Understanding Body-Focused Repetitive Behaviors

To this day, Katie Koppel, a 23-year-old recent college graduate who lives in Boston, still remembers the exact moment she first pulled out her hair. She was a bored 7-year-old, sitting in front of the television. Mindlessly, her fingers wandered to her face and landed on her eyebrows. "I pulled out half my eyebrow in a couple of hours," Koppel recalls. "I just remember looking into the mirror and seeing what I had done, and not understanding what had just happened. I felt this tremendous sense of fear." Koppel's pediatrician thought her hair loss might be caused by lupus. Her parents were stymied. Nobody thought to ask Koppel – who by then had begun shutting herself in closets for hours at a time, yanking at her face and scalp with swollen fingers – if she was pulling her hair out herself. Eventually, Koppel's mother did a Google search for "unusual forms of hair loss."

She discovered a clinical term for her daughter's condition: trichotillomania. Trichotillomania is a condition in which individuals feel the compulsive urge to tug out their body hair. Leg hair, scalp hair, arm hair and armpit hair are all fair game, as is facial hair, eyelashes, chest and pubic hair. However, Koppel and her mother would soon learn that trichotillomania falls under an even broader umbrella of little-understood disorders called body-focused repetitive behavior, or BFRBs. These are behaviors that involve compulsively damaging one's physical appearance – picking at skin, pulling hair, biting nails and even chewing one's lips or the inside of the cheeks. But wait – doesn't everyone pull their hair or pick their skin from time to time?

According to Dr. Nancy Keuthen, a professor of psychology at Harvard Medical School and co-director of the Trichotillomania Clinic at Massachusetts General Hospital, individuals with BFRBs "have tried repeatedly to decrease or stop. [Their behaviors] cause distress and impairment in functioning," she says. "All of us do some skin picking or hair pulling, whether you're going to admit it or not, but the people who come in for treatment are the people who are seeing significant tissue damage or hair loss." About 1 to 3 percent of the population is thought to have trichotillomania, and about 1 to 5 percent is thought to have a skin picking condition known as excoriation disorder. The people who have this clinical level of the diagnosis, Keuthen says, will often start picking or pulling around puberty – although they can also start earlier or later in life. Both men and women struggle with BFRBs, although women are more likely to seek treatment. Patients with BFRBs might spend an hour or more a day picking, pulling, biting or thinking about it. They'll constantly try to manage their urges – which might negatively affect their relationships, friendships, family functioning and focus at school or work. There are also medical and cosmetic concerns. Those who pick at their skin might experience infections and scarring. Individuals who pull out their hair might find it difficult to grow back. In rare and extreme cases, people can pick down to the muscle or dig away at their nose so much that their septum collapses. And, of course, like many psychological conditions, trichotillomania, excoriation disorder and other related behaviors are accompanied by stigma. BFRBs are "disorders of isolation and of shame," says Koppel, who wears a wig to hide her hair loss. "I think in a lot of ways that's more damaging than any more physical or medical consequences could ever be. Every single person I know with trichotillomania has, at one point, felt like they were the only one who did this.

They didn't know it had a name, they didn't know it was diagnosable. And people were reinforcing that shame by telling them [they] could stop if they wanted to." Men with trichotillomania often escape scrutiny by shaving their heads or beards. With women, who tend to have longer hair, it's a little harder to hide. And those with excoriation disorders will often pick at areas covered by clothing or wear garments to conceal their marks. So why do people pick and pull? Doctors are still trying to figure that out. Trichotillomania and excoriation disorder are both listed in the Diagnostic and Statistical Manual of Mental Disorders; both are considered obsessive-compulsive spectrum disorders, though they're unique from OCD. (Nail biting, lip chewing, nose picking and other behaviors aren't yet listed; they aren't as often reported, nor are they as widely studied.) "OCD is really all anxiety-driven," says Carol Mathews, a professor of psychiatry at the University of Florida. "You feel a sense of relief when you've acted on your compulsion, but you don't feel a reward. With hair pulling, you feel a sense of relief, a sense of reward, if you got the right hair or you got that scab." Mathews adds that OCD is usually accompanied by obsessions – fears of contamination, or a thought that you might harm someone. Compulsions are in direct response to those thoughts. But rather than being triggered by thought, hair pulling and skin picking are driven by urges. "It's a very physical act," Mathews says. "There are mental compulsions that you can have with OCD, but it doesn't have to be a physical compulsion." BFRBs feel different for everyone. Some people feel an increased sense of tension or anxiety before they pick or pull, and a feeling of relief after. Yet others pick or pull – almost in an absent-minded manner – when they're understimulated or bored. And many individuals engage in both hair pulling and picking; Keuthen says that up to half of people with trichotillomania also have excoriation disorder. "They're kind of kissing cousins," she says. Angela Hartlin, a 29-year-old from Dartmouth, Nova Scotia, who has excoriation disorder, finds she's more prone to picking while dealing with stress.


