Traction Alopecia: The Hair Pulling Question

Traction Alopecia: The Hair Pulling Question

Until a few years ago, I engaged in a series of behaviours that resulted in me losing a lot of my hair. My hair pulling and other hair related behaviours caused traction alopecia. Because I engaged in these behaviours for so long, my hair follicles became so damaged that they stopped producing new hairs. Thus, the hair pulling question is what condition was the cause of these behaviours.

 

 

This post will attempt to examine the behaviours I engaged in that led to me losing my hair. I will do this by looking at the criteria for a number of possible disorders that could explain my behaviours, such as trichotillomania (a specific form of self-harm) and self-harm (non-suicidal self-injury).

 

As I look at these different disorders I will see which diagnosis best accounts for my hair destroying behaviours. Hopefully, I’ll be able to answer the hair pulling question by the end of the post.

 

Trichotillomania

 

Let’s start with a quick definition of trichotillomania. Trichotillomania is a condition where you’re driven to pull your hair out. This can be the hair on your scalp, your eyelashes, facial hair, or even your pubic hair. This condition has been linked to stress and anxiety. Thus, it could be the result of trying to manage those feelings.

 

Also, like with a lot of conditions, trichotillomania often occurs with other mental health problems, such as depression disorder and other repetitive body-focused symptoms. For example, nail biting and skin picking. 

 

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Do I, or did I, suffer from trichotillomania? Let’s compare my behaviours to the description of the disorder, by looking at some of the diagnostic criteria for trichotillomania:

 

Recurrent pulling out of one’s hair, resulting in hair loss

In order to try and make my dreadlocks look perfect, I often pulled out my hair. I did this to make my dreadlocks look less fuzzy because proper fully black people don’t have fuzzy dreads: that’s white people dreads. I’d pull the stray hairs sticking out of my dreads, rather than just ripping my hair out in a more haphazard kind of way.

 

One of my triggers for this behaviours was when a light source would be shining behind me and casting a shadow in front of me. If I could see a shadow of a stray hair, it would cause me to pull it out, if it was sticking out of my dreads. If it was loose hair across my scalp, then I’d hit it with my hands repeatedly until they flattened down instead.

 

Repeated attempts to decrease or stop hair pulling

I only made one proper attempt to stop pulling my hair out or to decrease the frequency of me doing it. That’s largely due to the fact that my dreads helped hide the damage it was causing. Leaving me blissfully unaware of the damage I was causing for far too long.

 

The hair pulling causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

It did cause me a lot of psychological distress. However, this isn’t down to the hair pulling, per se, my other hair damaging behaviours our almost entirely to blame for this distress.

 

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Whenever I was alone, even for a few minutes, I’d beat my head like a drum, causing my head to hurt, giving me headaches, and causing my fingers to swell. If I was in my room with someone and they went to the bathroom, the second the door closed I would just start slapping the hell out of my scalp, and I wouldn’t stop until the door opened again as they returned.

 

 

I couldn’t stop myself from doing it, even though it was hurting me so much. It was a totally automated behaviour, I didn’t even think about doing it or plan to do it, it would just happen when I was alone and I wasn’t doing anything with both my hands.

 

Pulling my hair out, undoing and redoing my dreads, and over tightening my dreads all to try and make my dreads look perfect, combined with beating my head at every opportunity, caused me to lose my hair. It left me with patches of hair growth that follows the lines of a lot of my former dreads.

 

The hair pulling or hair loss is not attributable to another medical condition (e.g., a dermatological condition)

There was no other physical health problem that could have been the cause of my hair loss. I would refuse to take medication (Anti-Depressants And Me: My First Run In With My New Mental Health Trust) where hair loss was a possible side effect. My dreads were far too important to me.

 

The hair pulling is not better explained by the symptoms of another mental disorder (e.g., attempts to improve a perceived defect or flaw in appearance in body dysmorphic disorder)

Because hair pulling isn’t the primary cause of my hair loss, it is highly likely that this could be explained better by another condition. 

