‘What Have I Done?’ An Introduction to Trichotillomania

apprehensive woman using tweezersImagine having long, beautiful lush lashes, and then in an instant, realizing you have mindlessly yanked them out for no apparent reason. Worse yet, you have pulled the majority out, so chunks of lashes are now missing from your eyelid. You are ashamed to go out in public looking that way, and now are desperately trying to hide the damage. Silently destructive, trichotillomania is a strange-sounding word for a damaging obsessive hair-pulling issue.

Trichotillomania, trich for short, causes those afflicted to pull hair from their scalp, eyelashes, eyebrows or other areas of the body. You know you have it when you feel compelled to pull and distressed once you’ve done it. Trich is known as a body-focused repetitive behavior (BFRB), along with skin picking and nail biting, and is categorized in the Diagnostic and Statistical Manual (DSM-5) under obsessive-compulsive and related disorders. Although it would seem that this categorization is correct since it does have an obsessional component to it, an argument can be made that it should be treated differently than other obsessive-compulsive behaviors.

Why on earth would anyone want to pull their hair out? This question ruminates in the minds of those who have never experienced the urge to pull and stirs the shame felt by those who experience this issue. After all, society deems long eyelashes, lustrous hair, and perfect skin beautiful. Therefore, removing the beauty becomes taboo and shame inducing.

The reason hair is pulled is not clear, but what experts have learned is that it feels necessary to remove undesirable hair (the compulsion), and not to pull would create tension and anxiety. Often this behavior is felt when idle, such as driving a car, talking on the phone, reading a book, or other sedentary activities. Triggers can be identified for some people; others have no known trigger, thus making it harder to treat.

From my personal experience, I feel a sense of tingling and itching in my eyelashes. This sensation does not go away until an errant eyelash (or twenty) have been removed. Once the seemingly offensive lashes are out, a wash of remorse and regret immediately takes hold. I often buckle under the shame, and set about a course of action never to have it happen again.

I am not alone. One out of every 50 adults will experience trichotillomania, according to the Trichotillomania Learning Center. Body-focused repetitive behaviors typically appear in late childhood and early puberty. Although it occurs equally in both boys and girls initially, it becomes predominately a female issue in adulthood.

What the research literature does not address is the underlying obsession and unforgiving quest for perfection. If an eyelash is wayward, it must come out so as not to have an imperfect lash line. If a scab is forming, removal is necessary to achieve smooth skin. This compulsion to achieve perfection in life zeroes in on those afflicted with trich, and escalates the issue.

Did trichotillomania come first; or did the perfectionistic tendencies bring it out? We will never know. However, it can be argued that lurking beneath the surface of someone with trich is a perfection-obsessed ripple waiting to lap up the opportunity to pick and pull.

Although no one treatment approach is best, body-focused repetitive behaviors like trichotillomania are showing responsiveness to cognitive behavioral therapy and companion therapy such as dialectical behavior therapy, habit reversal therapy, and acceptance and commitment therapy. By learning to understand and change the thoughts, feelings, and behaviors associated with trichotillomania, people are gaining ground in conquering it.

© Copyright 2014 GoodTherapy.org. All rights reserved. Permission to publish granted by Angela Avery, MA, LPC, NCC, therapist in Clarkston, Michigan

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

  • 10 comments
  • Leave a Comment
  • Lesley

    Lesley

    June 9th, 2014 at 4:24 AM

    You get these little obsessions like this, all of us have, but most of us not the extreme that you are talking about here. I went to school once with a girl who had bald patches in her hair because she was constantly pulling out this one spot of hair over and over. It would no more get long enough to tug on and she was pulling it out where it was trying to fill in. I didn’t know her well at all, but it didn’t take many of us long to figure out even at an early age that there was something that was off about that. I never know what happened to her, but I hope that she got some help because this is just one of those things where there is something going on and they show their wounds on the outside for everyone to see.

