More Than a Fidget: Living with a Hair-Pulling Disorder

Medically reviewed by Timothy J. Legg, PhD, CRNP on March 24, 2017Written by Carson Leigh Brown on March 24, 2017

My realization

hairpulling

When I was 14, I started at a highly selective high school. Always a lover of math, I happily enrolled in Algebra II+, an accelerated honors class where my inevitable drowning quickly became obvious. The worst moment of that first semester in a new place stands in sharp relief nearly a decade later.

I was taking an exam, hidden behind these cardboard “test tents” to prevent cheating (trusting atmosphere be damned), and hair fell like snowflakes around me. It was the first time I remember pulling my hair out, strand by strand, due to stress and anxiety. By the time the test was over, there were three questions unanswered on my sheet and a visible layer of hair littering my desk and the floor. Confused, I hastily swept it away.

I’d never been conscious of this habit before, and I didn’t realize how pivotal that test would be in dealing with this strange diagnosis: trichotillomania.

What is trichotillomania?

Trichotillomania (trich), as defined by the Mayo Clinic, is “a mental disorder that involves recurrent, irresistible urges to pull out hair from your scalp, eyebrows, or other areas of your body, despite trying to stop.”

Estimates say that 0.5 to 3 percent of people will experience trich at some point. But it’s a tough guess to make: Symptoms are known to fade and return, society is more accepting of hair loss in men, and embarrassment in general can lead to underreporting.

My triggers

Typically, hair pulling is triggered by anxiety and stress. I was twirling a few strands as I chose what to type just now, which is normal for me.

College essays were always a double whammy for me because they left me at my most vulnerable and led to ridiculous pulling sessions. I hated writing them, so I put them off. I’d end up immersed in my stress. Once, my sophomore year, I was typing frustratingly with one hand and pulling with the other. I felt messy and defeated, but that wasn’t my nadir.

A vicious cycle

When I graduated middle school, my hair shone with health. Vibrant, thick, and silky, it was my crown jewel. Over the next three years, I was forced into increasingly short haircuts to combat my uneven, sparse ends. Websites often say people with trich will go to nearly any length to disguise hair loss, which always struck a nerve. Obviously. Wouldn’t you?

Trich is a compounding anxiety. You pull because you’re anxious, and you’re anxious because you can’t stop pulling. Some people with trich experience widespread balding, losing noticeably large sections of hair. For a handful of years, I had a small bald patch, hidden a couple inches behind my right ear. The spot is still sensitive to touch, a shadow of my self-inflicted trauma.

Why pull?

It’s difficult to describe why we pull. Our brain thinks it’ll be a reprieve to our anxiety. There’s a satisfaction, the briefest cool of relief that arrives with the smart of a fresh pluck. My hair has different textures, and I’d pull the coarsest strands because they never quite matched the others, like I was striving for a twisted perfection.

Some scientists describe trich as related to obsessive compulsive disorder (OCD). They both involve “recurrent obsessive and/or compulsive thoughts and actions,” and both are caused by imbalanced chemicals in the brain. That makes the most sense to me. People with trich are profoundly struck by how senseless our actions are, but that isn’t nearly enough to make us stop.

Really, trich just names how we act out our heightened anxiety. Many people aren’t even aware of it, and years go by before they seek treatment. The first step is always noticing you’re pulling in the first place.

Seeking help

Self-awareness isn’t the strong suit of many high schoolers, and I was no different. My friends struggled with eating disorders and serious depression, balancing prescriptions with their sense of well-being.

I read about trich online, but my parents were dismissive. They had bigger problems to deal with than my vanity. The anxiety didn’t seem like the pervasive issue. It didn’t occur to me that it was treatable.

Finding treatment

In college, I would turn to therapy after learning about anxiety specialists. I was sufficiently internet-educated to realize I had more meaningful options than cursing the universe every time I swept a pile of hair into the trash. Going to therapy in a glass-walled, high rise office in downtown Chicago was mostly prompted by a lighter class load (having time to devote) and a desire for change.

Spinning rings, beaded bracelets, sitting on your hands, replacement fidgets — the suggested methods to replace the harmful behavior were endless and largely uninteresting to me. The underlying anxiety was the bigger issue for me and my psychologist, but accountability to her kept me (mostly) on the straight and narrow. Eventually, the sessions became too expensive and study abroad broke my weekly habit. I wouldn’t seek treatment again for over a year.

Coming to terms

I’m more comfortable with trich now. Much has changed since the first time I said “trichotillomania” out loud to a friend six years ago when she asked me, “Did you just eat your hair?” Sixteen-year-old me stumbled through an explanation: “Well, no. See I have this thing, trichotillomania, and people with it tend to run hair they pull out across their lips and face. It’s a weird habit … I don’t eat it … that would be … gross.”

It was a cringe-worthy moment. It’s true, some people with trich do run their plucked strands against their face and lips. I don’t have an explanation for that one. Awareness has made it pretty much disappear in my case.

But I’ve also stopped caring about most of my trich-related tendencies. They no longer define my self-image. I don’t see them as something to hide, nor do they inspire shame in the same way. Some of this is due to maturing through college, but I attribute it mostly to returning to therapy.

Tuesday nights, I meet with an affordable psychologist. She helps me address trich honestly and thoughtfully. Her expertise is beautifully accompanied by her demeanor. My conclusions are my own. I’m never pushed into an idea that doesn’t fit, so I can manage the symptoms of trich more easily now. I have a prescription for anxiety, and I’m more aware of my triggers and how to effectively navigate tough times.

Moving forward

It is still difficult to explain something like this to someone. Societal discomfort makes people keep their questions to themselves. And how do you explain why you can’t just distract yourself with some other habit? It’s tumultuous. I explain trich as “a weird thing my brain just does.”

It’s annoying at times and can make a person self-conscious, but awareness and self-forgiveness is half the battle. I joke that trich is an easy self-diagnosis, when so many things aren’t.

Not everyone with trich needs or wants treatment. The condition manifests itself in varying severities. If you have trich, the most important advice I can offer is to avoid feeling embarrassed and to know that it isn’t permanent. We tend to be people with type A personalities, so don’t be too hard on yourself. You’re doing fine. 

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