Question: I do indoor tanning about twice a week and I have been an indoor tanner for about 4 years. I am now 22. I know it’s bad for me but I like the way I look tanned and I find tanning relaxing and enjoyable. I don’t have the money to go to beach holidays but nobody gives people who go and lie on a beach a hard time so whats the difference? There are a lot of stories going on right now about people getting addicted to tanning. How do I know if I am one of them?

Iona Health Says...:

Indoor tanning has received strong attention in the media and research literature as causing more problems than damaged skin from excessive exposure. There is growing evidence that indoor tanning, involving UV radiation, may be addictive like alcohol and drugs. How does this happen?

Current research shows that indoor tanning taps in to the brain reward center like addictive substances. With indoor tanning, the same areas of the brain, i.e. brain's dorsal striatum region and the medial orbitofrontal cortex (each of which plays a role in reward and reinforcement) are activated and light up. When the brain has this type of reaction, there is a strong potential for addiction. For more information about this, go to this website:

http://health.usnews.com/health-news/family-health/cancer/articles/2011/08/15/more-evidence-tanning-beds-may-be-addictive

Other articles which discuss indoor tanning as an addiction can be found at:

http://www.newsmaxhealth.com/health_stories/addicted_tanning_beds/2010/04/20/314588.html

http://www.huffingtonpost.com/2011/08/11/tanning-beds-addictive-drugs-booze-alcohol_n_924481.html

http://psychcentral.com/news/2011/08/11/tanning-bed-addiction/28530.html

The addictive quality found in people who are indoor tanners can be easily seen in people who have skin cancer or skin cancer surgeries and continue to expose themselves to the UV radiation associated with indoor tanning. The interesting correlation, in one study cited above, showed that people who abuse alcohol and/or drugs are more likely to abuse or be addicted to indoor tanning.

How can you know if you are addicted to indoor tanning? According to one doctor, you know if you are addicted when you continue to expose yourself to damaging or harmful effects of RA radiation after you have experienced harm. In other words, addicts continue to use despite the adverse consequences of their addiction. If you do not have any adverse effects that you are ignoring, and you are able to tan in moderation, you may not have an addiction to indoor tanning.

I hope this has been helpful to you. I do appreciate your question and honesty. If I can be of service to you, please let me know.

Respectfully,

John W. O’Neal, Ed.S, MSW, MA LPC, NCC

Question: I am not very happy with my life right now. I feel like most of my day is dealing with frustrations. I am a pretty anxious person and I have a hard time making friends or other close relationships. I guess I am just not feeling very good with my life. I also have serious financial problems because the only way I know how to make myself feel ok is to go out and buy something. I never go out and buy big things that might actually make me happy, like a new phone or a vacation or things like that I just go out and buy some worthless stuff that I don’t even need, all the time. Mostly I buy stuff that is consumable or disposable in some way. It’s not the stuff that makes me feel better, just the going to the store and spending some money that lifts my mood for a few minutes. I know it is crazy to act like I do and I am going to get evicted from my apartment unless I can stop wasting all my money buying worthless stuff. I tell myself I won’t do it again but it seems to be something I can’t stop myself from doing. Especially when ever I have some free time. It is OK when I am at work but when I am walking home after work or on lunch break I will always buy stuff, everyday. I am too embarrassed to tell my family about my financial problems. I do not know what to do. I think I have an addiction to spending money.

Iona Health Says...:

You have made an important step in your recovery. First, you have identified the problem and the exact pattern of the problem. You know when it is NOT a problem and when it is. For example, you don’t need to plan on how to manage yourself when you are at work. You may need a plan to manage yourself with you are on breaks, at lunch, or have unstructured or free time. I am impressed that you recognize that you are generally anxious and struggle to establish, perhaps maintain, social relationships. To offset these uncomfortable, undesirable feelings you exercise a behavior which (1) pulls you out of the anxiety and social isolation, and (2) provides you with some euphoria by masking the inner pain you have reported. From your description, you are managing your anxiety and lack of social support by self-soothing behavior; i.e. spending money you don’t have in a repetitious way. However, by your description, you are progressing in the shopping behavior to the point where it is threatening your financial well-being and home. The difference between an undesirable habit and an addiction is “loss of control.” Only you know if you have lost control over your spending or not. If you have lost control, your assessment of your current situation is accurate. If you would like to answer some questions about whether or not you are a spending addict or would like more information about this addiction, please go to http://moonviewsanctuary.com/addiction-treatment/spending-addiction-therapy.html

Next, let’s define what shopping addiction is. Professor Ruth Engs, RN, EdD, College of Applied Health Sciences, at Indiana University, defines shopping addiction, or compulsive shopping, as: 

“ … an uncontrollable need to overspend in order to compensate for feelings of depression or anxiety, or to boost self-esteem. Shopaholics generally tend to spend well beyond their means. Often the urge to shop is a means of coping with other issues or a means of relieving stress. In that sense, shopping addiction shares has some things in common with alcoholism, compulsive gambling and overeating.”

