Trichotillomania: I Pull Out My Hair

You know how sometimes people say things like, “I’ve been pulling my hair out trying to get this paper done,” or whatever? Well, in my life, it’s not an idiom. When I’m stressed out, I get real and actually pull my hair out. It’s an anxiety-related, impulse-control disorder called trichotillomania (that’s DSM-IV DR 312.39 for those of you who care). I guess it’s a pretty weird thing to have, and most people I know have never heard of it before, so I thought I’d share with you some information and some of my experiences.

So, trichotillomania is exactly what it sounds like, that is if you are Greek. But it’s a disorder where folks pull out their hair. It’s not only on their head either. People pull their hair from their scalp, eyelashes, eyebrows, beards, chest, pubic hair and more, sometimes causing noticeable bald patches.

I first started suffering from it probably around 5th grade. It got noticeably bad in the 6th grade when I got a pretty substantial bald spot at the crown of my head. I was too nervous to tell my mom why I was really losing hair so they started pumping me with a bunch of weird vitamins that obviously didn’t work.

Girl picking at her hairI didn’t really start to understand what it was until a 20/20 episode about it aired like in the early 2000s. These were obviously very extreme cases where girls had to wear wigs because they pulled their hair out so much. I’m quite lucky that my case is not that severe, but it was an extremely validating moment for me to hear that I was not crazy (at least not for the hair pulling) and that it’s something that actually exists and happens to other people. I heard the term trichotillomania from a doctor a few years later that I mentioned it to in passing. Not only did it exist, there was a long, weird name for it, too!

So, when you find out you have a weird disorder, you usually want to know what causes it, right? Well, there’s not a lot of information out there, except it is known as a self-soothing mechanism. Trich.org describes it as a Body-Focused Repetitive Behavior (BFRP). BFRPs also include severe nail biting, skin picking, skin biting and nose picking (all of which I experience to varying degrees, and yes, even nose picking). Sixth grade, when it got really bad, was really the genesis of my being a neurotic bitch. It was a tough year. I had to go to a different school in a weird mountain town, had to deal with bullies and JTT never answered my letters. I was stressed out.

A lot of folks falsely associate trichotillomania with self-harm, and I want to say a piece about this. It is not, in my opinion, self-harm. It’s not supposed to hurt, although it does sometimes. I’m not trying to hurt myself when I do it, and I never have. I’m not purposefully trying to mutilate myself; I’m just trying to fulfill an urge I do not understand. I had a brief history of self-harm later in my life that operated very, very differently than my hair pulling. While there might be trichotillo-folks out there who did use it in a self-harming way, it’s not typical. From what I’ve gathered, trichotillomania is a lot closer to OCD-like symptoms than self-harm symptoms. BFRPs are not OCD-related, but OCD-like. I suppose there’s room for debate, but most of the time when it’s described as self-harm, it’s done so by someone who has never experienced it or has cursory exposure to it.

So, you’re probably wondering, what’s it like? Well, let’s just say I really want to pull some hair out talking about it and writing about it so much at the moment. I’ve probably pulled out a few over the past hour while meditating over this. I figure I’ll explain what it’s like for me, but I’m sure it’s different for everyone. I most often pull my hair when I am in a stressed, but physically-relaxed state. I pulled out so many hairs in math class.

What actually happens to me physically is I will start to feel a dull tingle at the base of my hair. Sometimes I feel like I can feel every single root of my hair. I’ll start to feel around, usually right around my hair part. I have really thick, straight hair, so sometimes I feel around for an irregular-feeling hair–like a frizzed hair, or an odd curly hair. I’ll find it, grab it right by the root, and I’ll pull it out. I’ll often examine it, and I am especially pleased if it’s the kind that has a white build up at the end of it (this is weird, gross shit, I know). The weird part to me is the fact that I tend to bite it once it’s pulled out. That 20/20 episode I mentioned earlier featured a girl named Mandy who did the same thing.

The key is that I would look for something “different” among my hair. The NeuroBehavioral Institute said, “People with RBD tend to seek to find an area either of their skin or a hair that “˜feels’ right or “˜feels’ different. Once they have zeroed in on this area, they engage in their repetitive behavior in an almost unconscious manner,” which is pretty accurate to my experience.

