake-up call to the food industry. Gluten-free may not necessarily be the healthy choice many people think it is. Most gluten-free food items available on the market today are massively deprived of dietary fibers and natural nutritional ingredients," cautions the professor.

"Therefore," he goes on, "there is an obvious need for availability of fiber-enriched, nutritionally high-quality gluten-free food items, which are fresh or minimally processed to consumers who prefer a low-gluten diet."

"Such initiatives may turn out to be key for alleviating gastrointestinal discomfort and in addition to help[ing] facilitating weight control in the general population via modification of the gut microbiota."

Source: MedicalNewsToday

New evidence that social media increases loneliness

Although experts have debated the potential link between social media use and decreased well-being for years, a new study adds more fuel to the fire.

According to the first author of the new study, which featured in the Journal of Social & Clinical Psychology, no scientific study has proven a causal connection between the two until now.

University of Pennsylvania psychologist Melissa G. Hunt believes that her team is responsible for the first experimental study of Facebook, Snapchat, and Instagram use.

She argues that previous studies were either limited in scope or used "unrealistic situations," such as monitoring participants for only brief periods in laboratory settings.

"We set out to do a much more comprehensive, rigorous study that was also more ecologically valid," says Hunt.

Why Facebook, Snapchat, and Instagram?

Hunt's team focused on Facebook, Snapchat, and Instagram because they are the social media platforms that are most popular with undergraduates.

The study included 143 undergraduates at the University of Pennsylvania who each completed a survey to determine their baseline mood and well-being at the start of the study. They also all supplied a week's worth of data from their smartphones to demonstrate their current social media habits.

Hunt's team randomly assigned each participant into one of two groups. They instructed the undergraduates in the first group to continue using social media as usual and asked those in the second group to limit their use of Facebook, Snapchat, and Instagram to just 10 minutes a day for each platform.

Over 3 weeks, the participants made their smartphone data available to the researchers and completed surveys that examined a range of factors, including the participants' anxiety, depression, loneliness, and fear of missing out.

The results showed that the group who reduced their social media use experienced significant decreases in depression and loneliness. These effects were "particularly pronounced for folks who were more depressed when they came into the study."

The study only investigated three social media platforms, so it is not yet possible to determine whether the findings might also apply to other social media platforms. However, Hunt intends to investigate this in future studies, one of which will focus on college students' use of dating apps.

Should you quit social media?

Based on these findings, Hunt offers some advice for social media users who may be worried about the effect that these platforms could have on their well-being:

"When you're not busy getting sucked into clickbait social media, you're actually spending more time on things that are more likely to make you feel better about your life. In general, I would say, put your phone down and be with the people in your life."

"It is a little ironic that reducing your use of social media actually makes you feel less lonely," she says. "[...] When you look at other people's lives, particularly on Instagram, it's easy to conclude that everyone else's life is cooler or better than yours."

However, although Hunt believes that there is a strong case for limiting screen time on these apps, she emphasizes that her team's study does not conclude that young people should give up social media entirely.

In February of this year, Jeffrey Hall, an associate professor of communication studies at the University of Kansas in Lawrence, claimed that two of his studies had debunked the "social displacement" theory that the more time people spend on social media, the less likely they are to devote time to socializing with people in "the real world."

"I'm trying to push back on the popular conception of how this works," Medical News Today quoted Hall as saying. "That's not to say overuse of social media is good, but it's not bad in the way people think it is."

Source: Medical News Today

Addicted to Social Media?

The use of social networking sites such as Facebook, Twitter, Instagram, and Tinder has become the cornerstone of modern communication and connection as it allows users to create a sense of belonging and redefine their way of being. Despite the many positive benefits and impacts of these sites, the recent Cambridge Analytica scandal has reignited discussions about the place of social media and social networking sites in our lives.

From a mental health perspective, concerns have been raised about the negative impact of excessive use of social networking sites on the health and wellbeing of users, especially that of young people, who are enthusiastic users of this technology. Back in 2011, Dr. Daria Kuss and I were the first academics to systematically review the scientific literature on excessive social media use. Although there were few studies at the time, we did find that for a small minority of individuals there was a significant detrimental effect on many aspects of their life, including their real life relationships and academic achievement among those still in education. We argued that such signs are indicative of addiction.

Over the past five years there has been a proliferation of studies assessing how excessive social media use can impact negatively on health. In a recent paper Dr. Kuss and I again reviewed the latest research on the topic and showed that social media use for a minority of individuals is associated with a number of psychological problems, including anxiety, depression, loneliness, Attention Deficit Hyperactivity Disorder, and addiction. Because social media is most frequently accessed via smartphones, their usage is intimately intertwined and their mobile nature contributes to excessive checking habits, which often derives from what is commonly labelled as the ‘fear of missing out’ (FOMO).

The good news is that very few people are genuinely addicted to social media. However, many people’s social media use is habitual and it can start to spill over into other areas of their lives and be problematic and dangerous, such as checking social media while driving. Other behaviors may be annoying rather than dangerous, but may be indicative of problematic social media use, such as checking social media while eating out with friends or constantly checking your smartphone while watching a movie at the cinema. Others may snub social contact with their loved ones or friends and prefer to check out social media on their smartphone instead (so-called ‘phubbing’).

