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by Aarti Gupta, PsyD
trichotillomania

I recently discovered that two friends of mine suffer from trichotillomania, or compulsive hairpulling. It came as a surprise to me, and even as a clinical psychologist, it was difficult to detect because neither one of them pulls out their hair in an obvious manner. Although about 3 percent of the U.S. population experiences trichotillomania during their lifetime, few people know what it is — and even fewer want to talk about it, which adds to the elusiveness of this disorder.

Trichotillomania (pronounced trick-uh-till-uh-may-nia), often called trich, is characterized by an uncontrollable urge to pull out one’s hair — from the scalp, eyebrows, eyelashes, or other areas of the body — to neutralize an anxious feeling. If the hairpulling is severe enough, it can leave bald patches, which my clients often describe as embarrassing, isolating, and frustrating.

Hairpulling can take place unconsciously or consciously due to boredom, stress, anticipatory anxiety, zoning out, and other circumstances. After pulling out hair, my clients may even report feeling relief or satisfaction as they describe having “scratched an itch” or “pulled out a hair that didn’t belong.” Family and friends can find it perplexing that a loved one could find this habit pleasurable. Indeed, it could be a sign the person may be dealing with unresolved anxiety or an inability to cope with stress in a productive way. But sometimes no defined reason can explain the behavior.

If you or someone you know suffers from trich, the best bet is to find a licensed psychologist who is trained in cognitive-behavioral therapy (CBT) and habit reversal training to help manage symptoms. In the meantime, I’ve compiled a list of questions NOT to ask the person suffering from trich because these can often do more damage than good.

What Not to Do

1.  Don’t ask, “Why don’t you just stop?”

Chances are, the person already asks themselves this question every day. This diagnosis can carry a lot of shame, and this statement assumes it is easy to stop pulling. If someone could stop, they would.

2.  Don’t suggest, “Stop covering your bald spots so you can actually see the damage.”

Covering up is controversial. While some clients find it freeing to take off their makeup and wigs, others find it shameful and embarrassing, and they can regress to feeling hopeless, helpless, and far from their goals of stopping the behavior. Until you know how someone will react to this strategy, skip this advice.

3.  Don’t say, “You need to learn to relax, and maybe the pulling will stop automatically.”

Usually, this isn’t true. My clients with trich have hairpulling on their mind constantly (which can be mentally exhausting) and have uncontrollable urges to pull. These urges typically require much more than just relaxation to reverse themselves, so don’t assume it’s that easy.

4.  Don’t carefully observe the person and signal or say something when they are pulling...

…unless the person asks you to do this. Many people feel watched and judged with this technique, so ask them if verbal notice would help before becoming the “pulling police.”


About the Author

Aarti-Gupta,PsyD-websize.jpgDr. Aarti Gupta specializes in CBT for anxiety and related disorders, as well as body-focused repetitive disorders such trichotillomania. She is Clinical Director at TherapyNest, A Center for Anxiety and Family Therapy in Los Altos, California.  

Other resources:

What Is… Trichotillomania? Causes, Treatments, and Resources

ive suffered from trichotillomania since i was a young child. the thing that had helped me the most i think is the support ive received from the people who love me. maybe just remind her youre there for her and you love her. but on the other hand, everyone is different and has different ways to cope and not pull. i also don’t known your guys’ relationship so im unsure of how often you tell her you support her. but yeah,, its a good idea to let her know youre there for her and you love her. even if it doesnt help it sure makes you feel good to know someone cares.

My fiancé is trying to help me through my mania. We made a deal last night because I want him to stop smoking cigarettes. So he came up with this deal that if I stop pulling my hairs out of my eyelid and eyebrows, he will stop smoking. It’s helping me because I’ve attempted to pull all day and thinking of how he is supporting me and not judging me in this condition I have, and instead is trying to help me, he motivates me to eliminate this embarrassing condition. Plus it’s helping him to stop smoking. I’m hoping it will go on for the rest of my life so I can see how beautiful I really am.