Small bald spot at crown of head
Very similar to what my bald spots looked like

When it was at its worst, I would usually pull out closer to 10 hairs at a time. As I’ve gotten older, I don’t pull nearly as much. It was pretty severe in college (I started having bald spots again), but then in order to avoid the cosmetic issues associated with trichotillomania, I developed dermatillomania, which is skin picking. I’d start picking at my scalp, and I’d get these large scabs and welts on my head, which I’d only pick even more. I still struggle with this, and a lot of the time, you can find me with one hand on my head exploring my scalp for imperfections. This can often hurt, and I want to point out that I do not enjoy the pain. The pain is the worst part, and I only bear it because I have an impulse to pick at it even though it hurts like hell, which is part of why I do not believe this is associated with self-harm. The pain is not welcome, and if I could do it without it hurting, I’d gladly do that (I’d also gladly learn to stop, as well).

So besides bald spots, some of the other cosmetic issues I’ve had are really frizzy hair. Sometimes when the hair starts to grow back, it grows back kind of thin and frizzy/curly (I have very straight hair). I also have really bad dandruff from the scalp picking.

There are treatment options, none of which I’ve tried. Fortunately the symptoms are mildly and superficially disruptive to my life so treatment isn’t a priority, but Cognitive Behavioral Therapy seems to be the leading treatment option, in conjunction with medication (anti-depressants and anti-anxiety meds, mostly). CBT does seem like a good treatment option, since it is a behavior based-issue. CBT can incorporate such methods as Habit Reversal Training and Exposure and Ritual Prevention.

Something like 1-2% of Americans have trichotillomania, so there’s gotta be at least one or two of you Persephoneers out there willing to share your experiences. I don’t think I’ve ever talked to anyone else who goes through this, so it’d be really enlightening and awesome to hear from you.

If you want to learn more about trichotillomania or other BFRBs, I’d suggest starting at the Trichotillomania Learning Center, http://www.trich.org. And below was that eye-opening 20/20 episode. Oh, the wonders of YouTube.

 

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awkwardette

Michelle M. aka awkwardette is a multi-disciplinarian. She moonlights as an activist while earning her big bucks making the internet easier to use. She also writes about pop music on PopMinx.com and aspires to be Amelia Fletcher when she grows up. She prefers listening to The Jesus and Mary Chain when doin' it.

30 thoughts on “Trichotillomania: I Pull Out My Hair”

  1. Thank you for this particular post. I’ve been racking my brain and mostly unsuccessful trying to find out why my five year old is suddenly obsessed with “fixing my tangled hair, mom!” on the crown of his head. It’s not tangled, and no matter how many times I use detangling spray and comb it out he continues to insist on pulling at it.

    Now seeing that is an anxiety related condition and given the stress related things we have endured over the past few weeks, it is no wonder he’s trying to find something to sooth himself. The length of time he’s been pulling his hair coincides with the week his grandpa (and best friend) went into the hospital for heart surgery AND moving to a new place. The surgery went well, but recovery has not. It has been nearly 4 weeks since my son has seen, let alone spend the weekend, with his grandpa and grandma. (However, we did see them in Christmas day for a half hour.) The more time passes without seeing them like he use to, the more often I see him pull at his hair.
    It will be some 4 more weeks before grandpa will even be able to have his grandson over to the house for any length of time. I don’t know how to help my son until then. I can only hope his symptoms decrease as grandpa gets better. But what do I do the next time something stressful happens to him?

  2. I don’t bite it, but I have been known to run a strand from one corner to the other between my pursed lips just for the sensation… although that’s really rare and likely when I’m just super stressed and not even paying attention to what I’m doing.  I do visually inspect strands often, though.  Sometimes more earnestly than others.  I don’t know what I expect to find.  If ever I were to find something there, it is certain I would totally freak out and pull all of my hair out from all over my body at one time.  Sometimes the roots seem larger than others, and that gives me some sense of satisfaction… or justification; as in: “Oh, got it.  That’s why that particular point in my scalp was driving me mad!”  I have crafted my pull over my lifetime.  I usually try to control it; but I’m going back to college now, and… well, algebra.  Need I say more?  Now, because I am so much more aware, generally speaking, I will just kind of find that perfect spot and gently tug at that “right” single strand of hair until it just releases itself from my scalp, as opposed to that tiny “pop” when I force it out a little more purposefully.  I guess it just depends on my mood.

