by Aarti Gupta, PsyD

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.

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.

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

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!

What makes things worse is that all of my family are skin doctors. They've done all of these, and have compared me to various bald mythological characters. It makes me laugh at first, but honestly, I'm just trying to find a way to cover everything up and not do too much damage to myself. I want to live a healthy life. I'm still really young, and every time my family mentions this issue, I feel like I've aged by a decade. When I was in second grade, they paid my best friends to slap my hands whenever I pulled. When I was in fifth grade, they asked me whether or not my friends have gotten disgusted and have left me yet. My dad has suggested multiple times that if I can't do things well, I should go kill myself. Nothing really related to trich, but it made me want to cry every time he said that, especially since I knew he cared and that he only said it as a strategy for me to not actually do it. But I have noticed that before he'd started saying it, I had been more hopeful about my general view of life. I don't think I'm depressed. At least I would like to think I'm not? I mean, I don't know. I can't seem to do anything right. My head feels like it's full of trash and oil, and I feel like sometimes it makes my hair grow weird. So I just fumble around and grab the strands that curl weirdly. I just want to cry right now. I have no idea whether or not it's related to events in my everyday life, but whenever I do something, I'm doing it wrong and I want to cry but I don't. The three times I've been out of the house, it hadn't been my choice. I was chased out of the house. I didn't run. Once, it was after my dad had said it could've been much worse. That he could've hit my back with the stick like the ancient Chinese prisoners and broken it instead of my thighs, where there was protection from the thicker tissue layers. And before that, there was a blurry memory I didn't remember well because I'd been crying, but I'd yelled back, and he'd grabbed a knife from the kitchen. I knew he would've never. And he didn't. He threw my brother's boots instead. And yet I'm compared to my cousin, who's now twenty something and has never graduated high school. Heck, I'm called a poorer version of my cousin, because her dad had more money. I have good grades. I do very well in things I'm interested in. I dedicate a lot to things that catch my interest. I finished costumes for the musical in a matter of days, I've worked on my singing and my cosplays and my dresses until three in the morning, and I plan special events to the smallest detail. It's just the things that don't that I fail to try hard in. It's like I'm relying purely on luck to get pass my everyday life, and I don't know what I want anymore. Is this a rant? I don't know. I want to talk to someone, but it's so hard. I feel like there's really no one there I can talk to. Going to school counselors and therapists means confirming to my dad that I have mental problems, and I would feel disgusted by myself for letting him believe that. Speaking to my family would result in more scorn. They already hate my face enough as it is. Speaking to my friends would be awkward and vaguely attention-seeking, seeing as they have their own problems. Speaking to myself, I don't like. My mind comes up with so many worse scenarios each time I think. I don't want to die. I don't want to be depressed. I don't want to pull my hair. I just want to talk to someone that I won't have to hide my face to whenever I cry and won't ridicule me or have their own problems or pull in a college intern student into the room to observe their work while I speak. I want to talk to someone strong who won't pull me down or let them be pull them down with me. That's all.

Dear Rant,
Going to all this and still standing shows wat a strong character you are. Your grades at school will soon bring you to a new world with all the love and friendship you derserve. It appears that your father can't cope with the situation. That is not your fault. It's totally his responsibility and misfortune. Unluckily you suffer the consequences. But don't ever think that this is normal or that you deserve to be treated like this. A good idea to share you thoughts here. All the best to you. Xx

Dear rant, you need to get away from your father. He tells you, if you can’t do anything right ,just kill yourself. That is no loving father. Try to find someone who supports you and get away from that terrible man, that sais he’s a father. I think your hair pulling will improve with a person who shows you love. . Good luck

I’ll straight away get to the point. I am 24 years old, and i ve the habit of pulling my hair so badly that i can see the baldness in my scalp. Can anyone suggest me any product to regrow my hair?
Ps the urge to pull out, somehow i can manage but i just want to regrow my hair.

I am not sure about something to regrow your hair but there are hair fibers that do a great job covering up spots. They are called “Toppik.” Sally beauty salon carries them. I think eBay might have them too for even cheaper.

i ended up almost pulling out all of my eyebrow hair and i feel so ashamed and disgusted in myself and i look like a freak. i don’t know how to stop doing it though. i’m too scared to tell my mom about it cause i don’t want her to laugh at me and i don’t think she’ll understand so i’ve been filling them in but it’s only getting worse. this is the first time i’ve almost lost my eyebrows completely and i’m slightly freaking out. if anyone can help me with some tips to lessen the urge i’d greatly appreciate it.

I suffered with trich when I was 12 yrs old and although it was many years ago, I completely understand how you are feeling.
(I pulled my eyebrows out and was bullied at school.)
I think you should try talking to your mother about it, and explain how awful it’s making you feel both mentally and physically. I’m sure your mother loves you, and will want to support you any way she can.
If you just can’t begin the discussion with her, reach out to a school counselor, teacher, or another adult you trust, and explain what you’re struggling with. They can also help find a good therapist for you to speak with who can guide you, and offer expert advice. You are not a freak, and you are NOT alone. There are people who care, and who want to help you. It’s nothing to be ashamed of.

Please reach out to someone, so you can get the help you need. You shouldn’t be trying to deal with this on your own. A therapist can show you better ways to cope with your anxiety, and help make sense of what is happening. Many of them offer services on a sliding scale, if financial help is needed.

You deserve to feel better! This is a hard chapter in your life, but you will get through it!
Please take care of yourself! You can do it!