If you want to check whether you may be at risk of developing an addiction to social media, ask yourselves these six simple questions:

Do you spend a lot of time thinking about social media or planning to use social media?
Do you feel urges to use social media more and more?
Do you use social media to forget about personal problems?
Do you often try to reduce your use of social media without success?
Do you become restless or troubled if you are unable to use social media?
Do you use social media so much that it has had a negative impact on your job or studies?

If the answer to all six of these questions is “yes,” then you may have or be developing an addiction to using social media. We say “may” because the only way this can be confirmed is through a diagnosis from a clinical psychologist or a psychiatrist.

If you answered “yes” to a few of these questions, it is more likely that you are a habitual social media user and that what you should do is engage in ‘digital detox’ strategies that simply allow you to reduce the amount of time spent on social media. This can include simple steps, such as turning off sound notifications and only allowing yourself to check your smartphone every 30 minutes or once an hour. Other simple steps include having periods in the day where there is self-imposed non-screen time (such as during meal times) and leaving your smartphone in a separate room from where you sleep (just so you don’t get the urge to check social media before bedtime, during the night, and when you wake up).

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At a societal level, steps need to be taken by governments or organizations to help minimize and (in some cases) prohibit the use of mobile devices. Some such steps are in place in many countries, such as the banning of smartphone use while driving. Given the loss of productivity in both the workplace and educational settings, employers, schools, and colleges need policies in place to ensure that individuals are focused on what they should be doing. Many schools ban the use of smartphones in the classroom. Prohibition in other contexts such as workplace settings may also be justified if it is practical to do so. Some restaurants are now providing discounts on food bills if customers refrain from using their smartphones during their meal. These positive reinforcement strategies may well be the way forward in trying to decrease time spent on smartphones checking social media.

Source: Medical News Today

10 Things Every Pediatrician Should Know About BFRBs

Body-focused Repetitive Behaviors (BFRBs), a group of disorders that includes hair pullingdisorder, excoriation disorder (compulsive skin picking), and nail-biting, represent a group of problems not well recognized or understood by health professionals. Even psychologists, psychiatrists, and dermatologists may not always get it right, and so it should come as no surprise that pediatricians are not as well educated about them as they could be. As a psychologist, over the years I have seen countless examples of how these child specialists, when faced with a BFRB, would brush it off with such statements as, “It’s just a phase,” “Give it time—they’ll grow out of it,” “They must be really stressed out,” or “It’s just a bad habit.” Their suggestions can include punishing the child for the behavior, rewarding the child for not doing the behavior, putting bandages on their fingers, or having them wear hats.

I recently saw a case of a young adolescent girl taken to a dermatologist who examined the patient and simply sent her home with a prescription for a topical steroid cream. In another case, a pediatrician called a child’s hair-pulling "a bad habit" and recommended that the mother punish her child whenever she was spotted pulling her hair. No attempt was made to understand what was going on or to make a real diagnosis.This is, unfortunately, all too typical.

 My suggestions for medical professionals would be as follows:

1.     When you see a child with hair loss, do not neglect to ask if they pulled it out themselves. If there are scabs or skin wounds, ask if they did this to their own skin. Do not be surprised if you are met with excuses or denial, as many children and adults with BFRBs feel extremely stigmatized and may be reluctant to admit to doing it.

2.     These disorders have a great deal of emotional fallout and can be great sources of shame and isolation. Watch your own reactions when encountering people with BFRBs. Things like tone of voice, body language, facial expressions, and the way you examine them can have a very powerful impact. Try to be more reassuring that many other children and young people do these types of things also, and that this doesn’t make them abnormal or "bad" people.

3.     As far as we know, females with BFRBs may outnumber males at a ratio of 9 to 1.

4.     If necessary, also try to reassure parents that the pulling or picking is not a sign of some serious underlying disturbance, and can be effectively treated with the right type of therapy. Also, try to discourage parents from blaming themselves.

5.     Don’t simply assume that hair pulling and skin picking are due to stress, are a sign of some other deep underlying problem, or are some kind of developmental phase. These behaviors are much more complex than that and need to be understood. Aside from a minority of very early onset cases seen in toddlers that eventually resolve themselves, they are not simply developmental and can be lifelong. 

6.     Don’t assume the pulling or picking behaviors are a reaction to some kind of hardship or trauma, like abuse. These behaviors are largely due to sensory issues, and are most often done when a child is either understimulated (bored or sedentary) or overstimulated (stressed or even happily excited).

7.     In the case of hair pulling, be sure to inquire about whether or not the child is swallowing the hairs. Such behavior can lead to the formation of Trichobezoars. which then have to be removed surgically and can be life-threatening.

8.     Try to educate yourself about BFRBs. As a group, they involve around 5 percent of the population, so you will undoubtedly encounter them in your practice. The information is out there.  The TLC Foundation for Body-Focused Repetitive Behaviors provides an excellent source at bfrb.org.

9.     BFRBs can be effectively treated via a type of comprehensive behavioral therapy, but only as practiced by those who have specialized training and experience with these disorders. Ordinary talk or play therapy, or such approaches as relaxation training or hypnosis have never been shown to be effective interventions.

10.  Develop a list of referral sources in your region of specialized behavioral therapists who treat BFRBs, and don’t hesitate to send people to them for treatment. Effective treatment is out there if you take the time to look. You can get names from the TLC Foundation and also the Association for Behavioral and Cognitive Therapy.

Source: Medical News Today