Her skin picking "was personally driven by anxiety," Hartlin says, who once picked at her skin for hours a day and has experienced both infections and scarring. "I found it calming. So calming down the anxiety is something I have to do as part of my self-care routine. You have to know your own specific triggers and counter them." Hartlin eventually recognized her triggers. But it took help from a professional therapist, who started working with Hartlin after she appeared on a television show to talk about her experience with excoriation disorder. For years, Hartlin couldn't find help. Both Hartlin and Koppel faced a common problem that many patients with BFRBs experience – a difficulty finding a medical provider who understands their conditions. Many physicians have little clinical understanding of BFRBs and aren't trained to treat them. Or they'll mistakenly diagnose excoriation disorder or trichotillomania as an unrelated skin or psychological disorder. There are experts out there who treat BFRBs. But if you have a BFRB and don't live near a major hospital, your best bet is to seek a therapist who specializes in cognitive behavioral therapy, says Dr. Jon Grant, a professor of psychiatry at the University of Chicago. They should be well versed in these behaviors and can hopefully tailor their approach to fit your needs. Antidepressant medications like SSRIs, or selective serotonin reuptake inhibitors, are often prescribed for individuals with BFRBs. But although they might help with anxiety and depression – which, in turn, might alleviate skin picking or hair pulling – Grant says they show little efficacy for treating conditions like trichotillomania and excoriation disorder. However, studies have indicated that a pharmaceutical drug and nutritional supplement called N-acetyl cysteine might reduce patients' urges to pull or pick.

 Even then, treatment is highly individualized for each patient. Some people might respond to cognitive behavioral therapy, which teaches patients to recognize their thoughts and behaviors and change them. Yet others might not be motivated enough to fully engage in a series of sessions. N-acetyl cysteine might yield improvements in one individual, but not another. Bottom line? What works for you might not work for someone else – and vice versa. For instance, Koppel has not found much success with cognitive behavioral therapy, but she did once stop pulling for six months after trying hypnotherapy. And Hartlin didn't notice much of a difference with N-acetyl cysteine, but she greatly benefited from therapy. Is remission possible? Experts and patients alike agree it is – although "remission" might not necessarily mean that you'll never pick or pull again. Some people are able to stop completely. But you shouldn't be too hard on yourself if you occasionally find your hand straying toward your face or scalp, Grant says. Hartlin agrees. "Recovery is possible, but you need to accept yourself and where you're at with picking or pulling. Loving who you are will enhance your life," Hartlin says. "I'm in a state of recovery now where I … still have urges, but I can emotionally work through them." Hartlin still occasionally finds herself picking – but after many years, she says she's finally able to wear shorts for the first time.

She also finds it rewarding to spread awareness of BFRBs; she's formed support groups, and her memoir, "Forever Marked: A Dermatillomania Diary," recounts her years of struggle. And Koppel – who recently authored her own memoir – found her greatest source of solace through the Trichotillomania Learning Center, which was founded in 1991 to provide advocacy, awareness and support for individuals with trichotillomania. Since then, it has expanded to include those with other BFRBs. While Koppel isn't in "remission" per se, she is actively seeking treatment. Most importantly, she's no longer ashamed. "What I really attribute my emotional healing to is the Trichotillomania Learning Center's conferences," Koppel says. "I finally realized for the first time that I wasn't alone. It's one thing to read an article on the Internet, but another to be surrounded by people in a room who are going through the same experiences you are. That really drove things home in a way nothing else could."

Girl with hair loss condition puts unique twist on 'Crazy Hair Day'

A 7-year-old girl who lost her hair from Alopecia celebrated "Crazy Hair Day" at school-- with bling. In January, Gianessa Wride of Salem, Utah, began to lose her long brown locks. Her mother, Danielle Wride, first noticed a bald spot on the right side of her head. Extremely concerned, she scheduled an appointment with dermatologists. But before they could see a doctor, almost all of Gianessa's hair had fallen out. Danielle ended up cutting off the remaining bits.

So when Crazy Hair Day-- now called Crazy Head Day-- came around at school, Gianessa's mom came up with a creative way to help her daughter celebrate. Gianessa doesn't wear wigs because they make her head itch. She usually rocks beanies, hats, and scarves. But for the spirit day, her mom had something better in mind. Danielle got fancy with jewel stickers and decorated her head with pretty floral and owl designs.

The bling bling was a major hit with her classmates. Danielle tells FOX 5 DC Gianessa even won the award for best look in her class-- which we think was well deserved. Gianessa suffers from an autoimmune disease called Alopecia areata. The disorder causes the immune system to attack hair follicles, which results in hair loss. Danielle told FOX 5 they stopped seeing the dermatologist, mainly because there are not many treatment options and the side effects aren’t something they want to subject their 7-year-old to. "When she gets older, she's welcome to go down that road, and we will support her just like we are now," her mom said.

When Gianessa was first diagnosed, she didn't fully understand that all her hair would fall out, but her supportive parents helped her see that she is just like any other kid. "Some people have blonde hair or black hair, some have curly hair, straight hair, short hair, long hair. She just doesn't have any hair. And she is still fabulous!" her mom said. Bald is beautiful! We admire Gianessa for rocking her confidence so beautifully. For other parents or anyone going through a situation that makes you feel like you're less of yourself, Danielle says to keep going. "You are still amazing. Whatever you want to do put all of your effort into it, have a positive attitude, and you can obtain whatever goal you wish. Don't let it hold you back. Just put your best self forward and everything else will fall into place."

FDA Warns of 14 ‘Fraudulent’ Cancer Cure Companies

The claims seem remarkable. "If a person eats 6-12 apricot kernels per day, they will never have to worry about cancer," one site says. "Silymarin also seems to have anticancer properties. It can stop cancer cells from multiplying, kill cancer cells, and block their blood supply," says another. They're also false, the Food and Drug Administration says. It's warned 14 companies to stop making claims about herbal products and other treatments marketed to treat or prevent cancer. They cannot and some may be dangerous, the FDA says.

