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.

I 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.

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.