A little help controlling urges to pick and pull

In the last year or two, there has been something new and exciting in the field of urge control. Specifically for this blog, that refers to the urge to pick your skin or to pull your hair. It turns out that other types of related issues, where people experience difficulty controlling an impulse to do things (like impulsive gambling, shopping, etc.) might respond as well, but it’s a little early to tell.

There is an amino acid sold over the counter at health food stores called N-acetyl  cysteine (NAC) that, when taken regularly for a few weeks, can reduce or eliminate the feeling of having an “urge” to pull or pick. Dr. Jon Grant, currently at the University of Chicago, has done much of the research in this area, beginning when he was at the University of Minnesota. NAC is usually sold in 600 mg pills or capsules, and the effective dose for suppression of urges seems to be 1500 mg to 2400 mg per day. That means taking 3 to 4 tablets per day of 600 mg each.

Most people seem comfortable taking one capsule a day for the first week, then two capsules a day for the second week, etc. until they reach their desired dose. It doesn’t seem very likely to produce noticeable side effects, either, so it’s fairly well-tolerated. In fact, this is what they give as an antidote in the emergency room if you come in with an accidental Tylenol overdose.

It’s important to recognize in this situation that having an “urge” to pull or pick is only one of the causes that make someone do this behavior. Other triggers include the way it looks (visual triggering), the way it feels (tactile triggering), feeling bored, feeling anxious, and habit due to environmental triggers (like being in front of a mirror). NAC does not seem to have any effect on pulling or picking from these triggers, as it seems specifically to reduce only urges.

So far, the research suggests that about 50% of people will benefit from trying this amino acid. Some reports suggest that people benefit. Shortly after starting, other reports suggest that make take nine or more weeks at the target dose for people to notice an effect. It seems likely that this benefit comes from the impact that NAC has on the glutamate neurotransmitter system, one that has not been targeted in most research on related things like anxiety or depression. You can bet that research on this will continue, and possibly even shift into high gear.

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