    I started super young.  My mother; I have a specific memory of seeing her pulling at her eyelashes when I was maybe 4 or 5 years old.  I was fascinated that it didn’t hurt her.  And thus sprang my learned behavior for my own self-soothing mechanism.  It started with the eyelashes, and God love my friends for being able to say, “It really makes your eyes look weird when you pull out all of your eyelashes” and not treat me differently!  When I hit puberty, it was the pubes – I swear I could feel them growing in and I just couldn’t stand the sensation.  But I weaned myself of that behavior and then started on my eyebrows (besides, shaving’s just quicker lol)  I’ve *mostly* weaned myself of that, save for the thick brow that randomly emerges – MUST go.  I swear, one thick brow lash can make my entire eyebrow feel just weighted down.  I know this is so psychosomatic or whatever, but it really does feel like I can feel it.

    It is a complete compulsion and I mentally will argue with myself and sit on my hands or otherwise have to occupy them.  I remember the first time I read the term “trich” and the definition, I was so relieved to realize I wasn’t alone… and then I was like, “crap, I just called out another neurotic behavior.”  ha-ha

    So NOW, I do try to be SUPER conscious of the behavior, because my own daughter… dang it all… I caught her trying to pull out her eyelashes!!!  And she’s 5.  And she’s autistic, so she’s already pre-wired to have her own compulsions, which she does, now this!

    What I learned from your article is the classification of Body Focused Repetitive Behavior, or whatever… nail biting, skin picking and nose picking – all my kid.  :(  So, I never like, linked it to anxiety, though, I’m not sure why.  I knew it was stress related, but didn’t really put two and two together.  I hate taking my anti-anxiety meds because – well, they’re just addictive as hell and I seriously have a life that I need to BE here for and be able to function within it.

    hmmm.  Interesting.  I will speak in depth with my daughter’s doctor at her appointment next week about her skin picking, etc. and mention the concern of anxiety.  Makes sense.  Of course, my daughter can’t really tell me how she feels, so now I realize all of that is self soothing, not just because…

    Another thing that didn’t register as connected (I swear, I didn’t realize I was this clueless until I read your article lol) is the whole scalp searching thing.  Me.  Incessantly.  I make sure to always sit in the back of the room so people can’t see me messing with my head.  I don’t have any scalp conditions, not really, thankfully… here and there it gets really itchy, but I live in a very humid climate, so that kind of happens all over my body when I get too hot.  But I will pick at anything in my head, any little imperfection.  Why am I obsessed with finding imperfections in my head?!  If that’s not a loaded psychological question, I don’t know what is.  ha!

    Thank you. Most sincerely :)  I have learned some valuable information tonight because of your post.

    Now stop pulling your hair out!  You are more beautiful with it than without it!  ;)

  3. I am so happy I found Your post. I do the same thing when it comes to pulling my hair. i look for the squiggly like think hairs and and pull it out and bite the end.i do it like everyday. when i first noticed i was pulling my hair was when i was 14. i have ADHD and depression and anxiety. it sucks because my hair starting getting thinner and thinner. i used to have beautiful thick hair. and some of my family memeberr will ask me oh did you get  a hair cut? and i always say ya. but really in my head i say dude i pull my hair thats wwhy its getting fuckking shorter ok?! i dont tell people about my hair cuz i dont want the to think im weird or something like that. its really comforting knowing im not the only one doing this. i remember one time i pulled allot of my hair out and there was a hair ball the size of a soda cap maybe bigger and i was so surprised i started crying my eyes out. somethings that help me out stop pulling is making friendship bracelets or playing my xbox 360.idk something that keeps my hands busy usally helps. but yyeah im so relieved i got that out!

  4. I could have written this. Especially when I’m anxious — I tend to have a “higher” hairline when I’ve been stressed. After my worst few months, I had a wider part than normal and a patch at my crown. That was a year and a half ago, and inspired a chop-and-donate (I went from waist-length, which made the patches very visible, to a much less obvious bob). I’m noticing the hairline change again. :(

    One thing that helps me is making a tangle of yarn (not the good stuff, the less-pricey/more durable kinds) and picking that apart instead. Of course, that only helps when I have somewhere to pick at a big yarn knot, but it helps with some of the anxiety. Kind of.

