Buzz
Trichotillomania is a term used to describe the compulsion to pull out hair, eyebrows, or other body hair. This behavior leaves bald patches on the scalp and sometimes, individuals affected by this syndrome go to great lengths to conceal these patches. Around one percent of the adult population is diagnosed with signs of trichotillomania, with the majority of patients being women. The habit often begins in early adolescence, although it can start earlier or later. When accompanied by depression, this behavior can negatively impact one's social and work life. While it may seem impossible to resist the urge to pull hair, this condition can be successfully treated.
Steps
Identify the Triggering Causes
Track the times when you feel the urge to pull your hair. Reflect on situations that lead to this urge. Do you tend to pull your hair only when you're feeling depressed? Does anger, confusion, or frustration trigger this? Understanding the factors that drive your hair-pulling tendencies can help you develop more effective coping strategies.
- For two weeks, note the occasions when you catch yourself pulling your hair. Make a note of what happened before and how you felt at the time.
Record your feelings while pulling your hair. As you explore the triggers, make sure to note the signs that may be prompting this behavior. If pulling your hair helps alleviate your anxiety, that relief becomes a reinforcing factor for this behavior. Record all emotions experienced during and immediately after pulling your hair.
- Recognizing this pattern can help you respond better the next time you're anxious by using alternative coping strategies that bring you comfort, transforming the anxious response into a natural interaction, instead of resorting to hair-pulling.
- There are three distinct stages that most individuals with trichotillomania go through, though not everyone experiences all three stages. You might only encounter one or a few of them:
- 1. You feel tense and have the urge to pull a few strands of hair.
- 2. As you begin pulling, you experience relief, a sense of release, and a slight thrill.
- 3. After pulling, you feel guilty, regretful, and ashamed. You try to hide the bald spots with scarves, hats, wigs, etc. But eventually, they become noticeable to others, and you may feel the urge to withdraw. Many times, you may feel deeply embarrassed.
Examine the areas you're pulling hair from. Do you pull your hair because you dislike a certain type of hair? For example, some people feel compelled to pull when they spot gray hairs, and they want to remove them all because they dislike them.
- One way to address this trigger is by changing your perception of that hair type. In reality, no hair is inherently bad; each type serves its own purpose. Shifting your mindset might help reduce the urge to pull.
Consider your childhood experiences. The root cause of trichotillomania may stem from genetic factors or early environmental influences. Researchers have found similarities with the causes of obsessive-compulsive disorder, and they believe the origins of trichotillomania are linked to turbulent, unstable childhoods, or poor relationships with parents or caregivers.
- A study found that over two-thirds of victims had experienced at least one major life event, and one-fifth of them were diagnosed with post-traumatic stress disorder. This led to the hypothesis that hair-pulling serves as a self-soothing mechanism.
Check your family history. As you look for the causes of trichotillomania, pay attention to whether anyone in your family has had this disorder, obsessive-compulsive disorder, or anxiety disorders. If there’s a family history of this condition, you are at a significantly higher risk of developing trichotillomania yourself.
Develop Strategies to Combat Hair-Pulling
Develop your own plan. The "Notice, Interrupt, and Choose a Plan" strategy can help you stop pulling your hair. This process involves paying attention to when the urge to pull arises, interrupting the emotional chain and desire by listening to positive reminders in your mind. Then, you choose a different activity that brings a sense of calm and comfort.
Keep a journal or chart of your hair-pulling episodes. Writing down your experiences helps you become more aware of the time, triggers, and impact of the behavior. Record the date, time, location, and number of hairs pulled, as well as the tools used for pulling. Additionally, note the emotions and thoughts at that moment. This is a way to express the shame and clearly articulate the effect trichotillomania has on your life.
- After counting the hairs pulled, were you surprised by the results? How long did it take to pull all of them? Was it more than you expected?
Choose alternative ways to express your feelings. Once you’ve identified the warning signs and triggers, create a list of behaviors that can replace hair-pulling. Whatever you choose, the replacement behavior should be easy to do and easily accessible. Some suggestions to express your emotions and feelings include:
- Take a few minutes to clear your mind.
- Draw or doodle on paper.
- Paint.
- Listen to music that matches your current emotions.
- Call a friend.
- Volunteer.
- Do some cleaning.
- Play video games.
Use reminders to stop the behavior. If hair-pulling is happening unconsciously, you’ll need a physical reminder to interrupt the action. To create a barrier, try wearing ankle weights on your hands or rubber gloves to make it difficult to pull your hair.
- Alternatively, you can place sticky notes in areas where you typically pull your hair, serving as a reminder to stop.
Avoid triggering factors. While you can’t completely eliminate all the triggers for hair-pulling, you can reduce your exposure to them. If your partner is a source of stress, you may need to reconsider your relationship. Is your boss the cause of all the tension? If so, it may be time to explore new job opportunities.
- Of course, for many people, it’s not just about identifying and avoiding the triggers; some cases of hair-pulling stem from unavoidable circumstances such as changing schools, experiencing abuse, discovering a new sexual identity, family conflicts, the loss of a parent, or puberty-related hormonal changes. These are factors that are often difficult, if not impossible, to avoid. If you find yourself unable to avoid a trigger for any of the reasons above, or for others, try to accept the situation, minimize the behaviors, and create a list of people who can support you in managing the condition.
