Sam's Blog: Trichotillomania is an irresistible urge to pull out your hair. How to Cope with Trichotillomania

Trichotillomania is an irresistible urge to pull out your hair. How to Cope with Trichotillomania: "

Trichotillomania (trick-uh-till-oh-mania) is a chronic impulse control disorder that may leave you with bald patches on your scalp through repetitive pulling out of one's hair.

Trichotillomania is an irresistible urge to pull out hair from the scalp, eyebrows or other areas of one's body. Hair pulling from the scalp often leaves patchy bald spots, which people with trichotillomania may go to great lengths to disguise.^[1] People often start compulsive hair-pulling around the early teenage years, though some people start earlier or later than this.

It may feel helpless when you're in the bind of hair-pulling but it is a condition that can be treated, and with great success.

Steps

Missing eyebrow hairs might be a sign
Recognize both the physical signs as well as the behavioral signs. Trichotillomania is officially classified as an impulse control disorder, along the lines of pyromania, kleptomania, and pathological gambling. Hair-pulling can occur both deliberately and without even noticing. When assessing either yourself or another person for trichotillomania, the following signs might point to the disorder:
- Recurrent pulling out of the hair, resulting in noticeable hair loss
- Patchy bald areas on the scalp or other areas of the body
- Sparse or missing eyelashes or eyebrows
- Infected hair follicles
- Chewing or eating pulled-out hair
- Rubbing pulled-out hair across your lips or face
- An increasing sense of tension immediately before pulling out the hair or when resisting the behavior
- Pleasure, gratification, or relief when pulling out the hair
- The disturbance is not accounted for by another mental disorder and is not due to a general medical condition (i.e., dermatological condition)
- The disturbance causes significant distress or impairment in social, occupational, or other important areas of functioning.
Using a head scarf to cover patches can start happening more frequently
Be aware that the disorder can have three phases. Not all sufferers go through the three distinct phases but for those who do, they are:^[2]
- 1. An initial experience of tension accompanied by a desire to pull out some hair.
- 2. Pulling out of the hair commences. It feels really good, like a sense of relief, as well as some excitement.
- 3. Once the hair is pulled, the sufferer feels guilt, remorse, and shame. Attempts are made to cover the bald patches with scarves, hats, wigs, etc., but eventually it becomes obvious to everyone and sufferers tend to start hiding at this point, or to feel intensely humiliated.
Acknowledge that there is a problem. The first thing to realize is that this can be treated; it is a disorder, not something due to willpower or lack thereof.^[3] The disorder arises as a result of genetic makeup, moods, and your background and when it kicks in, it's a condition in need of treating, not something to beat yourself up over.
- On the other extreme, don't convince yourself that nothing is wrong, that your hair pulling is 'normal'. Trichotillomania can be considered a form of self-harm - even though it isn't as talked about as other forms of self-injury. Like all forms of self-harm, trichotillomania can become an addictive behavior. With time, it becomes harder and harder to stop; that is why it's best to bring it under control as soon as possible.
Determine if trichotillomania is the only disorder that's affecting you. Compulsive hair pullers may suffer from depression, obsessive-compulsive disorder, Tourette's disorder, bipolar disorder, phobias, personality problems, and in some cases, exhibit suicidal tendencies.^[4] Some hair pullers may find that they nail bite, thumb suck, head bang, and compulsively scratch or pick at their skin. Many individuals who are affected by this disease also have low self-confidence or are low in self-esteem. However, sometimes the feelings of depression can be a bit chicken and egg; is the loss of hair causing the depression through the desire to isolate yourself from others and avoiding enjoyable activities because you feel deep shame?^[5]
- Abuse of drugs or alcohol can stem from trichotillomania, as the sufferer seeks to get away from the sense of shame, unhappiness, and guilt involved.^[6]
Identify the triggers. The initial cause of trichotillomania could be genetic and/or environmental. Researchers see similarities with the triggers for obsessive-compulsive disorder and consider that chaotic, distressing childhood experiences or disturbed early relationships with parents or carers might be behind the development of this disorder.^[7] One study has shown that over two-thirds of sufferers had experienced at least one traumatic event in their lives, with a fifth of them diagnosed with post-traumatic stress disorder.^[8] This has led to speculation that it is a form of self-soothing for some sufferers, a way to cope.^[9] In your own case, regardless of what may or may not have brought on the condition, consider what kinds of situations cause you to resort to hair-pulling. Do you only do it when you're depressed? Angry? Confused? Frustrated? Understanding what triggers your hair-pulling can help you find other, more positive ways of coping.
Learn about the disorder. You will be more likely to feel a sense of control and less shame if you understand what causes the disorder and why it is so hard to control it. Brain scans have shown that people with trichotillomania have differences in their brain from persons not suffering from the disorder.^[10]
Write in your journal each time you pull your hair
Try to reverse the habit through your own motivation. There are several ways that you can approach dealing with the trichotillomania disorder yourself, by following some of these suggestions:
- Keep a journal or a chart of your hair-pulling episodes. Through writing you can get a good idea of the times, the triggers, and the impact of your hair-pulling. Record the date, time, location, and number of hairs you pull and what you used to pull them. Write down your thoughts or feelings at the time, as well. This is a good way of getting the shame out, and of expressing how the hair-pulling is impacting your life in general. And when you tally up the amount of hair you've pulled out, this can serve as a reality check on how much hair you're removing; is the result surprising to you? What about the amount of time spent on it, was it more than you thought?
- Express your emotions.
- Write out a list of the consequences you've experienced as a result of the hair-pulling. Do this for school/work, home, social events, etc. It might include infections caused by touching your eyelashes so much, and having to go to great lengths to find head coverings, etc. It should also include the relationship consequences, such as not going out to spend time with people you care about because you're afraid they will find out about the hair-pulling episodes.
Keep your hands busy – take up sewing, knitting, or drawing
Develop a plan to stop yourself. Clinical psychologist Dr. Pamela Stephenson-Connolly suggests that you develop a 'Notice, Interrupt, and Choose Plan' to help you stop pulling your hair.^[11] This consists of noticing when you feel like pulling your hair, interrupting the chain of feelings and the urge to pull your hair through listening to positive reminders in your head. You could even have Post-It notes placed in areas where you tend to pull your hair a lot, as physical reminders to stop. Then, you can choose to do something else instead, something that will relax you and calm you. Some suggestions for alternative ways of expressing your emotions and feelings include:
- Taking a few minutes to clear your mind.
- Drawing or scribbling on paper
- Painting
- Listening to music that relates to your emotions
- Calling a friend
- Volunteering
- Cleaning
- Playing video games.
- Physical reminders not to pull your hair can be handy
  If you want a physical barrier, consider wearing ankle weights on the arm that pulls, or a rubber glove to discourage pulling.
Reduce your stress through exercise
Reduce stress sources. Many sufferers find that stress triggers the desire to pull hair.^[12] Do whatever you can do reduce stress in your life and learn how to manage the stress you do encounter with better coping techniques.
- Do relaxation exercises. A progressive body relaxation exercise can be of benefit when the tension is high. Also, consider yoga, martial arts, and all forms of aerobic exercise that you enjoy.
- Meditation can be helpful.
- Ensure that you have a regular sleep pattern and that you're getting enough sleep every night.
Work on your self esteem. Improve your confidence and self-esteem as this can be a large source of your stress and feelings of inability to cope. In addition, practicing better self-assertion techniques can help you to overcome situations in which you feel challenged by other people. Remember that you are a wonderful and unique person; you are loved, and your life is precious. No matter what anyone else tells you, you should love yourself.
- Write down a list of your accomplishments and strengths.^[13] Refer to this often when you feel down about yourself.
Talking to someone you trust can help
Talk to someone. Find someone you trust and tell them about your trichotillomania; if you aren't able to tell them in words, write them a letter or an e-mail. If you are afraid of telling them about your struggle with this disease, at least talk to them about your feelings. If you have no trusted friend or relative to talk with, consider talking with a counselor - they may be able to provide compassionate help.
If you can, distance yourself from the triggers. Is your girlfriend the cause behind most of your episodes? Perhaps it's time to reconsider your relationship. Is it your boss who's causing you all this stress? Maybe it's time to find a new career opportunity. Of course, for many, the triggers aren't as simple to identify or get away from; for some, change of schools, abuse, newly realized sexuality, family conflict, the death of a parent, or even pubertal hormonal changes are behind compulsive hair-pulling, and these triggers are very hard - if not impossible - to get away from.
Get help. Talk to a counselor, therapist, or doctor. They can help you find ways of coping, and address any depression or other problems that may be contributing to your self-injury. If you go to one source, such as a counselor or therapist, and you feel you are not being helped, leave and find another one. You are not chained to one doctor or counselor. Go to another and another until you find a person you feel a connection with, and feel helped by your interaction.
- The types of therapy that may be of benefit to you include behavioral therapy (especially habit-reversal training), psychotherapy, psychodynamic psychotherapy, hypnotherapy, cognitive-behavioral psychology, and possibly anti-depressant medication.^[14]