Some ideas which have helped prevent shopping binges are:

1. Pay for purchases by cash, check, and debit card.
2. Make a shopping list and only buy what is on the list.
3. Destroy all credit cards except one to be used for emergency only.
4. Avoid discount warehouses. Allocate only a certain amount of cash to be spent if you do visit one.
5. "Window shop" only after stores have closed. If you do "look" during the day, leave your wallet at home.
6. Avoid phoning in catalog orders and don't watch TV shopping channels.
7. If you're traveling to visit friends or relatives, have your gifts wrapped and call the project finished; people tend to make more extraneous purchases when they shop outside their own communities.
8. Take a walk or exercise when the urge to shop comes on and take no money or credit/debit cards.
9. If you feel out of control, you probably are. Seek addiction counseling or a support group such as Debtors Anonymous: http://debtorsanonymous.org/.
10. Don’t keep secrets about your shopping binges. Tell someone you trust and ask for their support in changing this behavior.

Often to regain control over any addiction requires professional intervention or treatment. For more information about this, go to these links:

• http://www.interventionsupport.com/shopping-addiction/
• http://www.indiana.edu/~engs/hints/shop.html

My hope is that you recognize that this is a more common problem than might be realized and there is help. If I can be of any further assistance to you, please let me know.

All the Best,

John W. O’Neal, Ed.S, MSW, MA, LPC, NCC

Question: I steal stuff for no reason at all. Sometimes I’ll just be in some store and I’ll start feeling all tense and I’ll get this ridiculous urge to just take something and the urge is really strong. So I’ll pocket something that and I’ll walk out and I’ll feel kind of a high for a few minutes but then I’ll feel just so stupid for having done it again. Yesterday I was a drug store I go to all the time and they totally know me there and I was with my 4 year old son. I took a pair of 9$ sunglasses and stuck them on my hat, like I had been wearing them when I came in. Unfortunately, I set off the alarm when I went out. The owner is this very nice guy and I must have walked through the alarm system like 5 times while we tried to ‘figure out’ why it was going off. I was so scared and embarrassed but I was just trying to act like it was a mystery. They never clued into the sunglasses and eventually they just let it go, but I think they think I took something but since I am such a regular customer and a nice guy in their eyes, they just let it go. How do I learn to overcome these urges I have to steal? If I was arrested yesterday in front of my son I don’t know how I could have lived with myself ever again.

Iona Health Says...:

First, I would like to acknowledge you for caring enough about your child and yourself to begin problem identification. This is a major factor in problem-solving. With behaviors which cause embarrassment, shame, or loss of control are often frequented by strong denial. Individuals may rationalize impulse control behaviors, like stealing, with self-talk, such as, “Everyone steals something….I don’t need to worry about this because no one knows… If I get caught it will only be a first offense…I will never do it again… I haven’t done this in a while so it doesn’t matter,” and other minimizing, self-soothing, or rationalizing self-talk. This self-talk can serve to delay taking action for treatment.

This impulse control disorder is called kleptomania. A diagnosis only serves to give a language for clinicians and clients, and to develop a treatment plan. What we know about any behavior is it is

1. purposeful;
2. measurable;
3. predictable and
4. likely to repeat itself.
   

Any treatment plan would need to address these four aspects of this behavior.

Please note that kleptomania is not found in career thieves. However, it usually has a higher incident in women than men. It is usually out of character to steal, or as psychologists call it, ego dystonic, which means the person does not want to steal, and does feel guilty about the behavior. Two functions of this behavior are

1. an anxiety release, and
2. a temporary feeling of gratification.

Let’s discuss treatment for kleptomania. I recommend that you seek treatment for this problem is unlikely to improve without intervention; according to research literature. As you indicated, the loss of control of the behavior can result in legal, career, family, parental failure, image, and self-esteem problems. Tripping a store alarm, repeated examination by store employees/managers, and having you and your child stopped by store personnel sounds like a highly anxious and threatening situation. Remembering this incident could be used to motivate you to seek treatment as soon as you are able. Most people are reluctant to seek treatment because of their feelings of humiliation or embarrassment. Despite any reluctance, it is important that you seek help.