I have done this since I was 7. I don't know exactly what or even why it started happening and chances are your friend doesn't understand it either. Shaming is the worst, I have even learnt to apply false lashes to help hide it. Being there and not judging your friend is the best thing you can do.

yeah i have had it since i was around 6 people ask me things and it puts pressure on me but knowing that other people and going through the same as me helps

Just tell her you support her and love her and understand her, when she has the urge to pull or is pulling, don’t just sit on your phone, tell her you want to help and ask her if you want to go out or play a game to distract her from pulling or any other anxiety... my boyfriend just sits on his phone.. and it’s sad because it embarrassing asking for help knowing he sees me picking

Hiya, person I have done tips for you to help your girlfriend
You could tell her that she if beautiful inside and out (I know this one is supportive as it helped me)
You could tell her that she doesnt need other people's approval to be amazing
You can tell her that it will get better
And most of all give her lots of hugs because it makes people fell better 😄😄😄😄😄
I hope this finds you well and I hope that she feels better

I recommend you talk to her, ask her why she thinks she does it and when, ask her if wants to talk about it, and if she would wanna have help. Tell her you love her and that she is worth it, she may have depression, sometimes people pull hair as self harm instead of cutting. Help her find a new habit, coming fro someone who used to have trich and still does from time to time listen to her, and try to get her help trich will not go away on it’s own, it is a mental disorder that is very serious and that can be caused by another mental disorder she may have.
Sincerely, -CB

Hey just wanted to let you know that you’re not alone & I’ve been told the exact same by my parents. I too struggle with trichotillomania as I started pulling at a young age that started with my eyebrows to my eyelashes & my scalp. Over the years I’ve made an improvement from the urge to pull my eyelashes & eyebrows but as of today I am still trying to cope with an effective way to prevent myself from my pulling disorder... not easy but it’s a relieved feeling to know that we are not alone in this.

I suffer from trichotillomania and my loved ones laugh because i have no eyebrows but i used to not do that unyil almost 4 yrs ago i lost my daugther at 1mo & 2 days old and i realized it affected me more than i thought until i just stopped to think i held my grief in for so long as started pulling at my eyelashes and eyebrows to cope i still do it till this day and i dont know what to do or how to stop it

That's awful, I'm sorry for your loss. Maybe you could try pulling from somewhere else, I'm not putting my name so I feel okay in saying that I pull from my pubic area on my vag. At least that way your family won't see it.
I don't know why, I have no real reason to but I can't stop and I feel like it's never finished because it certainly isn't. I dig into my skin with tweezers to get ingrown hairs or even hairs that haven't broken the surface yet. I pull any hairs that look too dark or prominent at first and then I get the rest in whatever order I want. Needless to say, it is not as pretty as it used to be, but I'm afraid to let it grow out and heal over cause it'll be gross. There's little scabs and uneven redness and ingrowns(before I pull them) all over where I pull from. It's annoying but when I see one that doesn't belong I feel like I have to remove it from my body or I will be impure and ugly even though nobody else can see there besides my boyfriend, who says I should just shave because it looks painful to him. Sometimes I lock the door so he won't see because even with him I am still a little embarrassed about it. Should I just stop, can I just stop? I haven't tried to stop ever before. That's pretty much my whole story thing. I used to only tweeze my bikini line until about 4 months ago and I just started ripping away relentlessly and some of them hurt more than others but after they were out and gone it looked like no hair had ever grow there but now it looks like I tear my skin apart because I do. Maybe someone could offer me some advice as well.

OMG!!!!!!!!!!!! the SAME!!!!!!!! I have sooooo many ingrown hairs! I had a purple mound, and there were literally FOUR hairs in there! I could squeeze pus out of there. I had to figure out a way to get rid of it. I would dig them out with a sanitized safety pin..... too chicken to go to the doctor (I have other issues, but I would have to just completely shave so they wouldn't ask any questions) It sucks, but I also pull from my scalp. If I could stop that and just pull from "down there" at least that would be a start!

I can really relate to this. I also pull out of that region with tweezers, and I can spend an hour without noticing too much. Almost always, I sit on the bathroom floor, with a locked door, and use tweezers to pull out the darker hairs and the ones where more than one hair grows out of the same hair sack. I’ve also dug out the hairs that grown under the skin for more than a year now, and the scars I have make me really insecure. What if someone sees it, and asks questions/think I’m some kind of masochist or just plain weird and gross?

I also have a habit of pulling out the hairs from my knees (along with occasional eyebrows and eyelashes) and the ones that don’t hurt, just slide out, are the most satisfying.