"These companies used slick ads, videos, and other sophisticated marketing techniques, including testimonials about miraculous outcomes," the FDA's Donald Ashley and Douglas Stearn wrote in a blog post. "Often a single product was promoted as a treatment or cure for multiple diseases in humans and animals." The FDA has listed the 14 companies on its website and detailed the false claims they have made about their products, which include herbs, tinctures, supplements, teas and salves. The claims range from curing cancer to "detoxifying" the liver. t's illegal to make such claims without proving they are true and going through the FDA's process for verifying them. Just putting a little disclaimer at the bottom of an ad saying the FDA has not verified the claims doesn't cut it, the agency said.

"Hoping to skirt the law on a technicality, some sellers made false claims and then in small print provided a disclaimer that their products are not intended to diagnose, treat, cure or prevent any disease," Ashley and Stearn wrote. "Making such obvious claims and then saying later that you are not doing so might seem clever, but the technique does not comply with federal laws intended to protect public health." The companies are taking advantage of frightened cancer patients and their loved ones, said consumer safety officer Nicole Kornspan. And they make a lot of money doing it. Americans spend $30 billion a year on alternative therapies.

"Anyone who suffers from cancer, or knows someone who does, understands the fear and desperation that can set in," Kornspan said in a statement. "There can be a great temptation to jump at anything that appears to offer a chance for a cure." They especially take advantage of people's tendency to believe that "natural" cures and treatments are better than those developed by commercial pharmaceutical companies. But they're not only a waste of money — they can contain harmful ingredients.

For instance, "Everything Herbs" was advertising apricot kernels, which contain deadly cyanide. Apricot seeds were the basis for laetrile, an unproven but popular "alternative" cancer therapy sold online and in overseas clinics since the 1970s, despite much evidence it is worthless. "Contained within these kernels is a very small amount of a substance called nitriloside amygdalin. It goes directly to a cancer cell, stings it, and kills it," the FDA quoted the "Everything Herbs" site as saying. The website was down for repairs when NBC News investigated and a call to the firm's phone number yielded a voicemail saying the entire company was on vacation. Another site, DoctorVicks.com, sells a variety of herbs and supplements, including silymarin, also known as milk thistle. "Milk thistle's main ingredient silymarin has been found to support the liver in wondrous ways. It can help fix the damage done to the liver by alcohol or Tylenol, and can protect the liver from future damage," it claims. There is a compound that can help the damage done by Tylenol overdoses — it's called N-acetylcysteine (NAC) but it must be given immediately and by a medical professional.

Some studies have suggested silymarin may be helpful but it has not been approved and the dose has not been established. Dr. Vicks did not immediately respond to a request for comment from NBC News. The FDA has given the companies 15 days to come up with a plan to comply with FDA orders. The agency can prosecute and fine the companies and even seek prison terms. "The message to consumers is this: These products are untested. Some contain ingredients that may be a direct risk to your health," the FDA said. "The ingredients may interact in a dangerous way with professionally-prescribed treatments. They are not a substitute for appropriate treatments. Using these products can waste your money, and, more importantly, endanger your health."

Preventing Hair Loss From Chemotherapy

For many women, one of the first and scariest thoughts when diagnosed with breast cancer is not about the loss of their breast, but about losing their hair. A 2010 survey found that nearly half of breast cancer patients feel that hair loss is the most traumatic side effect of chemotherapy, with some experiencing less distress over losing their breast than their hair. And 8 percent of the women polled would choose to forego chemotherapy because it meant losing their hair. It's not hard to understand why hair loss can be so emotionally devastating. For many women, hair is an important part of their identity and sexuality, and losing it diminishes their sense of self. Hair loss can also take away your privacy – since it's such a very visible and constant reminder that you're sick with cancer. Unfortunately, until recently, most American women did not know about nor have access to a treatment that helps prevent chemotherapy-induced hair loss. Cold caps have been used in Europe for more than 40 years, and in 2015, a newer scalp cooling technology, called DigniCap, was Food and Drug Administration-cleared for use in the U.S. Two studies published recently in the Journal of the American Medical Association found that approximately half the women who used this scalp cooling device were able to keep more than 50 percent of their hair while undergoing chemotherapy. The news was even better for women receiving taxane-based chemotherapy (Taxol, Taxotere and Abraxane), with two-thirds of women able to preserve more than half their hair. According to hair experts, that 50-percent mark is important because hair loss isn't noticeable to other people until more than half of it is lost.

How Scalp Cooling Prevents Hair Loss

The hair-making cells, called hair follicles, are very sensitive to chemotherapy. Cold caps and scalp cooling systems keep the scalp cold, which narrows the blood vessels, reducing the amount of the chemotherapy medicine that reaches the hair follicles. It also decreases the activity of the hair follicles, slowing down cell division and making the follicles less affected by the chemo treatment. To be effective, cold caps need to be worn for a period of time before, during and after a chemotherapy treatment. It's also important for a cap to be tightly fitted to ensure it's coming in contact with the entire scalp.

