Wednesday, July 22, 2009

Trichotillomania: cures, shame, localization, management

From lily-day's deviantArt
Trigger warning.

Via Shakesville comes a story about trichotillomania and a possible cure:

A new study published this week in the Archives of General Psychiatry may hold promise for those who compulsively pull their hair. Researchers say participants who took an antioxidant called N-acetylcysteine, sold over the counter at vitamin stores, had significant improvement over patients who took placebos.

I like this article because it also non-judgementally addresses the shame of trichotillomania, or compulsive hair-pulling:

Trichotillomania is such a stigmatizing disorder that people will go to great lengths to hide it -- to explain bald spots to acquaintances, some patients will lie and say they had cancer, Woods said.

"I have talked to patients who have pulled for 25 years, and their husbands don't even know it, they hide it so well," he said.

I've had trich for about seven years now. It's manageable, now; I don't touch the eyebrows I once tore out almost entirely. (Actually, I really like the thick Brooke Shields look of my eyebrows now).

One issue I had with the article was its localization of hair-pulling to the eyebrows, head, eyelashes, and pubic hair. Trich is far from limited to those areas - in fact, I usually avoid those areas when I do pluck these days. I tend to go for the hair on my feet (particularly my toes) and my fingers, the dark coarse hairs around my nipples, and stray coarse hair on my chin and neck.

I go for hairs that stick out, that don't bend, that poke. Maybe it's because they're easy to find, visually and texturally. Maybe it has something to do with the way they subconsciously clash with my view of feminine women as possessed of only soft, and downy body hair. At some point, it was ingrained in me that only men have coarse or dark hair on their chest and chin, and perhaps I'm punishing myself for that.

As Liss at Shakesville mentioned in the comments of the article above, trich can be a good stress reliever when controlled. Usually, I only pluck to get rid of the coarse hairs that my fingers find over and over again on my chin, and occasionally when stressed I'll go after others. As long as I'm not digging (and thus creating sores) I don't worry too much about it.

But when it does get to the point where I'm obsessively looking for more, more "weird hairs", I know it's moved from stress relief to self-abuse. So I hide the tweezers. I know where they are, but stopping the automatic response of getting them out to pluck helps me to consider the compulsiveness of my actions and dampens the need.

Those of you that have trich: how do you manage it? Is yours typically localized?


  1. Ack, having to be careful with this article because I'm apparently more trigger-able than I realized. (Which is not your fault: you warned very well.)

    My trich started in seventh grade, at least, noticably. I find that, like you, it takes on the form of self-punishment. Although I also pull at my eyelashes when stressed, or tired, intially it began with a (possibly OCD-related?) horrible fear of dandruff. I would notice my head itching and for some reason decided the best way to deal with it was to isolate a piece of dry skin and pull it out along a strand of hair, or rub at my eyebrows hoping to make the dry flakes come out.

    This turned into just pulling at the HAIR, or plucking the hair of my eyebrows, when I couldn't eradicate the problem from in between the hairs.

    Similarly, I hate the hair on my knuckles and toes, or the long hairs that I can get on my neck at times. They feel manly to me -- especially because I got a lot of soft hair on my neck during a time when I was having hormonal imbalances having to do with too much testosterone -- and they make me selfconscious about being ugly. Which is totally relevant to this blog in another light, you're right: who told us that girls had to be hairless and soft, or only possessing of light, downy arm hair and long flowing head hair - but nothing else?

    I never associated my picking out of particularly bothersome dark body hairs with trich because I thought it was just self consciousness, but you're right: they are connected, as is my self-consciousness ABOUT my hair and my hair health.

    The eyelashes are separate: they feel ITCHY, or stuck together. Even when I know that logistically it's because I have sleep dust that I've totally gotten rid of, or I'm having an allergy attack, it feels to me as if the eyelashes being removed is the only way to stop it. And when I'm stressed or sleepy the feeling returns.

    And I have that (EVEN BIGGER TRIGGER WARNING HERE) horrible side effect of trich where the feeling of a hair popping out at the root is the most satisfying of feelings. With my eyelashes, which are the worst plucking problem to this day, that *pop* of a hair coming out not because I broke it, but because the root has been removed, being able to see the little white curly bit at the end as I hold it in my hand, is both nauseating and addictive.

