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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.

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