Weighing Your Options

There are two different types of devices used for preventing hair loss: cold caps and scalp cooling systems. Cold caps are similar to ice packs and are kept in a special refrigerator before they're used. Because they thaw during a chemotherapy session, they have to be replaced with a new cap every half hour. It's difficult to change the caps on your own while having an infusion, so another person is usually needed to help with the process. Both the caps and fridges are usually rented by the patient. The cost depends on the number of chemotherapy sessions needed and how many months of treatment is involved. A typical cost for these caps is about $500 per month. Depending on your insurance plan, the cost of renting the cap may be covered. There are also charitable programs that provide financial assistance to women who can't afford to pay for a cold cap. Scalp cooling systems are a newer computer-controlled cap device attached to a small refrigeration machine that circulates coolant throughout the chemotherapy session, eliminating the need to change caps during the treatment. As mentioned earlier, DigniCap has been FDA cleared; another, the Orbis Paxman System, is pending FDA clearance. These systems are owned by a limited number of cancer treatment centers around the country and offered at a cost to patients receiving chemotherapy. Patients are usually charged between $1,500 and $3,000, which may or may not be covered by insurance.

Results and Side Effects

The results of scalp cooling treatments vary and, for some women, they are not that effective. An important factor is the type of chemotherapy and the dosage you're taking. Studies have found that women who are given only taxane chemotherapy have far better results than those who get only anthracycline-based chemotherapy (Adriamycin, Ellience and daunorubicin). Hair type may also impact hair loss. There is some evidence that women with thicker hair may not respond as well to scalp cooling as those with thinner hair. This may be because thicker hair prevents the scalp from getting as cold as it needs to be for the treatment to be effective. It's essential that the caps be tightly fitted and cover the entire scalp. If not, hair loss can occur in the areas where the cap is not close enough to the scalp. There can also be some discomfort when using both cold caps and scalp cooling systems. Reactions can include cold-induced headaches, chills and neck and shoulder pain. Additionally, there are some concerns about the risk that the caps prevent the chemotherapy from fully killing off the cancer cells that might be in the scalp, and therefore put women at risk for a future cancer. However, many studies in Europe where it's been used for decades have not found any increased risk of cancer in the scalp after the use of the caps, and the FDA considers such cases extremely rare. If chemotherapy is part of your treatment plan and preventing hair loss is important to you, make sure to discuss the options with your physician before chemo begins. Ask about the effects that your chemo regimen and hair type might have on the results, as well as whether a scalp cooling system is available at your treatment center and their success rate in preventing hair loss. And make sure to find out whether your insurance covers any of the costs so you're not stuck having to pay unexpected bills. If hair preservation is not possible or the right choice for you, but you feel that hair is important to preserve some sense of normalcy, there are wonderfully styled wigs that are far more natural looking and comfortable than in the past. Many are available at a low cost, but high-quality human hair wigs can be pricey. Some women find scarves and turbans work best for them and can get very creative with their design, while others discover a sense of empowerment and beauty in baring their bald head.

7 fitness and diet apps to help make you healthier

If we told you getting fit was as easy as downloading an app, would you believe us? While you actually have to use the applications to see results, there are plenty of innovative options that can help you tackle your health and wellness goals. Whether you're a fitness novice, a marathon runner, or fall somewhere in between, the best workout apps target your specific needs for a personalized diet and/or exercise experience.

Calorie Counter and Diet Tracker by MyFitnessPal Free-$10 MyFitnessPal is a calorie counter and so much more. The database has over four million foods (and is still growing) — you can look up your eats by scanning the bar code, or use the recipe calculator for your own creations. It will also track your activity and help you set up a custom plan based on your goals. Want to know how many calories you burned cleaning the kitchen? It'll tell you.

Strava Running and Cycling Free-$6 Whether you use it for running or cycling, Strava allows you to track your time, distance, speed, and cadence while also recording elevation changes. And there's a competitive aspect to it too. You can try to outdo your best record and the records of other users. The large active user base means there's always plenty of competition on the leaderboard. FitStar Personal

Trainer Free-$5 From full gym routines to quick at-home ab workouts, FitStar Personal Trainer has whatever you want. Like with actual personal training, you start with a fitness test to begin at a level that's right for you, and after each workout, the app asks you questions to help tailor the next workout to better suit your needs. Complete with instructional videos and audio tracks, it really is a personal trainer in your pocket.

Lose It! Free-$40 per year With an extensive database of grocery items, recipes, and restaurant meals, Lose It! is still one of the top apps for weight loss. Not only does it track your food (calories and nutritional value) and activity to set up custom plans for you, but it's also a community. You can share recipes, exercise routines, and motivation with your friends. It gives you all the information you need in easy-to-read graphs and easy-to-follow instructions. Plus, it reminds you when you forget to log your food, which never hurts.

ClassPass $40-$115 per month Not a member of a gym? No problem. Depending on which plan you buy, ClassPass gives you access to a variety of different workout classes like spin, barre, yoga, and even hot Pilates — all of which you can see and schedule conveniently from your phone.

Fooducate Free-$2 Navigate the grocery store aisles with ease. Simply scan an item bar code to receive the nutritional information and the fine print you would otherwise miss (e.g., additives, preservatives, and no-no ingredients like high-fructose corn syrup). Scan something that's not such a good choice, and Fooducate will provide some healthier alternatives. And for produce and other items without bar codes, just type them in, and the app will deliver all the pros and cons plus a quick-reference letter grade from A to D-. It'll also look out for and alert you to allergens if necessary.