    And then I look in the mirror and my eyelashes are half-gone, which makes me feel completely horrible about myself, and also makes me want to pick at them to even it out.


    But I am doing better. It comes and goes. I'm learning to deal with things by looking for good remedies: things to avoid (mascara, I've learned, is a not great idea, because it makes my eyes itch), things that help (giving myself something to do with my hands like typing, knitting or drawing, washing my face, taking allergy meds regularly, getting plenty of exercise to relieve stress, and most of all reminding myself that the feeling will go away on its own if I let it).

    I find it SUPER interesting though, to think about how we are often led into these anxieties by social pressure. That honestly hadn't occurred to me before - at least in this case - and I'm glad you brought it up.

    Sorry for the essay! Haha. I hope some of this was helpful, or at least interesting :)

  2. faye, I am so glad to hear that someone else is deeply satisfied by the *pop* of a hair coming out at the root. I have been unable to adequately explain it to anyone.

    My therapist seems worried about my hair pulling, but like you, rachel, as long as I'm not digging, I don't worry about it. If I can confine myself to pulling from my underarms where it's socially acceptable for me to not have hair, I can almost embrace it as a relaxing activity.

    I recently tried to stop pulling. After two weeks I realized I'd simply replaced it with skin picking. No thanks. I'll take bald eyebrows over scabby arms any day. If it has to be one or the other, I'll pull.

  3. I posted a comment on Shakesville, but I thought I'd drop in here as well.

    Instead of trich, I have dermatillomania. Ever since I got my first zit, I haven't been able to resist touching and messing with any bumps or zits on my skin. I scratch at my scalp too, sometimes to the point of drawing blood.

    I can relate to the deeply satisfying feeling the behavior gives, and even though I know it's going to make my skin look awful I can't help it.

    And oddly enough I've tried to replace my picking with hair pulling (specifically my eyebrows, they are so thick) but its not as satisfying to me.

    It's gotten better, but it mostly gets better as my skin gets clearer so I do my best to keep it clear!

  4. Faye, thank you so much for sharing that. I did the same thing with my dandruff, pulling it down a strand of hair until it came out. Sometimes the hair came out with it, and while it never developed into trichotillomania, I did it for a long time and it was *really embarrassing*. I had no idea other people did it, too.

    Kedawen, I do the exact same thing. It is weirdly, and grossly, satisfying. I do what I can to keep my skin clear, so I don't pick, but nothing seems to work for my acne, so it doesn't really help. Again, one of those things I had no idea other people did, too.

  5. Everyone here - thank you so much for sharing. It was scary to discuss this publicly, and I'm humbled that you all would do the same.

  6. Thanks for posting this. I have dermatillomania (I mostly pick at my scalp).

  7. We talked about this a little bit on twitter and how my picking at wounds may be at least peripherally related.

    Right now both of my inner cuticles on my thumbs (the portion of the nail that faces the other fingers) are torn up horribly. I pick and pull and scratch at the skin when even the smallest cut, abrasion or dermatological anomaly shows up. I turn simple acne into open wounds (thankfully I'm reasonably acne free or I'd be covered in scars) and I scratch at ingrown hairs at rashes until they get far worse.

    It's compulsive and irrational on my part and I really am at a loss on how to fight it. I end up doing it while not thinking about it and even when I am I still catch myself sneaking a pick or a scratch. I just had to stop myself 3 times from picking at my cuticles while writing this comment alone.


  8. Thank you for this post. It's the hard, coarse hairs for me as well. I have always wondered if it was a femmey thing as well, or part of some 'the nail that sticks out gets hammered down' part of my psyche.

  9. I have both trich and dermatillomania. Began as trich and now I'm picking at my scalp like crazy. For some reason I only go for my head with both. Bald spots... I have 3 of them! I also have anxiety and panic disorder.

  10. Ps ladies. When it comes to trich, ever since I started picking at split ends its helped deter my hair pulling. Dermatillomania has me now tho :(

  11. I've had derm/trich since I was a small kid- picking at my eyebrows, lashes, skin, and scalp until red and sore. I now pluck my eyebrows quite thin so I can't find the stray hairs during the day. However, recently I was confronted about my problem by my boyfriend, and though I have been able to almost completely stop picking my skin I've all but replaced it with pulling my hair :(


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