Treatment typically consists of, some combination of, behavioral self-control techniques, stress management, cognitive behavioral therapy, self-help groups, and medications. For additional reading about kleptomania and common medications utilized, please go to these sites:

http://www.mayoclinic.com/health/kleptomania/DS01034/DSECTION=treatments-and-drugs

http://www.brainphysics.com/kleptomania.php

http://kleptomania.supportgroups.com/

It would be helpful to have an assessment and treatment by a knowledgeable mental health professional or program. My hope is that this information and recommendation is helpful to you. You and I both recognize that this behavior threatens your future and well-being. Please do not wait to address this problem with the same rigor and honesty you have exerted in this request. If you ever need anything from me, please let me know. I wish you every success and a Happy Holiday.

John W. O’Neal, Ed.S, LPC, MSW, MA, NCC

Question: I have started chewing my fingernails again. It’s a habit I thought I had beaten as a 9 year old but in the last couple of months I have found myself back on the old habit and it just seems to be getting worse. I have an excellent job as a restaurant hostess and my personal appearance and grooming is very important, and having guests walk in the door to see me with my fingers in my mouth is not going to work at all. I have tried using the bad tasting nail polish stuff but it doesn’t work for me at all – It just doesn’t stop me. How can I beat this disgusting habit before it costs me my job?

Iona Health Says...:

Compulsive nail biting is a body focused repetitive behavior that results in the destruction of one's own fingernails and often the skin around the nails and cuticles. Nail-biting is fairly common, but for some it is more than just a bad habit. It can become quite serious, as people who suffer from compulsive nail-biting may experience bleeding, bruises, infections, or even permanent damage to the fingers. The behavior is often unconscious, and people with this compulsion may have difficulty stopping because they may be unaware of their actions. Although is considered a behavioral problem, it is classified by psychiatrists as a type of impulse control disorder.

Although some people may consider this an Obsessive Compulsive Disorder (OCD),it is more accurately described as a obsessive compulsive spectrum disorder. Many spectrum disorders are classified as impulse control disorders — where impulsivity can be thought of as seeking a small, short term gain at the expense of a large, long term loss. In your case, this problem could result in the loss of employment, self confidence, and income.

It is important to be aware that all behavior serves a purpose or purposes. Some of the purposes that nail-biting has historically provided is (1) self-soothing or calming effects, (2) stimulation which helps keep one alert or awake opposed to becoming bored or distracted, and (3) to satisfy a need for perfectionism which can involve how one appears, to include the hands and/or nails. An important first step would be to become highly aware of what or whom triggers your nail biting at work or anywhere you do it. This could be helpful in establishing how your thoughts, feelings,and behavior could be contributing to nail-biting. There is a possibility that once you understand how this behavior serves a need or condition, you may be able to substitute nail biting with a more desirable or acceptable behavior.

I would like to commend you for trying some things on your own to conquer this problematic behavior. This problem could be part of a bigger problem which may not be readily apparent. Nail biting can become compulsive and progress into a self-perpetuating behavior. The nail biting can lead to anxiety and shame which can result or perpetuate more of this behavior.

What can you do to stop your nail biting? Initially, people who engage in nail biting do not consider it a real disorder so do not often seek help. However, when these people feel out of control and crazy with their nail biting, they may not know what kind of help is needed should they seek it out.

The good news is that nail biting responds very well to therapy and medications. SSRIs have generally become the preferred medication for anxiety disorders, including nail biting. SSRIs have less side effects than other forms of antidepressants, less withdrawal symptoms, less danger in the event of an overdose and overall are considered safer that other types of drugs Common SSRIs include Prozac, Luvox, Zoloft, Paxil, Celexa, and Lexapro.

Medications should not be considered a stand alone treatment for nail biting. Because it does fall into the obsessive compulsive spectrum, excellent results have been obtaining by utilizing Cognitive Behavioral Therapy (CBT) augumented by the use of medications. It is highly advisable that you consult with a psychotherapist trained in the use of CBT with impulse disorders and who has access to a doctor who can accurately prescribe medications, if needed, for you.

Please consider taking advantage of the free support groups on this site for people with self-mutilating or who are on the obsessive compulsive spectrum. Good luck in managing a very managable problem. If I can be of further help to you, please let me know.

All the best,

John O'Neal, Ed.S., LPC, NCC