Alleviate itchiness and unusual sensations on the scalp. Use completely natural essential oils to soothe the pores and reduce itchiness, but more importantly, shift your behavior from pulling hair to gently brushing or combing it. You must use products derived entirely from natural sources, such as a blend of essential oils and castor oil. Never use products made from chemicals.
- Additionally, be cautious of products promising rapid results. Any treatment that guarantees instant outcomes is usually unreliable, as hair-pulling cannot be cured overnight.
- You can also ask a doctor for numbing medication to apply to the scalp, which is helpful if hair-pulling is triggered by “itchiness” or strange sensations. In a study of a 16-year-old girl, it was found that temporarily using numbing cream alongside psychological therapy successfully treated her hair-pulling behavior.
Accept Yourself and Boost Self-Esteem
Embrace the present moment. Hair-pulling habits often stem from the denial of uncomfortable emotions or negative feelings. Use mindfulness techniques to help you confidently accept these negative emotions as a natural part of human experience. You don't need to avoid them. As the urge to escape negative emotions subsides, the hair-pulling behavior will gradually decrease.
- To practice mindfulness, sit quietly in a comfortable spot and take deep breaths. As you breathe in, count from one to four; hold your breath for the next four counts, then exhale for another four counts. As your mind starts to wander, gently accept the thoughts without judgment and let them float away. Continue focusing on your breath.
Build Self-Esteem. Many people who struggle with hair-pulling also tend to have low self-confidence and poor self-esteem. To enhance self-esteem and accept yourself, apply Acceptance and Commitment Therapy (ACT), a psychological treatment method. This approach helps individuals recognize their value and focus on life goals. Building self-esteem is a key step in the healing process.
- Remember that you are unique and amazing, people appreciate you, and life is priceless. No matter what others say, always love and cherish yourself.
Replace negative thoughts with positive ones. Negative thoughts about yourself can lower your self-esteem and trigger the urge to pull hair. Self-criticism, fear of failure, and other negative thoughts make you feel like what you have isn't enough. Start shifting this mental habit to build and enhance your confidence. Here are some examples to help you change the way you think about yourself:
- If you think, "I don't have anything interesting to say, so it's no wonder others think I'm pitiful." Challenge those negative thoughts by telling yourself: "Sometimes I may not have much to say, but that's okay. I don't need to entertain others or lead every conversation."
- Replace self-criticism with constructive thinking. For instance, if your thought is: "I won’t be able to have dinner with others anymore. Last time, I embarrassed myself with my words and ruined the evening. I’m so stupid." Replace it with: "I felt embarrassed about the dinner, I made a mistake, but that's fine. I'm not stupid, I was just being too honest."
- As you practice recognizing and changing these thoughts, you'll notice your self-esteem and confidence improve.
Write down your achievements and strengths. Another effective way to accept emotions and boost self-esteem is by creating a list of your achievements and strengths, and regularly revisiting it.
- If you're unsure what to write, consider talking to a close friend or family member. They may offer helpful suggestions. No accomplishment is too small to add, so be sure to include everything.
Learn assertive communication. Practicing assertive communication techniques can help you manage challenging situations. For example:
- Learn how to say no. If someone asks you to do something you're not comfortable with, assert your wishes by simply saying no.
- You are not obligated to please others. Avoid doing things just to gain approval. Identify what truly matters to YOU and ask for what you need.
- Use the word “I.” This technique helps you communicate that others must take responsibility for their feelings and actions. For instance, instead of saying “You never listen to me,” try saying “I feel ignored when we talk because you keep looking at your phone.”
Reduce Stress
Identify and eliminate stressors. Many individuals dealing with this condition find that stress triggers their urge to pull hair. You need to focus on reducing stress in your life and learning to manage its triggers with more effective techniques.
- Start by making a list of what causes you stress. These could range from major issues like finances and work to smaller irritants such as waiting too long at the checkout counter. While you may not be able to avoid all stress, try to minimize your exposure to it.
Dynamic relaxation: muscle tension and release technique. You can reduce stress by practicing the dynamic relaxation technique of muscle tension and release. This method helps reduce muscle tightness and signals your body to relax. By tightening and releasing muscles, you gradually guide your body into a calm state.
- Tighten a muscle for six seconds, then release it for another six seconds. Pay close attention to how each muscle feels as it relaxes.
- Start from your head and work your way down to your toes, continuing until you feel your entire body relax.
Practice meditation. Meditation can also help in reducing stress. A regular meditation routine, or simply dedicating 10 minutes a day, can clear your mind and restore your energy.
- Choose a peaceful place for meditation, sitting or lying down. Begin by breathing deeply and slowly. You can also try guided imagery, where you visualize a serene setting such as a beach, a winding river, or a forest.
Get enough sleep. Establish a habit of sleeping at a consistent time and ensure you get enough rest, which means aiming for at least seven or eight hours of sleep each night.
- If you struggle with insomnia, try listening to calming music before bedtime. Avoid using any screen devices for at least 15 minutes before going to bed.