 

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A range of behaviours or rituals involving hair can accompany hair pulling. Thus, people may look for a particular kind of hair to pull

It could be argued that this is what I need, I looked for (or was drawn too) specific hair, hair that was sticking out of my dreads that made them look anything less than perfect. These were the only hairs I would properly pull out.

 

By enlarge, my other hair damaging behaviours accompanying the hair pulling was far worse. What I did do that had no benefit to me was slap my scalp across the top, the back (to a much lesser extent), and the sides of my head: basically wherever my hair grew from. I originally started doing it when I first got dreads and my head was crazy itchy because you can’t wash them for the first few months. But even when the itchiness went, I was still doing it.

 

What makes it worse, all the head beating has caused my scalp to develop slight indents where the roots of some of my dreads were beaten into it. This makes shaving my head an utter bloody nightmare, and I mean bloody in the literal sense.

 

Verdict

 

Although it’s easier to explain my issues to others as being trichotillomania, it’s a disorder I don’t think I suffer from. Yes, I have pulled my hair out, but it wasn’t due to the kind compulsion typical of this condition. My hair pulling behaviour was due to my ethnic identity problems and my need for my dreads to be perfect.

 

 

Also, my need for my dreads to be perfect now applies to shaving my head. Every time I shave my head my scalp ends up covered in blood, which will leave my head sore for days. I rarely shave my head because of it. I choose to wear stuff like du-rags instead because I just can’t handle the time, effort, and pain shaving my head requires.

 

Thus, I’m no longer pulling my hair out, instead, I’m now fixated with my head being perfectly shaved, even though it causes me harm. Which suggests to me the underlying reason for my hair destroying behaviours are still there, making trichotillomania unlikely.

 

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Habit

 

Could My hair destroying behaviours be better understood if they were split into two groups? My scalp slapping, which was rarely triggered by any thoughts being in a group on its own. The other group being made up of my hair pulling and over tightening of my dreads, which sometimes were.

 

Maybe, I really need to look at these two groups being defined by different disorders, rather than considering them as a collective of behaviours that could be explained by one disorder.

 

 

My scalp hitting certainly started out as an innocent behaviour. When I first got my dreads my scalp itched like crazy, so I was scratching it a lot. My mum suggested just lightly tapping my scalp with my hands to elevate the itchiness, which worked well. However, once the itchiness stopped after a couple of months, my scalp hitting didn’t: it only got worse as the years ticked by.

 

Habits are meant to be behaviours that are automatic and that are engaged in regularly. But are also actions that can be easily stopped without really thinking about it, like brushing your teeth. Thus, my behaviour was no longer a habit because of the harm it was causing me. Plus, I wasn’t able to stop the actions like a can when cleaning my teeth.

 

Verdict

 

Engaging in the head hitting behaviour was causing my fingers to swell on a regular basis, it was also causing me to have headaches and neck ache all the time. My obsession with over tightening my hair to try and make them perfect, and the less frequent pulling out of stray hairs sticking out of my dreads, also don’t fit the idea of a habit.

 

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Clearly, these behaviours stopped being a habit 15 odd years before I stopped engaging in them. They had obviously become a very unhealthy compulsion of some sort.

 

Compulsive Behaviour

 

Most people will be aware of the more extreme version of this, Obsessive-compulsive disorder (OCD), whereby something the sufferer obsesses about makes the anxious. Thus, they engage in behaviours that help control and sooth this. For example, excessive cleaning.

 

Compulsions or compulsive behaviours are defined as repetitive behaviours like hand washing or mental acts like counting. These occur in response to an obsession or according to rules that must be applied rigidly.

 

Much like trichotillomania is a compulsive behaviour, my behaviours clearly had a compulsion about them as well.  Whenever I was alone I would slap my head like I was dripping a basketball in the NBA.  

 

 

But they were compulsive in a way that was different from trichotillomania. They also weren’t compulsive in the same way OCD sufferers express themselves. Most of the occurrences of my behaviours lacked an intrusive or obsessive thought in which to trigger the behaviours. 

 

However, the underlying thought that caused some of these behaviours to manifest in the first place, did serve a self-soothing need. Plus, even if I wasn’t thinking about these underlying causes, they clearly were always there.