  5. I too am a hair puller/scalp picker. I think it started in high school with hair pulling. I did the same thing – found that “imperfect” strand, pulled it out, and examined it. I would also search for split ends and pull them apart. I never had bald patches though, even though I pretty much only pulled from the crown. I tended to do it when I was deep in thought, so when I’d get up from sitting in class or reading a book at home there’d be a pile of hair surrounding me. I didn’t start picking at my scalp until college, but I’d always been a scab picker so I guess it was a natural progression. Picking at my scalp pretty much replaced hair pulling for me. My hair is cut really short these days which has also helped with the pulling, but the scalp picking is just as bad as ever. I search for the ‘bad’ skin and pick at it until it bleeds, and then once it scabs over I have something to pick at again. It’s an incredibly frustrating cycle, and I don’t seem to have enough self control to stop it.

    I also have anxiety and OCD symptoms, so maybe this is something I should talk about with my counselor – I’ve been too embarrassed thus far to admit to anyone.

  6. I learned the word trichotillomania when I was a kid, because a girl the year before me in school had had it.  She was super-stressed in school and ended up with a few bald spots.  She also had a different sort of nervous/stress-related disorder.  She ended up going back home because the stress was too great.  For a long time, trichotillomania was just an addition to the “Long Words I Know Which Sound Awesome and Occasionally Get Stuck in my Head on Repeat” meme that actually exists in my head.  [Endoplasmic reticulum is on the list as well.]

    But then, a few years ago, the daughter of a friend-of-a-friend went through this with her eyebrows.  But her parents and extended family had no idea what it was.  She was 8 and picking out her eyebrows and eyelashes and they didn’t know why.  So they told her to stop.  And then they warned her to stop.  And they punished her.  And they told her how she wouldn’t be pretty if she kept doing it.  My friend was telling me about this whole saga, and how she’d tried to intervene, because her family had done the same thing to her, before they discovered she had alopecia.  I asked if they’d had her talk to anyone at all, and mentioned the term [now firmly ensconced as my meme-word], and the girl from my school.  It turned out that having a new baby in the house, and twin baby cousins over all the time, and a younger sister not yet out of diapers… was all kinda stressing her out.  She talked with a therapist for a while and over the next 6-12 months, eased up on the picking.  Her eyebrows and eyelashes are fully back in, and nothing’s recurred since (that I’ve seen).  [However, her mother has been diagnosed with breast cancer now, and the stress on the family is quite high again. If you pray, please pray for them.]

    I pick any pimple resembling blemish on my body.  I have no self control.  And it gives me peace to complete the task.  I’ll agree that while on the outside similar ‘picking’ habits may appear as self-harm, they are more about grooming, and the desire to make the body uniform/clean/smooth.  It’s not about the pain, it’s about the tactile result – at least, for me.

     

  7. My little sister had trichotillomania really bad in elementary school, to the point she wore a wig and had to have surgery a couple of times to have bezoars removed because she would eat her hair. Her doctors think her habit came from stress an anxiety related to her having been in and out of the hospital since she was born because of another condition she has. She’s an adult now and she doesn’t show any signs anymore, but though her worst years were probably around 3rd-4th grade, she still would have off and on impulses throughout her childhood and high school. Of course this all comes from my perspective not hers, but I agree it was more of a soothing mechanism/compulsion rather than self-harm. Thank you for sharing, I’ve sent your story to my sister. I know as a child she struggled really hard with this because she thought she was the only person with this problem. It wasn’t until my mom found a support group 100+ miles away (and made up of adults, not other 9 yr olds) that my sister realized she wasn’t alone.

  8. I’ve been reading Persephone for a while, but I registered just to leave this comment!

    I have had trichotillomania since I was a little kid. I remember pulling out hair and making it into little balls in kindergarten, and I did it enough that my teachers were always inspecting me for lice (a kid that picks at her scalp that often has to have lice, right?).