Exercise regularly. Research indicates that consistent physical activity can greatly alleviate stress. While exercising, your body releases endorphins, which contribute to feelings of excitement and well-being.
- You don’t have to run for an hour every day. Instead, engage in any type of exercise you enjoy, such as yoga, martial arts, or even gardening, which can help boost your mental energy.
Seek Support
Talk to a close friend or family member. Find someone trustworthy and share your experience of trichotillomania with them. If speaking out loud feels difficult, consider writing a letter instead. If you’re reluctant to discuss your struggles with this condition, at least open up about your emotions.
- You may also want to explain to your friends or family the triggers that lead to hair-pulling. This way, they can gently remind you when they notice you're about to engage in this behavior. They can also assist you in identifying alternative actions to replace hair-pulling.
- Ask your friends and family to offer words of encouragement when they see you successfully implement a substitute behavior.
Seek support from a mental health professional. A therapist or counselor can assist you in coping with this condition. They can also address issues such as depression or other factors contributing to self-destructive behavior.
- If the professional you consult doesn’t help you improve, consider finding another one. You are not obligated to continue with a specific doctor or specialist. What matters most is finding someone who understands you and can help solve your problems.
- Effective treatment options include behavioral therapy (especially habit reversal training), psychotherapy, psychodynamic therapy, hypnosis, cognitive behavioral therapy, and antidepressant medication.
Consider medication options. Several medications have proven effective in treating trichotillomania. For instance, drugs like Fluoxetine, Aripiprazole, Olanzapine, and Risperidone have been used to help regulate brain chemicals, alleviating symptoms such as anxiety, depression, and other emotions that trigger the urge to pull hair.
Get assistance from an online or phone support group. If you can’t find in-person counseling, there are other support options. The Trichotillomania Learning Center (based in the United States) offers various online support groups.
- For instance, in the US, Seven Counties Services provides a free hotline for support.
Diagnosing the Condition
Recognize the signs and behaviors indicating the disorder. Trichotillomania is classified as an impulse control disorder, grouped with conditions like pyromania, kleptomania, and gambling addiction. Those suffering from this condition often display other characteristic behaviors, including:
- Chewing or eating the hair after pulling it out.
- Rubbing the hair against the lips or face.
- Feeling extreme tension right before pulling hair or while resisting the urge to do so.
- Experiencing relief, satisfaction, or pleasure from pulling hair.
- Pulling hair without realizing it (referred to as “automatic” or unconscious pulling).
- Being fully aware of pulling the hair deliberately (referred to as “focused” pulling).
- Using tweezers or other tools to pull hair.
Recognize the physical signs of the disorder. There are several indicators that suggest you may have trichotillomania, such as:
- Noticeable hair loss due to frequent hair pulling.
- Bald patches on the scalp or other areas of the body.
- Sparse or completely missing eyelashes or eyebrows.
- Infected hair follicles.
Observe other compulsive behaviors. Some individuals may also engage in behaviors like nail-biting, thumb-sucking, head banging, excessive scratching, or picking at the skin.
- Monitor these behaviors over several days to determine if they are habitual. Pay attention to the duration and frequency of these actions.
Assess if you have any other disorders. The question arises: is trichotillomania the only condition you're dealing with? Many individuals with this disorder also suffer from depression, obsessive-compulsive disorder, Tourette's syndrome, bipolar disorder, anxiety disorders, personality disorders, and in some cases, suicidal tendencies. To determine if you have additional conditions, it's important to visit a doctor or mental health professional.
- However, it's difficult to pinpoint which condition came first. Could hair loss have triggered depression, leading to feelings of embarrassment that make you want to avoid social interactions and recreational activities?
- Typically, to successfully treat trichotillomania, it’s necessary to address the accompanying conditions as well.
Consult a doctor about hair loss. Even if you believe you have trichotillomania, it's essential to visit a doctor to rule out other causes related to hair follicles. Conditions like alopecia or scalp fungal infections can cause hair loss as well. During the examination, the doctor will look for signs like unevenly broken hairs, curly hairs, or other abnormalities that indicate trichotillomania.
Acknowledge trichotillomania as a legitimate disorder. The first thing you should know is that this is a treatable condition, not a matter of willpower or lack of determination. It is a disorder influenced by genetic traits, current emotional states, and past life experiences. If you are affected by it, treatment is necessary rather than self-blame.
- Brain scans have shown that individuals with trichotillomania have abnormal brain activity compared to those without the condition.
Understand that this is a form of self-harm. Don’t deceive yourself by thinking everything is fine, or that hair-pulling is a “normal” behavior. Trichotillomania can be considered a form of self-harm, even though it is seldom referred to as such. Like all forms of self-destructive behavior, trichotillomania can lead to addiction. Over time, the disorder worsens, and resisting it becomes more difficult, which is why it's essential to gain control as soon as possible.
Warning
- Abusing stimulants or alcohol can stem from trichotillomania, as individuals may seek to escape feelings of shame, unhappiness, or guilt. If you notice yourself developing a tendency to consume more alcohol or stimulants, you should seek help immediately.