I was brave enough to introduce my mom trichotillomania, but I asked a bit later what her thoughts on self diagnosing was, and she asked if it was about trich, and I chickened out. I couldn’t talk to her about it, because she said before that it’s easy to find a word on the internet that you can relate to (but most likely it’s nothing).

I, too, lost a child. My son, it's been 6 years and I still pull and have NO eyebrows!! I also pull if there is a hair on my leg I missed shaving. I can't stop. My husband constantly says, stop picking!! Nobody understands how bad I wanna stop

I have pulled my hair out since I was 13 at 13 I was very badly bullied at school then at 14 I lost my bestfriend to epilepsy which I've suffered with since 3 years old then at 15 I lost my nan who I was extremely close too then at 18 i lost a friend I've grown up with then at 19 I recently lost my cat I've always pulled my hair since I was 13 at school getting bullied til now and I can't help it my parents tell me to just stop but it's not that easy I don't even realise I'm doing it sometimes I've only recently thought about going to the doctors about it because I used to have very nice long hair but now it's like a patchy bald mess and it makes me feel very insecure

I’m so sorry to hear of all the trauma you have endured in your short life. No wonder you’ve been pulling! Instead of going to an insensitive medical doctor to address the hair issue, I would suggest some counseling. There’s free and low cost counseling almost everywhere. Look up something called The YWCA. I went through a lot of trauma growing up and into adulthood and I started constantly pulling. I wound up buzzing all of my hair off and you know what? It was the moat freeing day since I started pulling. If there’s no hair there, there’s nothing I can pull. I put growth oils on my scalp everyday and eventually the patch went away and my curls are thicker and healthier than ever because of that buzzcut. I wish you all the best my dear.

I never used to even have the thought of pulling hair out until I started wearing makeup my sophomore year of high school! I would always wear mascara and it would clump up. The clumping would get annoying and that’s when I would pull out the clumps, that led to a couple eyelashes being plucked out, it hurt at first but then I got used to it and it steadily started to become a habit. About a few months later I started to wander my hands on my scalp, it would be frizzy for this damp Texas weather in the mornings and I would start pulling hairs from the back of my scalp, it wasn’t that bad until i entered college. I tend to stress out bad and pulling hair would relieve my stress until I looked the mirror and saw the damage I had done to my eyelashes, my scalp hair during my freshman year wasn’t so bad but I’m still in college, I’ve gotten better at not pulling my lashes and they were fully grown and thick and I was proud, for the longest I stopped pulling both head and eyelashes was about 3 months but when something comes it, it starts all over again, it’s a never ending battle and it sucks so bad! I’m glad my parents don’t judge me too much but I’m thankful for the things they tell me to help me stop, my mom doesn’t understand why I do what I do but my dad does cuz he had a very small case of trich. I think I learned it from him subconsciously cuz every time he thinks, he rubs and tugs at his mustache a little. Anyways, I pray that we find a way to cope with this or find a substitute to stop this hair pulling, I wish we could just tell our brains to stop but prayer is strong enough to end this bad habit

Wear a hat! Try to find a wig and wear a headband around it. I think it is trauma related (for everyone who has lost someone) Are you a girl? It affects more girls. It could be anxiety. Read about it. Maybe if you ever go to the doctor, say you have anxiety issues. I am not a fan of meds, but try therapy. Play your favorite music. Try to calm down. Spend more time with people so you are not alone to pull. I do that sometimes. That is where I go crazy, if I am alone.

i have that said to me all the time. im not sure why but it makes it much worse. I wont stop ill just try not to do it in that person's presence. I hope that all gets better for you. Im truly sorry for your loss

I am so very sorry for your loss. I lost a baby boy at 3 months old. He was very sick. I started pulling my ir and ye lashes out many yrs ago. As a teenager. I am 61 and now and then when I am stressed I think is when I tend to do it. Time will heal your pain. The Lord was a great help to me.

