When People Pull out Their Hair – The Facts About Trichotillomania

When People Pull out Their Hair - The Facts About Trichotillomania

Trichotillomania is a chronic, recurrent compulsion to pull one’s hair that results in physical as well as mental and emotional pain.

Trichotillomania is a disorder that affects 1-2% of the population, a majority of them female. Symptoms usually start in adolescence following puberty. The main feature is the recurrent compulsion to pull out one’s hair. Hair is pulled from any area of the body, the most common being scalp, eyebrows, and eyelids. Episodes of hair pulling vary over time and can be cyclical, but a person will spend a considerable amount of time doing it, sometimes several hours per day. 

Another key symptom is recurring attempts to stop or decrease hair-pulling behaviors.

Also, the behavior causes significant distress in a person’s life. This distress causes dysfunction at school, work, or in social settings are other areas of functioning. Finally, the compulsion to pull hair cannot be explained by another medical problem or another mental health problem.

There are many reasons to pull hair. In some cases, hair pulling gives an emotional release, a way to focus on a different type of pain, or a way of soothing. For some, pulling hair leads to gratification or pleasure. Not all who pull hair do so consciously. While some pull hair with full awareness, there are others who do it without noticing what is happening.

Compulsive hair pulling is a stressful disorder often hid from family and friends. A cycle of negative emotions goes with the behavior including guilt, shame, and embarrassment. Many people who suffer from compulsive hair pulling prefer isolation, withdrawing from social interaction for fear of judgment. A person is left to deal with the disorder alone, internalizing negative emotions and often struggling with depression and anxiety. Not only do those feelings spark anxiety, but anxiety can worsen hair pulling activity.

Many people who struggle with trichotillomania, or compulsive hair pulling, associate hair pulling with anxiety. One study found that out of 894 people struggling with trichotillomania, 84% of them said anxiety was associated with it. Others report that hair pulling gets worse when anxiety increases.

In addition to the mental and emotional distress of the disorder, there are physical health risks as well. Pulling hair out at the roots on the scalp can result in permanent damage. People who suffer from trichotillomania often have spots where hair no longer grows or the hair that grows is not healthy. Scabs and infections can develop on the scalp resulting in severe discomfort or disfigurement. If eyelashes are pulled, it can result in a condition called blepharitis, inflammation of the eyelids. Pulled hair that is swallowed can cause digestive problems.

Trichotillomania is a chronic, compulsive disorder that if left untreated can cause significant distress and pain. The good news is treatment is available. Therapists who specialize in treating body-focused repetitive disorders use a variety of evidence-based treatments to help clients manage symptoms and address any co-occurring issues like anxiety or depression that exacerbate hair pulling. There are many people who find hope and manage symptoms with treatment and a supportive community.


About the Author: Trudi Griffin

Trudi Griffin is a NCC Licensed Professional Counselor putting her clinical knowledge, experience, and passion for research to write about mental health for publications such as www.trichtop.com. She earned a Master of Science degree in Clinical Mental Health Counseling: Addictions and Mental Health from Marquette University (Milwaukee, WI), and is a double graduate of the University of Wisconsin Green Bay with Bachelor’s degrees in Communications and Psychology.

26 Comments

Laura

My daughter’s trich started at age 11 and while it has continued through age 17 (current), it turned out to be the first noticeable symptom of Lyme disease and co-infections (especially Bartonella). Children’s symptoms are often the more “psychological” type symptoms, but they are not making it up! See this book for a list of symptoms more people in the mental health profession need to know—I wish I’d had it 6 years ago.

When Your Child Has Lyme Disease: A… https://www.amazon.com/dp/0996224300?ref=yo_pop_ma_swf

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Melissa C

Hi Laura,

Did your daughter’s trich subside after treating for Lyme and Bart?

My daughter also has trich and we’re going down the path of testing for Lyme and co-infections.

Thanks,

Melissa

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Julia

I started hair pulling and eating at about 12 years old. My teenage years were awful. I was practically bald. Gradually my pulling slowed down but didn’t cease for about 40 years. I’m now 60 and have a full head of hair. I think mine started when I changed schools and didn’t have any friends, and by pulling my hair I had no chance of making friends, it was a vicious circle. I had no medical help or support and was extremely depressed. It became a habit. My hair was growing back but I still continued to pull, but I managed to control it so I looked normal. Never went to a hairdresser. Couldn’t bear to have people behind me and never went outside if it was windy because I glued what hair I had done in place to cover bald areas with tons of hairspray.
I feel fortunate now that those days are over, if I can offer support in any way I will.

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Karen Young

I’m so pleased to hear you found your way through. Thank you for sharing your story. There is something very powerful in ‘me too’.