    It got worse when I hit puberty, and I remember the worst it got was in my sophomore/junior year of high school. I have a very similar process to yours (but without the biting), and it is the absolute worst when I am sitting still. I did a lot of reading for school that year, and any time I am reading is pretty much ground zero for pulling. I had a large bald spot on my crown and my part was about an inch wide, and the floor next to where I read was COVERED in hair. I eventually spoke to my guidance counselor and my parents about it, and we went online and read about it. At the time, some sites recommended dietary changes because they thought the “tingle” you describe could be some sort of allergic response; I tried ALL KINDS of crazy diets, including one where I could only sweeten my food with fructose. Eventually I think I just grew out of it a little bit, or maybe I just got better at keeping my hands occupied? For most of the rest of high school and part of college I had to work closely with my hairdresser to come up with a way to basically have a Trump-style combover since a large section of my hair was very short and just wanted to stand up like a mohawk.

    These days I don’t pull from my crown so much any more, but it never quite recovered and the hair back there can appear quite thin. I recently went through a couple of months of pulling my eyebrows pretty severely and I had to pencil them back in everyday, but they’ve mostly come back now. I’ve also pulled out large swaths of my leg hair, and once I pulled out most of my pubic hair. It’s just one of those things I have to consciously think about more than other people. My husband knows, but I’ve told him that it doesn’t really signify anything, it’s just an odd quirk like nail-biting, and he generally doesn’t comment.

    I’ve also got dermatillomania, which is harder for me to control, and it doesn’t help that I have moderate acne anyway. I literally can’t stop picking at the little scabs on my face, which of course doesn’t help AT ALL. I will pick and pick at something until it bleeds, I don’t stop until it feels smooth under my fingers. This often makes my face look about 1000% worse than it needs to.

    Thanks for writing this article, it’s good to get some exposure for trichotillomania! It’s nice to hear other people’s stories.

    1. I really appreciated your comment. I had college friends with dermatillomania who really struggled with it while in school (they were in competitive nursing programs), but after reading your comment, I think one of them must have had trichotillomania, too, probably as a related anxiety response. I wish I had read this article during those few years, because I could have been more supportive for what she was going through.

      To be honest, I thought her hair was falling out from the stress, but some of what you mention here makes me wonder about trichotillomania: the long study sessions at the end of which there would be hair everywhere (I used to tease her about it, which just makes me feel like a complete ignorant ass now), the bald spots at her crown and part that we would try to cover with teasing and creative brushing…

      Isn’t it strange how many ways humans have of responding to stress and anxiety? I’m a little socially anxious butterfly with evening panic attacks; others pull and bite hair; still others bite their nails and toenails (husband!).

       

  9. As a recovered nail biter, I totally understood your distinction between your pulling and self harm. I used to bite my nails all the way down to the skin and sometimes further–my skin was semi-often infected (a finger would swell up around an area I had made bleed) and I would sometimes end up bleeding around the nail or under it. And I didn’t like that part! I disliked that part a lot! But I just couldn’t help biting my nails, so that was just part of the deal. I finally did quit, without too much difficulty, really, and now I do occasionally peel at my nails or poke at my cuticles, but not to the point that I bleed or get infected anymore (and only rarely badly enough to mess up my nail polish, which is a major victory!).

  10. Last winter, I was under extreme stress while trying to deal with some really severe dental issues. The hairball under my couch should have had a name and a water dish. I love to pull the coarse + curly ones also. I don’t ever bite the hairs, but I do get satisfaction from pulling the perfect strand. I think I briefly had a thin patch when I was 12 or 13, and certainly last winter my hair was getting noticeably (to me) thinner, but generally my only real problem is the occasional tumbleweed. I also went through an eyelash-pulling phase. The skin-picking issue is more annoying, because it’s really kind of gross (or at least I’ve been conditioned to believe this). My dad is also a picker. Not sure if he’s aware of why he’s doing it; it’s not really something we bond over.  All of these behaviors really come to the fore when I am feeling stressed or overwhelmed.

    ETA: It just dawned on me that one of my sisters is an X-treme nail-biter, and the other plucked her eyebrows nearly to extinction when she was a teenager. Thank goodness my mom was there to make us all feel bad about our disgusting habits.

  11. I found this a really informative read, thank you. I had a brief experience with this as a child (I used to twist a bunch of my hair up right by my temple and pull it out all at once), but it sort of disappeared after a few years and talks from my mom. I am grateful; I have enough on my plate with just garden-variety anxiety.