I'm so sorry for the loss of your baby, it happened also to a very close friend so I really do understand. I also live with Trich, which I'm only learning of the 'nick name' this evening. I've lived with it for a long time & didn't know to talk to someone & get help, so that's what I would say is if you can go & talk to your Dr. to get some support & talk to someone who will do just that & support you, not laugh at you.
I hope something you've read on here has helped you in some way.
It can get better for you, don't struggle alone.
Cheryl

I wish I could comment that this condition will eventually resolve on its own, however, that's not the case. I am very, very embarrassed that this disorder started when I was over 50 years old! After several severe losses and prolong stress, anxiety, depression, I began tweezing hair from my legs - and I can't stop. I am over 65 now and the compulsion is incessant. I am so embarrassed and must use dermablend in public if any part of my legs will be visible. I have spent thousands of dollars on creams and serums in the hopes of fading the ugly scars. I understand certain new cosmetic procedures MAY reduce the scars severity on my legs, but I'm too embarrassed to seek this out. Just wanted to put this out there that this is not only a young person's disease. I am just miserable - yet still compulsed.

I’m so sorry about your loss. I started pulling when my cousin passed away. It’s been 10 years and I still pull my eyebrows. Although I can’t find a cure, I’ve found products that really help grow my brows and lashes. There’s a website called Forchics and they have products called forbrow and forlash that you apply before bed.

I have suffered from trichotillomania for around 7 years since I was 7 and I have always let them grow by themselves which is a long and tedious process and it also has made me worried that they wont grow back but now you have suggested this I am definitely going to try it

my Parents never told me this was an actual disorder and I have been pulling my hair out since I was 8 years old and I’m 19 now. I’ve felt so alone and could never explain why I do what I do and I can’t ever wear my hair down I have to wear it up in a ponytail because it hides my bald spots. People would always call me a slob in school because I wouldn’t ever wear my hair down or look nice because there was no way I could and look normal. And throughout this I've felt alone and so weird. Just today I learned I’m not, other men and women go through this and I’m not weird.

Even I am embarassed by this in my college.. 3yrs back I started pulling my hair from scalp.. I didnt know anything about it till today I searched why I have been doing this and got to this.. I love putting my hair down but the bald patches are seen everywhere.. I want to stop doing it but can't.. Why do people think that I like pulling my hair .. I don't , I do it unconsciously.. My mom has been shouting at me for doing this and telling me to stop but I don't know why I can't .. I think I have not been going through any trauma in my life though this is happening.. If anybody can help please reply.. Thank you!

i am 14 years old i actually pull my eye brow hair most death love pulling my knuckle hair hairs every were the lest place i pull is my real hair trying to let it grow out actually but yea i am very young and i dont even stress it just feels so good to me it satisfies me .

I have always had a slight case of trich as a child and i just recently figured out it was a disorder. At first i tied knots in my hair and yanked it out, then i pulled out my baby hairs in the front of my head and now i am struggling with twirling and untangling the knotts out of the back of my head. I still have hope that we can all get throught this! Find something to distract your self, i find that when im watching tv or i am bored i start to pull. So i went out to my local doller tree and bought stress balls, slime and little things to distract myself. I also highly reccomend a low bun for pulling from the back of your head it has saved me in so many occasions. 💕

YAY!!!!! I love you, anonymous friend!!!! I totally agree! We need to stay strong. I think it makes us stronger, and more caring, knowing that we understand each other. That is exactly what happened to me. We will survive!

I’ve suffered for 2 years now. I feel so helpless, but found a couple of things that have helped me.
Whenever you find yourself picking, cover your finger, and calm down. The reason why you might be pulling is probably stress. Also, put a hat on if you pull your hair. There is this bracelet that can tell you when you start pulling. Search up Keen Trichotillomania Bracelet. Find a plan and keep your mind to that plan. Don’t feel bad when you pull. You can’t be perfect. Also remember the phrase: Your in now, not yesterday. That means that if you pull, you shouldn’t spend your time regretting it because you can’t fix what you did. Focus on now. Good luck.

i feel that i am suffering from trichotillomania and my parents and friends tell me it’s disgusting and that i should just stop doing it but i cant

I started my condition in the 3rd or 4th grade. My mom use to whoop me for my condition to try and get me to stop, and at the time we didn’t know what it was, but common sense should’ve told my mom something had to be mentally wrong. Family members yelled at me for it. My family members thought I had cancer, which I don’t know how and they had me believing that I could develop cancer from picking at my hairs. I don’t do it on my head. Just my eyelids and eyebrows. I have a fiancé who is trying to help me through this and I love him for supporting me. He made a deal with me because I want him to stop smoking cigarettes. He said that if I stop pulling, he will stop smoking cigarettes. That deal motivated me. I slipped and pulled two hairs out not too long ago but I’ve done better than I did days before today because I would pick all day. Things take time and I am patient. What motivates me is my fiancé, seeing pics of beautiful women, or seeing pics I’ve taken with filters that gave me eyebrows and eyelashes. Another thing I do is redirect myself by watching tv or playing the game because I’m a game freak. I still get great compliments on my facial appearance but I could look better with my hairs. That’s what motivates me. And cameras/mirrors give you different images so I barely like to look in them.