Video

Tips

Try keeping your hands busy while sitting or watching television. You could knit, pet a cat, or even try origami.
Make it difficult for you to pull out your hair. For example, rub petroleum jelly on the areas that you frequently pull hair from; this will make the hairs slippery, making it harder for you to get a good grip.
There are many ways to cover bald patches such as wearing a hat or styling your hair differently. Experiment for what best suits your needs.
Behavioral therapy has proven to be quite helpful in treating TTM, so talking to a doctor or psychologist should not be viewed as a last resort.
There are many risk factors that increase a person's risk of TTM, and they include: age, sex, and family history.^[1]
The most important thing that you can do is to love and accept yourself, regardless of your race, appearance, sexuality, and reputation. You deserve to be treated with respect, just like every other living thing on this planet - do not let anyone tell you otherwise.
Take vitamins and herbal supplements to help the hair re-growth process.

Warnings

Everyone is different. While one trick may cure somebody, it may not even help another.
People may make fun of you. If they do, ignore them because they are ignorant of the real reasons. If you know someone suffering from trichotillomania, do not belittle them or act as if they should 'just stop'. This is a disorder that needs treatment, not berating.
If left untreated, trichotillomania can lead to many complications. They include: hair loss, carpal tunnel syndrome, lifestyle restrictions, as well as emotional distress. Another complication that few people think about is the formation of hair balls; it's possible to develop a large, matted hairball when you eat hair that you've pulled from your body. Over a period of years, the hairball can cause weight loss, vomiting, intestinal obstruction and even death.