HealthyOut Free This app makes it easy to eat out without undoing your diet. Find local restaurants in your area (you can filter by cuisine and type of dish), enter your dietary preferences and restrictions (e.g., low-fat, low-calorie, gluten-free, heart-healthy, Atkins, Paleo, etc.), and the app will do the rest. It'll note the healthiest choices on the menu, break down all the nutritional information, and suggest modifications to make your order even better.

7th-grader's science project finds cancer-fighting chemicals in green tea

Stephen Litt has been conducting science experiments since he was in first grade. Every year, the projects became more and more complicated — until finally, as a 7th grader, he came across something that gained national attention. The 12-year-old boy from Marietta, Georgia, discovered evidence that chemicals in green tea may have cancer-fighting potential. For this year’s science fair project, he tested epigallocatechin-3-gallate (EGCG), an antioxidant in green tea, to determine whether it could prevent breast cancer tumors in planaria, a type of flatworms. The research, which was part of his award-winning project for the Georgia Science and Engineering Fair, earned the boy praise from scientists across the country.

He was even invited to go on a private tour of the Allen Discovery Center at Tufts University while on spring break in Boston two weeks ago. “It’s not a cure for cancer,” his father, Lesley Litt, who trained as a chemist and assisted with the project, told CBS News. “What he found is a way to prevent cancer in these worms from those specific carcinogens. Their DNA is not the same as humans, but a professor at Tufts and a few others, they want to know what’s going on — they want to help.” Stephen was originally interested in researching the malaria virus after reading about it in class back in October. “I said, ‘Uh, no, we can’t bring that stuff into the house — it’s dangerous,’” his father said. Around that time, two close family friends were diagnosed with breast cancer. That’s when Stephen shifted his focus. “He started reading about cancer, specifically breast cancer,” Litt explained. “He found an article about how the Japanese might have lower cancer rates because of green tea. He then read an article in Live Science about green tea’s anti-cancer secrets.”

The article noted that in Japan, where green tea consumption is high, prostate and breast cancer rates are about three times lower when compared with the United States, according to the World Health Organization, although many other factors may play a role. Is there really a connection between green tea and fighting cancer? Stephen had to find out. So the boy, with help from his father, set up a lab in his house. Stephen ordered 100 planaria, which he divided into 4 groups. Each group was exposed to a different substance over the course of four weeks. One group was exposed to EGCG; the second group was exposed to EGCG for 24 hours and then two carcinogens (Stephen’s dad handled the hazardous stuff); the third group was exposed to the two types of carcinogens; and the fourth — as a control group — was only exposed to spring water. Carefully, Stephen studied the changes the worms experienced, documenting every tumor grown over the month-long period.

By the end of the experiment, Stephen determined that the worms exposed to EGCG and carcinogens didn’t grow any tumors, proving the antioxidant may actually help fight cancer growth in worm cells. “We’re very far off from finding a cure for humans,” Litt clarified. “But this really does advance the research and give us more insight into what’s going on with human cancer cells.” While it’s a good start, Litt says his son’s study is just beginning. Next year, he’s hoping to get a better microscope and hopes to transplant real breast cancer tissue into these worms. “He could use another year or two, hopefully at a unviersity lab,” said Litt, explaining that his future research will become more complicated. In the mean time, Stephen has plenty to keep him busy. Not only is he a straight-A student, he’s a Boy Scout, working on becoming a black belt in karate, he plays tennis, and he’s one of the top oboe players in the state. “Sometimes he even has time to play on his computer,” Litt said. His parents couldn’t be more proud of the aspiring chemical engineer, especially with his most recent science experiment. “He got results, which you don’t always get,” Litt said.

Meet The Inspiring Woman Embracing Her Alopecia, Even On Her Wedding Day

Kylie Bamberger looks every bit the blushing bride in her wedding photos. She’s wearing a white ball gown, clutching a bouquet of sunflowers and gerbera daisies, flanked by beaming bridesmaids. But there’s one major thing that sets her apart from typical brides: Bamberger is totally bald. Bamberger, 27, has alopecia universalis, an autoimmune disease that attacks hair follicles and causes total hair loss all over the body, including the head, eyelashes, eyebrows, and all body hair. She hasn’t worn a wig or covered up her head for more than five years.

“Being blonde is not who I am,” she says. “I don’t identify with my hair color." When you consider that a bad haircut is enough to send many women into a downward spiral, the fact that Bamberger rocks no hair at all is inspiring. Still, her path to self-acceptance and the unshakeable confidence she boasts today had its ups and downs. Bamberger, who lives in Los Angeles, first noticed a quarter-size bald spots at age 12. Doctors diagnosed her with alopecia areata, which causes hair to fall out in round patches. Three years later, with no warning, her hair began falling out in clumps while showering. “It felt like when you run your hand through a box of yarn,” she says. “I just remember going, ‘This is not normal.’” That was a Monday; by Thursday morning, she no longer had enough hair to pull into a ponytail. The teenager tried cutting her hair short and wearing hats, but eventually shaved her head and started wearing wigs. In college, she would work in the morning wearing a blonde wig, and change into a red wig before class.

Though wearing wigs made her look more conventionally “normal,” Bamberger hated them. “Just walking across campus, it would be so hot that I would take my hair off and dry it under the blow dryers in the women’s bathroom, because I would sweat underneath it," she says. "That was my lifestyle.” One day, she forgot to put her wig back on before class. “I just walked in…I was like, ‘Well, this is me!’” she says. That day, she finally dropped what she calls her phase of being two different people: a blonde and a redhead. The transition from bewigged to bald at times dampened Bamberger's spirits, and often left her frustrated. She felt self-conscious about her appearance, especially when people would stare and ask uncomfortable questions.