 

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These underlying causes underpinned my borderline personality disorder, my depression, and my anxiety disorders as well. Thus, if they can affect all my other mental health problems without having to directly think about them, why not these compulsive behaviours as well?

 

Verdict

 

My behaviours clearly wasn’t a habit and the head hitting was obviously a compulsion. But is it enough to simply classify my head hitting as just being a compulsion, and if so, what about my other hair damaging behaviours?

 

My head hitting might be explainable by compulsive behaviours, although it lacks the intrusive thoughts to trigger the behaviours. Plus, it doesn’t account for my other behaviours at all. So for now, I’m going to say no to this disorder being the cause of any of my hair destroying behaviours.

 

Self-Harm/Self-Injurious Behaviour

 

Although self-harm and self-injurious behaviour are essentially the same conditions, the latter seems to be used to exclusively describe the self-harm people with learning difficulties engage in.

 

The term ‘self injurious behaviour’ usually refers to any behaviour, initiated by the individual, which directly results in physical harm to that individual

Research Autism (2016)

 

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Because of its initial description, I did also consider if it was a self-injurious behaviour because it feels like it better describes my behaviours. I initiate behaviours that cause physical harm to myself, through my head hitting especially. But because this is normally a condition that is used to describe the actions of someone with autism or a learning difficulty, it doesn’t really apply to me.

 

 

A lot of what I read about self-injurious behaviour showed that it was just the way autism based work describes self-harm. Thus, I didn’t need to consider it as a third diagnosis possibility.

 

The traditional wording of self-harming could have possibly accounted for my behaviour. Head hitting is a common form of self-harm.

 

So let’s look at its diagnosis:

 

Intentional self-inflicted damage to the surface of the body with the expectation of physical harm, but without suicidal intent for 5 or more days within the past year

Given that I was engaging in head hitting dozens and dozens of times a day, hair pulling on a fairly regular basis, and over tightening my dreads on a very regular basis, it’s safe to say that they might all qualify for this. My head hitting behaviour especially.

 

However, I didn’t do it with the intent to cause, harm to myself, that was merely a consequence of my behaviours: not the intent.

 

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Person injures themselves for at least one of the following reasons:
  • ​To seek relief from negative thoughts or feelings

  • To resolve an interpersonal difficulty, or

  • To bring about positive feelings.

None of the behaviours ever brought about any positive feelings, nor did they resolve an interpersonal difficulty. But did I get relief from negative thoughts and feelings by engaging in any of the behaviours? I don’t believe so. My negative thoughts and feeling never went away, and more often than not, the behaviours happened without a thought triggering them.

 

Before the behaviour, a person experiences one of the following:
  • Interpersonal difficulty or negative feelings and thoughts  (including depression, anxiety),
  • Preoccupation about self-injury that is hard to resist
  • Frequent urges to self injure

 

 

None of these applied when I engaged in any of the behaviours that ended up destroying my hair. There was no urge to self-harm because most of the time I was engaging in the behaviour before I even knew I was doing it. I wasn’t preoccupated with irresistible thoughts of self-harm either. It’s possible that it could be linked to my depression, I’ve been constantly depressed my whole life, so I guess that’s a possibility.

 

The behaviour is not accepted by society

I don’t think a lot of my behaviours would have been acceptable by society at the time, and that goes for all my hair destroying behaviours.

 

The person is significantly distressed by the behaviour

I was definitely distressed by the behaviours because it was causing me so much pain, both physically and mentally. It also ended up costing me my dreads, which I’ve still not recovered from mentally.

 

The behaviour can’t be explained by another mental, developmental or other medical condition

I think this is the key criteria for if it is a self-harming condition or not because I think it’s possible that it could be explained by another, condition.

 

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Verdict

 

Although I’ve previously cut myself, which might fit the criteria of self-harming, for my hair related behaviours, I don’t think it quite fits. Thus, I’ll rule out self-harming as a possible cause of me losing my hair. I simply don’t tick enough boxes for this condition.

 

Body Dysmorphic Disorder (BDD)

 

BDD is an anxiety disorder related to body image, as the name suggests. People with BDD will suffer from obsessive worries about perceived flaws they have with the way they look. Sufferers will also develop routines and compulsive behaviours.