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Jacalyn

My 13 year old daughter started pulling her hair out about a year and a half ago. She was seeing the school counselor and it was helping. She can’t see that counselor any longer. There are so few counselors that work with children and the ones that do are far beyond what I can afford. I don’t know what to do. I want to help so badly.

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Karen Young

I can hear how distressing this is for you. It is so awful watching our children struggle. You are an incredible source of support for your daughter, and if professional support is out of reach right now, there are things you can do to help her through. Here are some resources that might help. There are articles on this link https://www.heysigmund.com/category/with-kids/anxiety-in-kids-and-teens/ and videos on this link https://www.heysigmund.com/category/with-kids/anxiety-videos-for-kids/. I hope this helps. Love and strength to you and your daughter.

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Nancy

The anxiety may have a physical cause as we found in our family. We found solutions that help through Dianne Craft, “the biology of learning” (www.diannecraft.org), and Trudy Scott, “the antianxiety food solution” (www.antianxietyfoodsolution.com).

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Dawn

1. Not always in just teens and adults, my son was 7, my neice about 7 and second son 3. They have since managed to control it (mostly).
2. I believe it is a symptom of something else, mostly anxiety of some kind and then the anxiety could be symptom of something else like sensory disorder for example. I doubt it occurs on it’s own.
3. Would be Interested if there was any research showing percentage of symptoms within family members, therefore suggesting it could be genetic.

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Sharon H

Wow, I’m so sorry to hear that such young people do this.

As for me, I know it is stress and anxiety. It can be traced to when we moved here in 2010. But I had been self-mutilating with a razor for about 15 years, so I feel it is just another expression of severe stress.

As for genetics, only my niece (14) cut her wrists superficially. She is the only family member to my knowledge that has done something like this. Maybe one other person besides myself is not enough to call it genetic, but again I don’t know the full history of my relatives.

I think we must remember that animals injure themselves as well while under extreme stress. Birds are the biggest examples of this, as they can pluck their feathers out until they are bald. Dogs can bite and chew their toes. It is of note that this behavior does not occur in the wild, but only in domesticated animals. Entirely stress induced.

Thank you for sharing. I know it is hard for me to write this. No one but my husband knows about the cutting, though obviously the hair pulling and breaking is quite apparent to him.

It pleases me that your children have been able to gain control over this. It seems we adults have a more difficult time, even with help. With children that young, some other mechanism besides anxiety could be at play.

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Mary

Although no doctor acknowledged this as a cause, my son suffered from this while having a spinal leak. I think it was either due to the low fluid in his brain, or due to extreme pain. He was unaware of doing it. I think physical causes should be addressed. He never did this before or after the CSF leak. It could also have been a medication side effect. They thought he had psychological issues, but a comprehensive psych exam confirmed he was one of the most stable teens she had examined. Once a doctor understood and repaired the leak, all symptoms were gone.

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Karen Young

Mary thank much for sharing your story. All information adds to our shared experience and moved us closer to understanding what we need to know.

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Jen

I love seeing these disorders being highlighted. I have dermatillomania, which is related to trichotillomania in both the underlying motivation and effects on the individual suffering from it. It’s still surprising to me they are not considered a very specific subset of OCD, and that very little research is done on them as a whole.

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Karen Young

Yes it’s such important information isn’t it. Hopefully the more we talk about it, the more research we’ll start to see in the area.

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Concerned great uncle

My sis noticed my great niece pulling out her hair. Sis said she looked over at my g. niece and she had a pile of hair on her lap, and she was separating small amounts of hair before she would pull it out.
She said it feels good. I’m very worried about my niece. (Her dad yells at them a lot. He is very selfish. She also has diabetes) what can I do? Please help.

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Karen Young

This may be a symptom of anxiety. Anxiety can drive all sorts of behaviours which are actually as a way to self-soothe or to distract from unwanted, anxious thoughts. This may be why your niece is saying it feels good. Anxiety is very manageable, but it will take time and persistence. If the behaviours are intrusive and getting in the way of your niece’s day to day function (family, friends, school) it might be an idea to speak with a counsellor or psychologist who can give her the support she needs. In the meantime, there are certainly things you can encourage her towards which will help. One of these is mindfulness. Research has shown that mindfulness changes the structure and function of the brain in ways that can protect and strengthen it against anxiety. If your niece is unfamiliar with mindfulness, a great place to start is the free Smiling Mind app, which has mindfulness meditations for children through to adult. It’s also important that your niece understands her anxiety. This article will help https://www.heysigmund.com/anxiety-in-kids/. There are also many other articles on this link https://www.heysigmund.com/?s=anxiety+children. For a proper diagnosis, I would encourage you to speak with a doctor or therapist. I hope your niece is able to find calm for herself soon. She is lucky to have you watching out for her.