To her horror, sometimes she was mistaken for a man in the women's restroom, and on more than one occasion, she was called a skinhead. The turning point in Bamberger's evolution came during collegiate soccer season. Her teammates were out to win games, not to gossip about someone’s hair (or lack thereof). On the field, she developed mental toughness, and discovered her personal power pose: "resting bitch face," as she calls it. Her icy stare intimidated players on opposing teams—and in everyday life, silenced rude whispers about her baldness. “If people were staring, I would stare back," she says. "If you’re going to go out bald, you have to have the confidence to own it. You’re not offending anyone.” Today, Bamberger—who works full time for her family's British food imports business—spreads awareness about alopecia through modeling and motivational speeches. She also promotes self-acceptance and self-love on social media.

In March, she participated in #WhatIModel, a joint social media campaign from Health and Sports Illustrated Swimsuit celebrating body diversity and positivity. Her video was among the most popular of the entire campaign, amassing more than 80,000 views. “I model acceptance. I model the ability to show your inner beauty, and that you don’t necessarily need all of this to have all of that,” she says in the video. “When I lost my hair, I was so focused on what I had lost, that I hadn’t necessarily realized what I had gained. I had gained the ability to finally love myself…. No one should ever be alienated because of the way that they look.” The stares and uncomfortable questions still happen, but Bamberger says she also receives compliments and, sometimes, even hugs. She’s come to appreciate the attention she gets while walking her bald. “As much as random hugs in the grocery store might not seem appealing, there’s something about the power of a hug, where even if it might not benefit me, that person who had to give me a hug really feels good about it," she says. "If I can be—as my husband calls me—the tortilla chip to their guacamole, if I can be the carrier for that good feeling, then let’s promote good feelings."

Ultimately, she hopes being bald can become as accepted as trends like unicorn hair are now. First, though, must come more acceptance, which she hopes she can have a hand in fostering. “Hair loss doesn’t make you unhealthy, and it doesn’t make you ugly,” she says. “Those are two massive, massive misconceptions. I am not sick. I’m only stronger. If you’re out there, bald, it just means you’re becoming stronger. If you’re out there embracing your bald, you’re stronger. Period.”

Doctors still divided on when women should start mammograms

Despite what the American Cancer Society and other health organizations advise, many doctors still recommend routine mammograms to screen for breast cancer in younger and older women, a new paper suggests. Experts are divided on whether more screenings are beneficial. The American Congress of Obstetricians and Gynecologists recommends annual mammograms starting at 40 for all women, whereas the US Preventive Services Task Force recommends biennial mammograms starting at 50 for all women. In 2015, the American Cancer Society updated its guidelines to recommend that women with an average risk of breast cancer have the option to start screening with a mammogram every year starting at age 40, and should undergo regular mammogram screenings starting at age 45. n the new paper, many of the primary care physicians and gynecologists surveyed said they still recommended screening for women ages 40 to 44 last year. The paper was published in the journal JAMA Internal Medicine on Monday. "All guidelines agree that discussions about mammography should begin at age 40. There is universal agreement on this age.

Where the difference comes is the age at which screening should be recommended without the need for an informed decision," said Dr. Richard Wender, chief cancer control officer of the American Cancer Society, who was not involved in the new paper. About 12% of women born in the United States will develop breast cancer at some time during their lives, according to the National Cancer Institute. The new paper involved data on 871 primary care physicians and gynecologists in the United States who self-reported their breast cancer screening practices in a mailed survey from May to September 2016. The data came from the Breast Cancer Social Networks national survey, which included physicians who were randomly sampled from the American Medical Association's physician masterfile. Overall, 81% of physicians who completed the survey recommended screening for women 40 to 44; 88% for women 45 to 49; and 67% for women 75 and older. "Our results serve as a benchmark for breast cancer screening recommendations as guidelines continue to evolve," said Dr. Archana Radhakrishnan, a researcher at Johns Hopkins Medicine in Baltimore and lead author of the new paper. "Despite changes to guidelines, doctors are continuing to recommend routine mammograms to both younger and older women," she said. "The recommendations varied depending on physician specialty; gynecologists were the most likely to recommend screening." Among the physicians in the paper who recommended screening, 62.9% recommended annual examinations for women 40 to 44, 66.7% for women 45 to 49 and 52.3% for women 75 and older. "I trust the results of the paper. The response rate was high for a survey. The distribution of specialties was reasonable and clearly reported," Wender said. Dr. Mitva Patel said that she not only recommends annual screenings for women 40 and older, she follows those guidelines herself. "I am 42. I have had my annual mammogram at age 40, 41 and 42," said Patel, a breast radiologist at the Ohio State University Comprehensive Cancer Center, who was not involved in the paper.