 

I’ve always had problems with my appearance due to my ethnic identity issues (mixed ethnicity), in part, due to the racism I suffered (Suicidal Child). This was very much reflected in my views on how my dreads needed to look, which led to the development of behaviours that cost me my hair.

 

So with that, let’s look at the criteria for BDD:

 

 
Abuse or bullying

Where do I even start with this? So much racial abuse from a vast array of bullies throughout my school years. This was also mixed in with various abuse from teachers and other adults as I grew up around (Suicidal Child).

 

If I hadn’t experienced the racist abuse I did growing up (Suicidal Child), then I wouldn’t have developed the ethnic identity problem that I did. If I hadn’t developed the ethnic identity problem, then maybe I wouldn’t have developed depression and borderline personality disorder. If I was suffering from these problems, I might still have my hair and my dreads today.

 
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Low self-esteem

I have always been constantly critical of how I look and how others look, it drives me mad. But I can’t seem to stop these thoughts, no matter how hard I try. But I’m worse to myself and would even live in envy of my white friends who everyone seemed to love.

 

Fear of being alone or isolated

I didn’t feel like I fitted in with anyone, because I clearly wasn’t white, like everyone else, and I didn’t feel like I was black enough either (not that there were any black people around).

 

Because of this, I obsessed over the perfection of my dreads because I have an issue around them needing to be perfect. I need them to be perfect, because black people have dreads that are without a hair out of place, unlike my half black/white self. Thus, it was driven by my ethnic identity issues.

 

I spent my early life wishing I was fully white, in order to fit in and so the problems of having brown skin would go away. Then I spent my teens wishing I was fully black because I didn’t feel like I could fit in with black people otherwise. Plus, if I’m going to get abuse for looking black as a mixed ethnic person, I may as well be the whole way black.

 

It also didn’t help that I couldn’t rely on my friends to actually act like friends. I knew I was being used and I knew most were talking behind my back (Suicidal Child). But through all these issues, all I wanted was to be accepted by my peers.

 
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Perfectionism or competing with others

Once I got my dreads done, I found myself both really happy and extremely distressed all at the same time. I was craving for the true black persons dread perfection, which was an impossible perfection for me to have. But I wished for it none the less. This resulted in the development of behaviours that would lead to me losing my hair.

 

 

I’d undone and redone my dreads many times. Once I did this when I was using speed, doing it in an impressively fast time. But it also caused me to cut my fingers a hell of a lot in the process. I kept doing this to my dreads because I was desperate for them to be perfect.

 

Repetitive touching, checking or measuring perceived flaw (minor or imagined)

Constantly trying to make my dreads look perfect through over tightening them and pulling out stray hairs. I was always touching my dreads to make sure the roots were tight (I just couldn’t help myself).

 

Avoidance of having your picture taken

I hate having my picture taken, the pictures I took for this blog post were the first I’ve taken of myself, willingly, in years.

 

Leaving the house less often or only going out at night to try to camouflage your appearance in the darkness

I rarely leave my place since losing my dreads. I’m also avoiding seeing people that knew me when I had dreads, so I don’t go to any of the places I use to go out to have fun. It’s also why I’m not currently in volunteer work either.

 

For someone like me, I would be happiest if no one ever saw me. I’m driven to isolate myself from everyone because it’s the least stressful way to be. This is a result of my ethnic identity issues, my anxiety disorders, and my issues with my looks.

 

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Depression, anxiety, or OCD

I’ve had depression for almost as long as I’ve been alive. I was suicidal at the age of eight (Suicidal Child). So you can mark off depression as a yes, and anxiety as well, which developed around the same time I got my dreads, but was drug-induced (Drug-Induced Psychosis And My Anxiety Disorders).

 

Verdict

 

I never had a problem with my hair and my hair destroying behaviours until I got my dreads. Before that, I’d always had a shaved head. Getting my dreads opened up a new unforeseen ethnic identity problem that would consume me and destroy my hair.

