This is a topic very close to my heart, because I paid the ultimate price for having this a form of trichotillomania and not doing anything about it. I’ve talked about this condition a few times, because it’s my cautionary tale. No one wants to lose their hair, but when it’s your own behaviours that cause it, it’s even more devastating.
What Is Trichotillomania?
Trichotillomania (trik-o-til-o-MAY-nee-uh, in case you wanted to know how to say it) or hair-pulling disorder, is a condition where someone has a recurrent, irresistible urges to pull out hair from their scalp, eyebrows/eyelashes, or other areas of their body (OCD UK).
In 2013, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (or the DSM-5), trichotillomania was included into the chapter on obsessive-compulsive and related disorders (Grant and Chamberlain, 2016). This put it alongside obsessive-compulsive disorder (OCD), excoriation disorder, body dysmorphic disorder, and hoarding disorder.
This is when people will pull their hair out intentionally to relieve distress or tension. Ironically, this can also mean that someone might pull their hair out to get relief from the urge to pull their hair out. People with this version of trichotillomania can develop rituals around their hair pulling, such as finding just the right hair to pull out.
This version of trichotillomania does as the name suggests. People pull their hair out without registering that they’re doing it. Meaning, they can be sitting in front of the TV, switched off, and be pulling their hair out without consciously starting the behaviour.
Signs Of Trichotillomania
Let’s get the obvious sign out of the way first; you’re pulling out your hair. The less obvious symptoms that might help you identify trichotillomania, because not everyone realises they’re doing it, are:
- Feeling uneasy/tense before pulling your hair out.
- Feeling uneasy/tense while trying to resist the need to pull your hair out.
- Getting a sense of relief when you pull your hair out.
- Finding broken hairs of varying lengths (Sah, Koo, and Price, 2008).
- Having patches which are bare because of hair pulling.
- Preferring certain textures or types of hair (WebMD).
- Distress or other issues with your work and social life caused by your hair pulling.
- Behaviours such as inspecting the hair root, twirling the hair, pulling the hair between the teeth, chewing on hair, or eating hair (WebMD).
Causes Of Trichotillomania
This might come as a surprise, but the scientific world isn’t entirely sure what causes trichotillomania (NHS). Some suggest that it could be caused by the following, could, being the operative word:
- It could be caused by an unhealthy coping behaviour to manage stress and anxiety.
- It could be caused by a chemical imbalance in the brain, similar to OCD.
- It could also be caused by puberty because of changes in hormone levels.
It can also be a type of addiction. The more someone pulls out their hair, the more inclined they are to keep doing it (NHS). Or, as I experienced first-hand, it becomes an addiction, in that a behaviour done often enough becomes automated. For example, stress might not have always caused you to pull your hair out, but one day you started and it provided some sort of relief. Done long enough, a behaviour pattern will be created and your mind will activate it whenever you’re feeling stressed or in need of relief.
My Hair Pulling Habits
It’s possible I was a mixture of the two trichotillomania types (focused and automatic) that the Mayo Clinic and Sah, Koo, and Price (2008) mentioned. But, most likely, it could have just been my body dysmorphia disorder (BDD). Although, having said that, trichotillomania could be my secondary disorder related to my BDD. As Sah, Koo, and Price (2008) stated, adult-onset of trichotillomania is better treated by addressing the underlying psychiatric condition. This is because the hair pulling is a symptom of their primary disorder.
I would pull my hair out of my scalp because I felt inferior as a mixed ethnic person (Black and White) with dreadlocks. Black people always seem to have beautiful dreads, whereas mine were closer to that of a White person’s dreads with a lot of fuzz. I couldn’t stand this fuzz. When my attention was brought to it I’d try to flatten it, but often pulled hairs out to get rid of it. It’s a whole thing about my identity and racist abuse growing up.
The flattening of my hair then became an automatic behaviour, which caused me to hurt my hands and my head as I repeatedly hit it like a set of bongos. But I guess that wasn’t strictly hair pulling. I would also constantly twirl my dreads around my fingers until they’d bleed, pulled any strands that stood out of my dreads, and tightened my dreads obsessively. My head hitting and dread twirling very much became an addiction. I’d do it whenever I was alone and not doing anything with my hands. All because of racism.
If you’d like to read more about my hair pulling habits, then check out the following articles:
Trichotillomania Tips, Treatments, And Coping Methods
Tips from those with trichotillomania
The following are tips for dealing with trichotillomania by those who experience trichotillomania, gathered by the NHS and The TLC Foundation for Body-Focused Repetitive Behaviors:
- Carry a stress ball with you so you can squeeze it when needed.
- Form a ball with your fist and tighten the muscles in that arm.
- Use a fidget toy, which you can find everywhere nowadays.
- Wear a durag, bandana, or a tight-fitting hat.
- Wear the durag, bandana, or tight-fitting cap to bed.
- Create a saying that you repeat out loud until the hair pulling urge passes.
- Have a soothing bath to ease any stress or anxiety.
- Use a breathing exercise until the urge goes away.
- Put plasters on your fingertips to make it harder to grip your hair.
- Try cutting your hair short.
- Create a sticker chart so that every day you go without pulling your hair, you can add a sticker. This will help you build a sense of achievement.
- Create healthy rewards to mark milestones for not hair pulling.
- Be patient with yourself.
- Find things to do that’ll keep your hands busy, such as knitting, cross stitch, or crocheting.