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Clara

I have been having this problem since my teenage years. God knows I tried everything to stop the pulling but none of them works.

The article mentioned body-focused therapy. Can anyone share more about this? How do I reach these therapists? Thanks!

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Jody

My son has rubbed my hair and or his since toddlerhood. I notice it more if he is sleepy. He also does this while he’s asleep. He is now 7 and I just noticed he has a bald spot on the top of his head.
I once had read an article long ago that had this behavior as a symptom of another illness. I can’t seem to find the article or one such since.

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Karen Young

If the compulsive hair cutting is getting in the way, it might be worth an assessment. This can be a sign of obsessive compulsive behaviour, which is driven by anxiety. If it is causing an intrusion into day to day life, a doctor or therapist would be able to guide you on the steps to take. If it is driven by anxiety (and again and doctor or therapist will be able to guide you), managing the anxiety will make a difference.

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Sharon H

A confession: I have a form of this disorder due to overbearing stress. It started about three years ago. I don’t pull the hair out but I break off pieces near the mid-length and bottom. Sometimes I don’t realize I do it in public.

This article is very helpful, but I am already on meds and my doctors have said unless we move away from this very stressful environment, I will continue to have this behavior. But it is so good to know that there are many others suffering with this and I’m not alone. Thank you for this. It was hard for me to write but now it is “off my chest”.

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Karen Young

Sharon you are so NOT alone! Thank you for adding your important voice. The more people like you who can share their experience, the more the conversation happens and the more understanding there will be around this important issue.

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Sharon H

Thank you. It has made me feel so much better; both the article and other respondents.

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Cheryl

Overbearing stress is my cause I believe. I’m going to start online therapy ASAP. I do t know how much it will cost but I’m going to stop!! I hope…..

I remember I started when I was numbing my emotions and then I felt like the pain of pulling it out made me “feel” something.

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Charlotte

Is there a name for compulsive skin picking? I thought it might be a symptom of OCD but I am not sure of that.

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Behaviour is never from ‘bad’. It’s from ‘big’. Big hungry, big tired, big disconnection, big missing, big ‘too much right now’. The reason our responses might not work can often be because we’ve misread the story, or we’ve missed an important piece of it. Their story might be about now, today, yesterday, or any of the yesterdays before now. 

Our job isn’t to fix them. They aren’t broken. Our job is to understand them. Only then can we steer our response in the right direction. Otherwise we’re throwing darts at the wrong target - behaviour, instead of the need behind the behaviour. 

Watch, listen, breathe and be with. Feel what they feel. This will help them feel you with them. We all feel safer and calmer when we feel our people beside us - not judging or hurrying or questioning. What don’t you know, that they need you to know?♥️
We all have first up needs. The difference between adults and children is that we can delay the meeting of these needs for a bit longer than children - but we still need them met. 

The first most important question the brain needs answered is, ‘Is my body safe?’ - Am I free from threat, hunger, exhaustion, pain? This is usually an easier one to take care of or to recognise when it might need some attention. 

The next most important question is, ‘Is my heart safe?’ - Am I loved, noticed, valued, claimed, wanted, welcome? This can be an easy one to overlook, especially in the chaos of the morning. Of course we love them and want them - and sometimes we’ll get distracted, annoyed, frustrated, irritated. None of this changes how much we love and want them - not even for a second. We can feel two things at once - madly in love with them and annoyed/ distracted/ frustrated. Sometimes though, this can leave their ‘Is my heart safe?’ needs a little hungry. They have less capacity than us to delay the meeting of these needs. When these needs are hungry, we’ll be more likely to see big feelings or big behaviour. 

The more you can fill their love tanks at the start of the day, the more they’ll be able to handle the bumps. This doesn’t have to be big. It just has to be enough. It might look like having a cuddle, reading a story, having a chat, sitting with them while they have breakfast or while they pat the dog, touching their back when they walk past, telling them you love them.

All brains need to feel loved and wanted, and as though they aren’t a nuisance, but sometimes they’ll need to feel it more. The more their felt sense of relational safety is met, the more they’ll be able to then focus on ‘thinking brain’ things, such as planning, making good decisions, co-operating, behaving. 

(And if this today was a bumpy one, that’s okay. Those days are going to happen. If most of the time their love tanks are full, they’ll handle when it drops a little. Just top it up when you can. And don’t forget to top yours up too. Be kind to yourself. You deserve it as much as they do.)♥️
Things will always go wrong - a bad decision, a good decision with a bad outcome, a dilemma, wanting something that comes with risk. 