So I have trichotillomania and i have resorted to trying my hardest to cover it up but its hard and before when my parents knew I still struggled with it they didn't understand. Will it always be this hard not to yank out all my eyelashes, or to not pull my eyebrow hairs?

So have mine! Don't worry about it! People who don't have the disorder do not always understand it. They can try, but it doesn't always work! Just try to stay calm. Identify what makes it worse (if anything) and try to avoid it. Mine is worse when I start worrying about a test, or what people think of me. It is always bad, but my hope for both of us is that it gets better. Hang in there! You are not alone!!!

I can agree as someone who pulls out their eyebrows and eyelashes consistently and have been trying to stop for 6 or 7 years parents consistently telling me these things and saying that I’m going to always be seen as a weirdo even though I know all of this and no matter how many times I say I can’t stop or it’s not easy to they just won’t stop saying it

Last night I pulled out every single strand of my lashes one by on, and the whole Time I was thinking to my self, “why am I so weird” “nobody is ever going to love somebody like me” and “just stop pulling” by the time I was done over thinking they were all gone. Now I’m laying in my bed at 2:05 pm crying, and depressed because I look like a freaking idiot sitting here bald eye’d. Embarrassed to even look in the mirror, I don’t want to go outside, I’m even considering quitting my job. Sometimes I think the best solution is to commit myself but I don’t want to be medicated, and suicide just isn’t an option for me anymore because I couldn’t imagine leaving my child to grow up without me. I JUST WANT THIS TO STOP!

I do the same thing. I try to stop so hard but it’s almost irresistible. A tip would be to find out from where it stems, is it self hate, etc. as soon as you find that out it gets a little easier. Also find out when and where you do it and put yourself in the opposite situations, but just remember that you can do all things through Christ so it’s not impossible.

I have suffered from the age of 4, I am now 27. I have not had eyelashes since the second grade and after being in at EF5 tornado and surviving, I have not had eyebrows since 2011. I utilize strip eyelashes and put them on every morning with glue. I can make a single pair last me 6 months and cake them up with mascara. I partake in microblading for my eyebrows that way people do not know I do not actually have eyebrows. If you need someone to help you or to follow so you don't feel so alone- Add me on Iinstagram @ jessiemcnally22. Lets be eachother's support. When you add me, send me a message that says #metoo so I can know who my fellow strugglers are. Lets do this toegther. We may not be able to beat it, but we don't have to go at it alone either. XOXO

I feel you. I just pulled out all of my eyelashes, and now I’m laying in bed crying again, for the 1,734th time. I’ve been so good this last year; I recently moved to Florida so I’m always in the water and didn’t want my new friends and bf to see me like I used to be, I actually had a full set of lashes for once in my life and was so proud to put on my mascara for once and not be asked “why are you wearing false eyelashes?”
I’ve pulled since 4th grade. I saw my mom doing it, and I think that’s what started it. We always said it’s because of stress. I do find myself doing it when I’m not even paying attention and not stressing about anything at all. But the moment it really happens and I notice what’s going on inside me I realize i May have bottled up feelings for a long time and now I’m coping with them.
When i was little I had crazy long thick lashes, now I just feel like I look sick and I want everyone to just leave me alone and act like I’m not here so I can not worry any more than I have to if they see me without false ones on.

I wish you the best, and I hope we don’t let ourself a think down the wrong path anymore. We have support and we can get through this!

I do the same fricken thing. I pull my eyelashes out until I have a mental breakdown and want to cry all night. If you talk to others about it, that really helps. I hate looking in the mirror after I just pulled. It makes me so sad and feel scared about what other ppl think. I get it.

I also suffer from this as well as dermatillomania. In fact, I just learned what picking my skin is called. I googled trichotillomania; and, I saw a link for Keen trichotillomania bracelet. I am going to look more into this. Good luck to everyone who suffers from BFRB. Hope this helps.

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