    I had never heard of BFRPs before this article. It gives me a new respect for my husband’s nail biting, which is quite severe.

  12. This is extremely similar to my hair pulling tendencies. I root around for a coarse, wiry hair, yank it out, examine it and–if no one is looking–bite it. I don’t actually eat the hair, I just have a compulsion to bite it. I don’t have a bald spot, but my hair is markedly thinner in one area at the back of my head. I tend to find more of the coarse hairs in this area, so it makes sense. I’m not trying to stop entirely, because honestly, when I find the perfect hair it feels SO GOOD to pull it out but I am trying to limit the amount I pull. Thanks for sharing this, makes me feel a bit less odd.

  13. One of my dear friends started to pull her hair out and eat it after she started taking multiple medications for OCD. The medication also caused her to not sleep for days, pick at her face, and do things like break our glasses and sleep on the shards. It was terrifying, because I had known her during the worst of her OCD days and while these behaviors were things she did, they just amplified after the medication. It was terrifying and upsetting to watch her go through it, even while she took a great deal of comfort in it.

    I pick at my fingers when Im at the “peak” of feeling overwhelmed and anxious and pull at my hair, but i wont pull it out. I dont think either of those are qualifiers, but it is something Im glad to see here but also wish was talked about more.

     

  14. *raises hand* I am the 1-2 %! Go me! I’ve been doing somewhat better than you, as in, I only ever had one small baldish spot once, in my teens, but the process you describe is still eerily spot on. To the point of eating some of the hair, just hopefully not enough for a bezoar – do please excuse my anonymous grossness. In any case, I’m glad it’s not just me and that it can probably eventually be explained by some specific sort of biochemical imbalance.

    I don’t associate it with self-harm either. Or at least it’s not a conscious form of self-harm. In fact it seems to be closer to misguided attempts at self-betterment, picking off “wrong” kinds of hair or imagined skin imperfections. And pica might figure somewhere in that pattern too.

  15. I started out biting my nails. I lost my hair at a pretty young age and the doctors suspected trich at first, but it was just regular alopecia. I moved from nail biting to finger-biting and picking, and I bite the skin on the insides of my cheeks and my lips. (I also nose pick, but I try not to do it too much). Right now, most of my fingers are “recovering”, but if the skin that grows in is hard I just bite it off all over again – so I can end up cycling it for weeks and weeks. I do it a lot more when I’m stressed, although I do it when I’m bored as well. People who don’t do these sorts of things often think I can just stop – but I can’t. I’ve tried, and I’ll end up doing it less for a while, but inevitably I get bored or stressed enough and then I’m right back at square one.

    Thanks for this, it really spoke to me and it’s nice to know we’re not alone!

    ETA: my sister and mother also do the skin-picking, although not quite to the same horrible extent that I do (I bleed on a regular basis).

  16. This was really interesting to read. Thank you for sharing.

    I’m one of those who considers trichotillomania as being somwhere in the realm of self-harm because it was definitely present in self-harm/mental illness communities that I know. Or rather, it’s hard to break the association to self-harm because of its presence in those communities. Especially when there was some severe trichotillomania going on (IE complete baldness).

    Again, thank you for sharing this, it’s been an interesting and thought-provoking read.

    1. Could it have been concurrent with the self-harm rather than related? There was definitely a point in my adolescence where I was experiencing both at the same time, and I suppose they were both self-soothing mechanisms, but they operated in two very distinctly different ways.

      1. I really don’t know, though my hunch is that in those cases, they would have been related.

        I’m aware that self-harm can be self-soothing, but on the whole, my experience of it is as a coping mechanism and like a lot of habits that go from being simply “unhealthy” to “detrimental”, I could see trichotillomania being related to self-harm and mental ill-health in general. But like many behaviours, they can present differently and with different connections for different people.

  17. Thank you for sharing love, this is really informative. I have a tendency to skin pick. I can’t walk past a mirror without scratching at something on my face. Years of gross acne has given me plenty of targets too! The only thing that stops me picking is not having anything to pick but that is easier said than done. As I type this, I’m running my hand over my zits and picking off the dry bits of skin (gross I know). The word compulsion really does sum it up.

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