BOSTON — When I was in high school, I never left the house without a pair of tweezers nestled comfortably in my purse. The fear that I would need them but that they wouldn’t be there greatly outweighed any anxiety or embarrassment I felt regarding the reason for carrying them; all that mattered was that they were easily-accessible when I felt the urge to pull.
In tenth grade, I was diagnosed with an impulse-control disorder called trichotillomania, commonly referred to as “TTM” or “trich.” This psychological condition is described by the American Psychiatric Association as “the recurrent pulling of one’s own hair with the potential for considerable hair loss.” As a 15-year-old struggling with depression, social anxiety, and a group of friends who related to and supported her destructive behavior, a diagnosis like this was not particularly surprising – I actually sort of wanted there to be something wrong with me so that I would have a reason, an excuse, to feel what I felt and do what I did.
But the urge is undeniable. It’s been over five years since my diagnosis, and I don’t carry tweezers around with me anymore (although there are three pairs on my nightstand; I lose them quite often), but the impulse to pull has never completely left. Many “trichsters,” as we’re called, pull hair from very specific locations on the body; the scalp is most common, with eyebrows a close second. I occasionally pull from my scalp and pluck random hairs from other parts of my body, but my primary pulling location – my chin – is relatively unique.
The urge to pull manifests as an obsession: I carefully select which hair to pull based on texture, length, and location; it’s as if there’s nothing else more important in the world than getting rid of that particular hair. The removal is accompanied by very odd feelings: gratification, relief, and a release of tension. I consider pulling to be a comforting nuisance, if that makes any sense at all. I can often be spotted picking at my chin or running my fingers through my hair, searching for those offending hairs, the ones that need to come out.
“I pull from my head,” my friend, ‘Anna,’ admits. “I find the thick hairs, the ones with more texture, and I yank them out. Then I play with them. I roll the roots through my fingers; I peel the split ends. I used to eat the roots, but that just got weird.” Anna and I used to sit together in Spanish class, and we would often catch each other in the midst of pulling when the lectures got boring.
Anna illustrates the main problem quite nicely: other people get freaked out by the “weirdness” of this disorder, which forces trichsters to be very secretive and find ways to conceal its manifestations.
Many sufferers also have related habits, such as nail-biting, knuckle-cracking, and skin-picking. Trich is considered a “cousin” of Obsessive-Compulsive disorder, and it is also thought to be related to tic disorders, especially Tourette’s Syndrome.
“A person with trichotillomania is not mentally unstable,” says Kerith Mercantonio, a recent graduate of Westmont College’s psychology program. “However, trichsters often feel depressed, [and] hair-pulling is associated with low self-esteem, shame, avoidance behaviors… anger, anxiety, and embarrassment. [They] are not comfortable telling others [out of] fear [of rejection].”
Most trichsters hide their condition and don’t realize that this thing they do to themselves has a name and that they are not alone, so it is difficult to get exact statistics. However, it is estimated that about one in every 32 people suffers from trichotillomania, and that the majority of sufferers – about 80 percent – are women.
Psychologists want to help, but the cause is unknown. Speculations include neurological problems and environmental conditions such as allergies, but the most likely culprit is genetics.
“If we can show [that psychiatric conditions such as trichotillomania] have a genetic origin, we can improve diagnosis, develop new therapies and reduce the stereotypes associated with mental illness,” says Dr. Stephan Züchner, assistant professor of psychiatry and researcher at the Duke Center for Human Genetics, who conducted a study in 2006 which suggests that gene mutations could be the cause.
Trich has no cure, but anti-depressants and/or anti-anxiety medications are usually prescribed to ease the severity of related symptoms. Behavioral therapy helps in some cases, but generally, people with trich have to learn to cope with the disorder.
Trich and I co-exist peacefully now, but my case is not severe. I have some minor scarring on my chin, and I once pulled half my eyebrows out with my fingernails without even realizing it, but that’s the worst it has ever been; most trichsters suffer bald spots or patches on their heads. Fortunately, there is almost never permanent damage to hair follicles, so given the opportunity, the hair will grow back.
Trichotillomania is not physically dangerous, but it can still be mentally and emotionally devastating for those with severe cases.
“I wore hats for a whole month once,” Anna says, looking at the floor and picking at her cuticles. Her case has always been worse than mine. “I pulled this big patch out on the back of my head. It was hideous and I didn’t know what to do or say, so I just hid it. But the hair length varied too much when it started to grow back, so I shaved my head.”
Anna’s hair is now down to her chin with no bald patches in sight. “It gets better,” she promises, looking at me again. “It never goes away, and it takes a lot of strength. But it eventually just becomes a part of who you are, and you stop defining yourself by it.”
If you or anyone you know suffers or may be suffering from trichotillomania, there is help available. I found talking to fellow trichsters much more comforting than therapy; the largest private online support group/message board is Brenda C’s Trichotillomania Pages and Message Board.
The Trichotillomania Learning Center is a wonderful online resource for both information and support. They can also be reached by phone at 831-457-1004.