 

It caused me to pull the loose hairs sticking out of my dreads in order to remove the fuzz and it caused me to over tighten my dreads: the results of which cost me my hair.

 

 

My head hitting was a compulsive behaviour through and through. The rest of my hair destroying behaviours were clearly BDD. But was the compulsive head hitting behaviour a compulsive BDD behaviour? Quite possibly.

 

Furthermore, BDD would also explain some of the other problems I have as well.

 

I worry about how my arms look too skinny because my elbow and forearm look too big. I also worry my legs look too skinny. Thus, I ware lots of baggy clothes and prefer not to be seen.

 

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I’ve starved myself on a regular basis and still do this from time to time. I’m still doing this because I’m unable to keep my weight under control with exercise, due to my physical health problems (My Relationship With Food).

 

I constantly worry about outbreaks of spots (The Weirdness Of My Anxiety Disorders), my pores, and my dry skin. They are a legit problem that I can’t see to do anything about, but worrying about them only causes me psychological harm. I’m constantly checking my face for spots, either in the mirror or with my fingers. All without drawing attention to myself when I do.

 

I avoided looking in mirrors because it makes me depressed, and only look in a mirror so I can check my face for spots.

 

As previously stated in this post, my need for perfection when it came to my hair (or lack thereof) didn’t stop when I cut my dreads off. Now I have to have a perfectly shaved head if I shave it, causing me to have a bloody and sore scalp. This need would make sense if I had BDD.

 

I also have issues with my body hair that’s not on my scalp. I’m constantly touching my beard because it seems uneven to me. The right side doesn’t grow the same way the other side does, and that plays on my mind. I’m constantly trying to get them to match up.

 

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BDD is clearly a factor in my anxiety disorders (The Weirdness Of My Anxiety Disorders). I say it’s a factor in my anxiety disorders, rather than it being a replacement diagnosis for them because of how my anxiety disorders affect me as an individual. My appearance based anxiety is nowhere near as crippling as my fear of losing bowel/bladder control (The Weirdness Of My Anxiety Disorders) which has caused me to have countless psychotic episodes.

 

Plus, the cause of those anxiety disorders was my reckless carefree use of drug mixing and alcohol.

 

So, I believe it was BDD that was the cause of all my hair destroying behaviours. It also explains a lot of my other issues as well.

 

A Few Tips

 

Keeping your hands busy can help avoid pulling your hair, or other such actions like nail biting and skin picking.

Play with stress toys or other fidget friendly items to keep your hands busy.

Reach out for help, such as joining a support group.

Read up on the condition so you can better figure out how to manage it: knowledge is power.

Create a list of stress/anxiety soothing tasks and activities, as anxiety/stress is often a trigger for these behaviours.

Another trigger is often a lack of control in your life. Thus, finding healthier ways to exert control could help in eliminating the behaviour(s).

 

So that’s my post, which disorder do you think best describes my behaviours? Have any of you suffered from, or are suffering from, trichotillomania, self-harm, BDD, OCD, or compulsive behaviours? If you’re ok with sharing, then let us know in the comments section below. Lastly, if you want to stay up-to-date with my blog, then sign up to my newsletter.

 

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Support

 

If you feel any of the disorders mentioned in this post may affect you too, then please check out the links for more information.

 

Trichotillomania (Hair Pulling Disorder) – NHS

Trichotillomania (Hair Pulling Disorder) – OCD UK

Trichotillomania – KidsHealth

Four Things to Not Say to a Person With Trichotillomania

Trichotillomania Support

Alopecia UK

Self-Harm – Young Minds

Self-Harm – Mind

Obsessive-Compulsive Disorder (OCD) – Mind

Body Dysmorphic Disorder (BDD) – Mind

Body Dysmorphic Disorder (BDD) – BDD Foundation

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4 thoughts on “Traction Alopecia: The Hair Pulling Question

  1. Wow -so honest and so raw. I know someone who suffers from hair pulling and it leaves them very distressed. Thank you for sharing your story x

  2. This was a very interesting read and taught me a lot I didn’t know. I hope you manage to work on and overcome your isolating tendencies as well, I know from experience how negative it can make one feel.

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