She added that the American College of Radiology and the Society of Breast Imaging both recommend yearly screenings for women 40 and older. "I put myself in patients' shoes when I make a recommendation as a doctor, and I say, 'this is what I would do for myself,' " Patel said. "There are so many different recommendations, and it can be confusing. So it's important for patients to make their decision for screening with their primary care physician, and I'm encouraged that this study shows most primary care physicians still believe in annual screening starting at age 40." Guideline groups bring different perspectives and weigh different types of data differently, said the American Cancer Society's Wender. "Screening guidelines will constantly change in response to the emergence of new evidence. This is a good thing. As we learn more, we can refine guidelines based on new information. That's why it's important to keep updating guidelines. Groups are asked to balance the risks and benefits of a screening test," Wender said. "Ultimately, there is no perfect answer. Guideline groups must bring their own values into the recommendation. Breast cancer is a good example," he said. "The risk of developing breast cancer steadily increases as a woman gets older; that makes it very hard to choose one starting age that is right for everyone. That is why shared and informed decisions in younger women are recommended by some of the groups."

 Neither the American Cancer Society nor the US Preventive Services Task Force recommend routine mammograms for women 40 to 44 because they are more likely to offer downsides than benefits, according to an editorial published alongside the new paper in the journal JAMA Internal Medicine. Drs. Deborah Grady and Rita Redberg, professors at the University of California, San Francisco School of Medicine, co-authored the editorial. Potential risk factors that can come with mammograms are overdiagnosis, in which a cancer that would otherwise never cause symptoms or death is found, and false-positive results, in which a patient could unnecessarily experience anxiety and take on the discomfort and financial costs of additional tests, such as a biopsy. "One important issue is that payment systems in the United States typically reward ordering tests and procedures over taking the time to talk to patients about risks and benefits. The fear of litigation is often mentioned as a reason for unnecessary testing," Grady and Redberg wrote in their editorial. "Other excuses range from the influence of many decades of hype in the general and medical media, the idea that early treatment must be good, that knowing is better than not knowing, the allure of doing something rather than nothing, and the conviction that patients like more testing," they wrote. "Limiting coverage of tests known to be harmful is a win-win for patients and the national health care system." Grady and Redberg pointed to the US Preventive Services Task Force's recommendations to screen women 50 to 74 every other year as the appropriate guidelines to follow.

Dr. Andrew Kaunitz said he encourages his patients begin screening every two years at age 50, which is consistent with the US Preventive Services Task Force's recommendations. "There are many factors explaining differing recommendations," said Kaunitz, professor and associate chairman of the University of Florida's Department of Obstetrics and Gynecology in Jacksonville, who was not involved in the new paper. "Clinicians are concerned that if they do not recommend starting screening earlier and they have a patient diagnosed with breast cancer at a young age, they may be sued," he said. "Although the best evidence indicates the benefits of screening mammograms are in fact quite limited, breast cancer advocacy organizations have been vocal and effective in convincing the public as well as health professionals that screening mammograms have major unequivocal health benefits. This makes it hard to move away from recommendations to start screening early." Similar to the findings in the new report, a previous study found that 75.7% of primary health care providers reported screening practices in excess of those recommended by the US Preventive Services Task Force. That study was published in the Journal of General Internal Medicine last year. "From my experience, working with patients, most say that they want to catch the cancer early. They'd rather find out," said Patel, the breast radiologist. Although most breast cancers are found in women 50 and older, about 11% of all new cases of breast cancer in the US are found in women 45 and younger, according to the Centers for Disease Control and Prevention. "These women who are diagnosed in their 40s, their cancer can be more aggressive," Patel said.

Even if a woman receives a false-positive screening result, Patel said, the anxiety that woman may feel is often short-lived, and as for the risk of overdiagnosis, there seem to be conflicting data on how often breast cancers are overdiagnosed. "Overdiagnosis is a difficult concept for clinicians and patients to comprehend," said Kaunitz, who wrote a commentary in the journal OBG Management last month reporting that more than one-third of tumors found during breast cancer screenings represent overdiagnosis. Some studies suggest that less than 5% of screened breast cancers are overdiagnosed while others suggest that more than 50% are overdiagnosed. "So, there's a lot of talk about all these different risk factors, and some of these societies are placing more emphasis on one of these areas, whereas we should focus on saving the most number of years of life, which comes with early detection," Patel said. "Rather than emphasizing the negative aspects of screening such as cost, anxiety or overdiagnosis, we should focus on the most important benefit of early screening, which is early detection and the number of years of life this can bring to the patient," she said. Some experts argue that more research is needed to help inform recommendations.

"We are continually understanding more about breast cancer screening -- about who should get them, the different age groups of women who really benefit from it and how frequently women need to have mammograms," said Radhakrishnan, lead author of the new paper. "The guidelines are continuing to evolve, and there is more similarity now between the American Cancer Society and US Preventive Services Task Force guidelines," she said. "American Congress of Obstetricians and Gynecologists also reports convening a group to look at their own breast cancer screening guidelines. Amidst all of these changes, we need to make sure that both women and physicians are made aware of what the recommendations are."

5 Foods That Can Boost Your Mood and Make You Happier

1. Raw Walnuts and Cashews An ounce of walnuts has four grams of protein (which fills you up and helps keep blood-sugar levels steady) and two grams of fiber (also helps fill you up), according to New York nutritionist Elisa Zied, registered dietitian and author of "Younger Next Week." They're also a good source of magnesium and phosophorus: Having low levels of magnesium has been linked to increased risk of depression, while high levels of magnesium have been linked to reduced symptoms of depression. Walnuts also contain cell-protecting antioxidants and are low in carbohydrates, which means they won't cause a spike in blood sugar and insulin. "Insulin spikes are a reason people's moods crap out, particularly in late afternoon," said Dr. Drew Ramsey, assistant clinical professor of psychiatry at Columbia University College of Physicians & Surgeons and co-author of "The Happiness Diet." Suggested serving: One handful

2. Kale One cup of kale is an an excellent source of vitamin A, vitamin C and vitamin K and magnesium, and a good source of fiber, said Zied. Kale is also high in copper, a trace mineral that works to support many vital functions. "[Kale] is one of the healthiest foods on the planet," said Ramsay. Suggested serving: For salads, shoot for one to two cups of raw kale. For juicing, about the same. For kale chips, homemade is best and shoot for five to 10 chips.

