Trichotillomania Unveiled: Navigating Stress, Coping, and Triumph

I am sure we have all heard the saying before, “I am so stressed I could pull all my hair out.” For many, this is just a metaphor to express high amounts of stress. We all go through stress, especially through college, with the many exams, presentations, and readings we all have to do. But for me, this metaphor is a very true reality of my own daily life.

I have been compulsively pulling out my hair since I was in third grade. My mother brought me to a therapist who was actually unsure what caused me to do so. She then asked Dr. Google; sure enough, I was diagnosed with a word I could not say until tenth grade: “Trichotillomania,” or Trich for short. Trichotillomania is under the visor of obsessive-compulsive disorders. The compulsive part is pulling the hair, while the obsessive part is having a sense of tension before pulling, constantly thinking about the “wrong hairs” that should not be there. There is almost a sense of ritual around the act of pulling the hair. If this ritual is not fulfilled, then stress, anxiety, and tension can percolate. When the hair is eventually pulled, it is followed by a feeling of relief or pleasure. 

However, the cycle continues until there is no hair left to pull. In high school, I pulled all my eyebrow hair and eyelashes out until nothing was left. The thought process

then was, “I am stressed because of school, so I pull hair to help with stress, but now I am stressed because I have bald spots, so I pull more to help with that stress. Because of that, I have no hair left to pull, so I always feel tense, and when the hair even starts to grow, I pull it immediately to relieve that tension.” This cycle will continue, and it's a hard thing to stop. School is an incredibly large pulling trigger for me. I pull more at school or when doing school work than at any other point in the day or in my life. I used fidget toys before they were cool and I was made fun of for using them, by both students and teachers in order to keep my hands busy so I would not pull. Eventually, I got a disability notice that allowed me to have fidget toys in class due to the teachers taking them away even after my mom tried to explain why I had them.

Imagine your already stressful college experience, now with the added bonus that you can not get too stressed or worried because you might start losing your hair. The pulling caused high levels of distress to me, as I noted that these behaviors may lead to embarrassment, shame, feelings of not being good enough, or self-consciousness. I have found many ways to cope with the stress and slowly got to the point of not needing to pull to cope.

First, I started with Cognitive Behavioral Therapy. The goal of this therapy is to enable the client to identify and challenge unhelpful thoughts, as well as to gain knowledge of practical self-help strategies. In therapy, the focus was not on “stop pulling” but instead on what is actually stressing me out in life and how I can cope with that—being aware of when I wanted to pull and when I did not want to pull. When a lot of background problems were being resolved and the feelings of “not being good enough” because I could not stop pulling started to get worked out, then I naturally just

slowly stopped pulling. That is not to say I am “cured”; if a particularly stressful exam or project comes up or, in general, just a lot of homework, I will pull a few hairs without notice. For a while, I had a simple solution: acrylic nails. Trying to pull tiny eyelashes and eyebrows with acrylics was difficult, so even if I was pulling without noticing, it took a lot more effort to pull out hair, leading to me not pulling at all or, at the very least, not losing as many hairs.

Therapy and acyclic nails combined actually resolved many of my issues, but I have other daily self-care I do. I try not to let school get to me and step away from homework when I feel it becomes overwhelming. I use soothing techniques such as cuddling my cat and walking for a little bit to move about. There are many things I have tried that did not work for me but worked for other ‘trichsters’, such as rubber bands on the wrist to cause pain if you pull, bandaids over fingers, wearing gloves, koosh balls, app trackers, hair samples to try and have the texture in your hand, etc. All of these came with their own difficulties or came with unwanted attention that usually caused an

embarrassing conversation.

Overall, Trichotillomania is stressful, but it has become a bearable process after many years of therapy, finding coping strategies that work, and some fake nails. If you know someone struggling with Trich, tell them they are amazing today; you will be surprised how much that is needed for those who feel they cause their own self-consciousness. There are plenty of days that I now forget my hair-pulling issue, which was a long road to traverse. I encourage anyone reading to do their own research - and not just into Trich but other not-well-known disorders. It is essential to avoid making assumptions what works for one will only work for some. Gaining knowledge about the possibilities can make overcoming such challenges more attainable.

 

REFERENCES

Healthdirect Australia. (n.d.). Trichotillomania.

Healthdirect. https://www.healthdirect.gov.au/trichotillomania

 

Pereyra AD, Saadabadi A. Trichotillomania. [Updated 2023 Jun 26].

 In: StatPearls [Internet]. Treasure Island (FL):

 StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493186/  

 

Wall, D. (2021, June 19). Trichotillomania: Fact sheet -

ABCT - association for behavioral and cognitive

therapies. ABCT. https://www.abct.org/fact-sheets/trichotillomania/