Often, the ‘right thing’ lives somewhere in the very blurry bounds of the grey. Sometimes it will be about what’s right for them. Sometimes what’s right for others. Sometimes it will be about taking a risk, and sometimes the ‘right’ thing just feels wrong right now, or wrong for them. Even as adults, we will often get things wrong. This isn’t because we’re bad, or because we don’t know the right thing from the wrong thing, but because few things are black and white. 

The problem with punishment and harsh consequences is that we remove ourselves as an option for them to turn to next time things end messy, or as a guide before the mess happens. 

Feeling safe in our important relationships is a primary need for all of us humans. That means making sure our relationships are free from judgement, humiliation, shame, separation. If our response to their ‘wrong things’ is to bring all of these things to the table we share with them with them, of course they’ll do anything to avoid it. This isn’t about lying or secrecy. It’s about maintaining relational ‘safety’, or closeness.

Kids want to do the right thing. They want us to love and accept them. But they’re going to get things wrong sometimes. When they do, our response will teach them either that we are safe for them to come to no matter what, or that we aren’t. 

So what do we do when things go wrong? Embrace them, reject the behaviour:

‘I love that you’ve been honest with me. That means everything to me. I know you didn’t expect things to end up like this, but here we are. Let’s talk about what’s happened and what can be different next time.’

Or, ‘Something must have made this (wrong thing) feel like the right thing to do, otherwise you wouldn’t have done it. We all do that sometimes. What do you think it was that was for you?’

Or, ‘I know you know lying isn’t okay. What made you feel like you couldn’t tell me the truth? How can we build the trust again. Let’s talk about how to do that.’

You will always be their greatest guide, but you can only be that if they let you.♥️
Whenever there is a call to courage, there will be anxiety - every time. That’s what makes it brave. This is why challenging things, brave things, important things will often drive anxiety. 

At these times - when they are safe, but doing something hard - the feelings that come with anxiety will be enough to drive avoidance. When it is avoidance of a threat, that’s important. That’s anxiety doing it’s job. But when the avoidance is in response to things that are important, brave, meaningful, that avoidance only serves to confirm the deficiency story. This is when we want to support them to take tiny steps towards that brave thing. It doesn’t have to happen all at once.l and it doesn’t matter how long it takes. Brave is about being able to handle the discomfort of anxiety enough to do the important, challenging thing. It’s built in tiny steps, one after the other. 

We don’t have to get rid of their anxiety and neither do they. They can feel anxious, and do brave. At these times (safe, but scary) they need us to take a posture of validation and confidence. ‘I believe you, and I believe in you.’ ‘I know this feels big, and I know you can handle it.’ 

What we’re saying is we know they can handle the discomfort of anxiety. They don’t have to handle it well, and they don’t have to handle it for too long. Handling it is handling it, and that’s the substance of ‘brave’. 

Being brave isn’t about doing the brave thing, but about being able to handle the discomfort of the anxiety that comes with that. And if they’ve done that today, at all, or for a moment longer than yesterday, then they’ve been brave today. It doesn’t matter how messy it was or how small it was. Let them see their brave through your eyes.‘That was big for you wasn’t it. And you did it. You felt anxious, and you stayed with it. That’s what being brave is all about.’♥️
A relationally unsafe (emotionally unsafe) environment can cause as much breakage as as a physically unsafe one. 

The brain’s priority will always be safety, so if a person or environment doesn’t feel emotionally safe, we might see big behaviour, avoidance, or reduced learning. In this case, it isn’t the child that’s broken. It’s the environment.

But here’s the thing, just because a child doesn’t feel safe, doesn’t mean the person or environment isn’t safe. What it means is that there aren’t enough signals of safety - yet, and there’s a little more work to do to build this. ‘Safety’ isn’t about what is actually safe or not, it’s about what the brain perceives. Children might have the safest, warmest, most loving adult in front of them, but that doesn’t mean they’ll feel safe. This is when we have to look at how we might extend bigger cues of warmth, welcome, inclusiveness, and what we can do (or what roles or responsibilities can we give them) to help them feel valued and needed. This might take time, and that’s okay. Children aren’t meant to feel safe with every adult in front of them, so sometimes what they need most is our patience and understanding as we continue to build this. 

This is the way it works for all of us, everywhere. None of us will be able to give our best or do our best if we don’t feel welcome, liked, valued, and free from hostility, humiliation or judgement. 

This is especially important for our schools. A brain that doesn’t feel safe can’t learn. For schools to be places of learning, they first have to be places of relationship. Before we focus too sharply on learning support and behaviour management, we first have to focus on felt sense of safety support. The most powerful way to do this is through relationship. Teachers who do this are magic-makers. They show a phenomenal capacity to expand a child’s capacity to learn, calm big behaviour, and open up a child’s world. But relationships take time, and felt safety takes time. The time it takes for this to happen is all part of the process. It’s not a waste of time, it’s the most important use of it.♥️

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