  • jason f

    jason f

    June 9th, 2014 at 3:55 PM

    Is this something that would show up pretty early on in life or would it come about mainly as being triggered by some sort of stressful event in one’s life?

  • Ms. Jernigan

    Ms. Jernigan

    June 10th, 2014 at 4:26 AM

    You see and read about things like this but I have never known anyone with this partucular tic/habit. It has to be very embarassing to do this and to know that you are doing it but feel helpless to stop it, especially when it leads to such visible results.

  • Angela Avery, MA, LLPC, NCC

    Angela Avery, MA, LLPC, NCC

    June 10th, 2014 at 9:28 AM

    Jason, this is a behavior that starts pretty early and there is some evidence that it is hereditary. As you mention, stressful triggers do come up and exacerbate the problem. Often multiple behaviors such as hair pulling, nail biting, skin picking and cheek biting happen together during the most stressful times. Thanks for the question!

  • Kirsty

    Kirsty

    June 7th, 2016 at 1:57 PM

    Hi Angela
    What about teeth grinding, is this part of the same set of behaviours? I think I’ve just realized almost by accident that I have experienced about 4 different bahviours potentially characterizable by the DSM iv over the last 10 years! It may have started with vegetarianism at 15, with nail biting and skin picking and some forms of disordered eating in varying degrees of severity through my 20s. Though perhaps before 15 I had other BFRBs like hair flicking / nail biting / cheek biting / teeth grinding, its too long ago to remember now. Even now at 30 I pull the little blonde hairs out of my neck, chew gently on the inside of my lips and rub my top lip on my nose when my concentration is fixed on something else. However if I play music I seem to work happily without these behaviours. I’ve also long wondered if I sit somewhere on an ASD scale.
    Many thanks
    Kirsty

  • kerr

    kerr

    June 11th, 2014 at 3:50 PM

    How do people who struggle with this see this as a step toward perfection? I would think the opposite that they would be concerned with how it makes them appear even more unusual for pulling out lashes, brows, hairs etc. Where is there then this line of thinking that this is all it takes for perfection?

  • Mery Kate

    Mery Kate

    June 13th, 2014 at 2:55 PM

    If I struggled with this I would want to know if there was anything that could help me quit besu=ides feeling like I had to go through my daily life with gloves on. I mean, how is this treated?

  • Tyne

    Tyne

    June 14th, 2014 at 10:01 AM

    My mom lived with trich all her life. Supposedly it started when she was a little girl and her parents split up and it was something that she always had to live with. She tried all sorts of things to stop, from therapy to who knows what to try to make it go away but in her case it was always a constant struglle to live like this. I remember always thinking just how pretty my mom would be if she didn’t have the bald patches, and this was when I was pretty young, but I also remember thinking about how much I wanted to help her make it go away and stop and never could.

  • Noelle

    Noelle

    April 28th, 2016 at 8:26 AM

    I’ve been dealing with this all my life.. and its so embarrassing.. I always want to look perfect but I just can’t stop pulling my hair.. but then after I do it I feel better physically but worse mentally.. so I put my wig on and shade in my eye brows to pull off a flawless look and no one ever notices but underneath the perfection as I see it always lies the damaged little girl I started out as

  • Kirsty

    Kirsty

    June 7th, 2016 at 1:36 PM

    Noelle please don’t think you are or ever were a damaged little girl. Put stress on an object it starts to show cracks. Put stress on a person and the same can happen. It doesn’t change the fact that with time and therapy you can be the best version of yourself, with or without grades of these behaviours. Don’t worry be happy. Love yourself as you are. Be kind to that little girl inside you who has an impulse to pull out a hair, be gentle and patient and let her heal in her own time. Xxx

Leave a Comment

By commenting you acknowledge acceptance of GoodTherapy.org's Terms and Conditions of Use.

* Indicates required field.

 

Advanced Search

Search Our Blog