3. Oysters "Oysters are incredibly low in calories and decrease inflammation," says New York nutritionist Bonnie Taub-Dix, R.D. and author of "Read It before You Eat It." Taub-Dix says oysters are heart-healthy and contribute to that great feeling after eating because they improve overall circulation. Oysters are also very high in essential nutrients like omega-3 fatty acids. And, of course, they've long been considered an aphrodisiac. "Oysters are always on the menu around Valentine's Day," says Taub-Dix. Oysters are also a great source of zinc — an undervalued mineral, said Ramsey — and vitamin B12. Zinc has a role in helping our bodies fight off stress and is essential to the part of the brain that regulates mood and memory. Ramsey calls oysters the "perfect brain food." Suggested serving: Six to 12 oysters

4. Coffee Coffee is practically a magic bean when it comes to mood lifting: The caffeine in coffee can boost mental focus and alertness and athletic performance. Coffee consumption may also protect against Type 2 diabetes and decrease the risk of depression. But the less you consume, the better it works. Ramsey recommends avoiding very sugary coffee drinks, which cause bloating. Suggested serving: Coffee has about 150 mg of caffeine per cup. Limit consumption to about 300 mg caffeine per day and consume it once a day, at the time you want to be most alert, TODAY nutrition editor Madelyn Fernstrom said.

5. Dark chocolate "Dark chocolate is one of the biggest mood boosters," said Ramsey. Dark chocolate not only provides immediate eating pleasure, but it has a high percentage of cacao, which has more antioxidant power than many other foods. Suggested serving: Two to four small squares a day.

Don't Believe These Baldness Myths

BALDNESS MYTH 1: IT'S YOUR MOM'S FATHER'S FAULT

It used to be that if you wanted to know your chances of keeping your hair, you looked at your maternal grandpa. If that guy had strong hair game, you were in the clear. If he was bald, your fate was sealed. Turns out that's just not true. "It's totally a myth that you should look at your mom's father," says Joshua Zeichner, Director of Cosmetic and Clinical Research in Dermatology at Mount Sinai Hospital in NYC. Why? Because hair density is a polygenic trait, meaning more than one ancestor’s genes determine what’s going to happen. “Look at your parents,” says Zeichner, “and your siblings. If a family member is bald or showed early hair thinning, then you need to pay closer attention to your own hair and seek care from a board-certified dermatologist earlier rather than later."

BALDNESS MYTH 2: BALD GUYS HAVE MORE TESTOSTERONE

Long standing legend has it that bald guys are victims of their own elevated testosterone levels. They also have more active sex lives. They compulsively chop wood. And all that boiling testosterone cooks the hair off their heads. (They have great beards, though.) In fact, studies have shown that men who go bald and those who don’t have the same levels of testosterone. It’s more about how sensitive your hair follicles are to the influence of hormones in your body. And what determines that sensitivity? Genetics.

BALDNESS MYTH 3: TANNING WILL BAKE YOUR HAIR OFF

There are those who say lying out in the sun speeds up hair loss. While there’s plenty of bad news about UV radiation, it’s not exactly making you go bald. Follicle function will continue even when you’re playing beach volleyball. The concern here is that sun exposure can degrade the hair shaft itself. You know how a summer at surf camp can make your hair blonder? It can also make it more damaged and brittle, which could lead to shedding. Not the same as male pattern baldness, but maybe a reason to use conditioner. Or wear a hat.

BALDNESS MYTH 4: WEARING A HAT TOO MUCH SUFFOCATES YOUR HAIR

Speaking of hats, we all know that bald guy who always wears a baseball hat. So which came first? The hat, or the bald spot? Pop science says hats can suffocate hair and speed up the rate at which it disappears. Actual science says that’s baloney. "If you're wearing a really tight hat, maybe that can put pressure on areas where it contacts your head," says Zeichner, "which could potentially lead to traction alopecia." That's the medical name for hair loss triggered by pulling hair too tight. But don't worry. "Unless you are being really aggressive with the tightness, there's nothing to worry about," says Zeichner.

BALDNESS MYTH 5: STRESS IS MAKING YOUR HAIR FALL OUT

The final thing you don't need to worry about? Worrying. This one's a bit more complicated. True, certain traumatic events have been linked to hair loss—big stuff like suffering an illness, or going through a really tough time and losing or gaining a large amount of weight. But according to the Mayo Clinic, types of hair loss associated with high stress are telogen effluvium, a "resting phase" in which hair follicles pause, and alopecia areata, patchy hair loss. Both of which can be temporary. Neither of those is what we talk about as male pattern baldness. And neither is related to the everyday definition of "stress." So if you're fretting about your evil boss, or what your new line should be on Tinder, do so without fear. But also, you know, fix it. Because there’s no reason to tear your hair out.