- Create reasonable goals. For me, I started by saying I’d only do a hair destroying behaviour for a certain amount of seconds. I then gradually reduced the time I’d allow myself to engage in those behaviours.
- Take an exposure therapy approach and look at your hair in the mirror until the urge to pull your hair passes.
- Brush your hair instead of pulling it.
- Journal about urges and feelings, so you develop a better way of managing them.
A story told in HelloGiggles found that someone who braided their hair accidentally found it helped with their trichotillomania. Therefore, this could be an easy solution to managing your hair pulling.
Recognise your behavioural patterns
This is what I did. I made an effort to bring my hair destryoing behaviours out of my unconscious and into my conscious mind. This allowed me to work out the patterns in my behaviours and develop a plan to tackle them.
Cognitive Behavioural Therapy (CBT) is the most common type of therapy for trichotillomania, which will use a method called habit reversal training (OCD UK). This method allows someone to recognise and become aware of their hair pulling, what triggers the behaviour, and then try to help a person replace these behaviours with something less harmful (a form of harm reduction).
This was something I did on myself. The first thing I did was force my hair destroying behaviours into my consciousness. But, I didn’t try to go cold turkey with my hair pulling behaviours, because that would have set me up to fail. Instead, as I’ve already said, I implemented a reduction plan which eventually got me to stop destroying my hair. Or rather, what’s left of it.
According to Healthline, vitamin A has been shown to increase the rate of hair growth. It might also help with sebum production, which will keep the scalp healthier and able to retain more hairs. You can increase your vitamin A by eating foods rich in it, such as sweet potatoes, spinach, and sweet peppers.
However, the American Academy of Dermatology Association warns against taking a vitamin A supplement to regrow your hair. It might seem like an easy solution, but taking too much of certain nutrients can worsen hair loss.
In the same HelloGiggles post, they also talked about products that could keep your hair flat. They talked about a product called Schwarzkopf Got2b Glued, a freeze spray. It was the little hairs that weren’t neatly in my dreads that I pulled out. If only I had known about such products, I might still have my dreads.
Hair loss medication
If your trichotillomania has started to cause your hair to stop growing in places, like it did for me, then hair loss medication could be worth trying. My GP prescribed this when I finally sort support for my hair loss after overcoming my hair destroying behaviours. However, no treatment is 100% effective, and this didn’t work for me. But then, I’d left it far too long to do something about it.
Finasteride and minoxidil are the primary treatments for male pattern baldness, but also as a treatment for trichotillomania and certain types of alopecia. However, they don’t work for everyone, they only work for as long as you use them, and as a result, it can be expensive (NHS).
See a dermatologist
As I said, my GP wanted me to try a product containing one of these ingredients before they made a referral. But, it didn’t work for me so my GP made a referral to the dermatologist.
When dealing with hair loss, it’s useful to speak to a professional and licensed dermatologist (American Academy of Dermatology Association). I was eventually referred to one by my GP, but they said it was too late, which I kind of already knew. So my advice would be to see a dermatologist sooner rather than later. The sooner you do something about it, the better chance you have of your hair recovering.
To help hide your hair loss and to help you stop pulling your hair out, you could try wearing a wig. However, I’m very aware that there’s a lot of stigma about wearing wigs if you’re a man.
I used to wear a tubular neckwear that you can turn into a long hairband made by a company called Buff. I used that to hide the fluff around my dreads and my roots. It actually helped. Nowadays I wear a durag to hide my patchy hair, because I’m incapable of shaving my head neat enough, because of my BDD. It can become quite the bloodbath.
Getting tattoos to have permanent eyebrows has become fairly fashionable for women. But you can also get tattoos that look like you’ve got a close shave. You may also know this as scalp micropigmentation. I’ve considered this myself, because that would be an easy way to fill in the patches. The problem is, I’d still need to shave my head.
This is also something I’ve considered. A hair transplant would take hair from the back of the head and place it in the areas that are thinning or where your bold patches are. However, this can be expensive. Plus, if you’re a man, you may expense male pattern boldness later in life. Therefore, it might not make sense to pay for this procedure to fix the hair loss caused by trichotillomania.
Artificial hair transplant
This is another hair restoring option, which uses surgery to implant artificial hairs. The downside to this is that your hair won’t grow, so you’ll be stuck with a specific style, unless you want to go shorter.
It’s weird to think that there’s no distinct cause for trichotillomania at present. That might change, of course, but for now it’s still quite an unknown. One thing is certain, trichotillomania, alopecia, and hair loss can be very stressful to experience. I know I still feel shame about the permanent hair loss of my trichotillomania. But don’t let this shame and embarrassment stop you from seeking options that might save your hair before it’s too late. I waited too long, and now the shame is everlasting.
There are many options you can try before you have to take more drastic measures, some so simple that you can do them today. So why not put them into action now, see how it works out, and while you wait, sort out what professional options you could follow up with.
As always, leave your feedback in the comments section below. Also, please share your experiences with trichotillomania and hair loss in the comments section below as well. Don’t forget, if you want to stay up-to-date with my blog, then sign up for my newsletter below. Alternatively, get push notifications for new articles by clicking the red bell icon in the bottom right corner.
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Unwanted Life readers.
Grant, J. E., & Chamberlain, S. R. (2016). Trichotillomania. American Journal of Psychiatry, 173(9), 868-874. Retrieved from https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2016.15111432 and https://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.2016.15111432.
Sah, D. E., Koo, J., & Price, V. H. (2008). Trichotillomania. Dermatologic therapy, 21(1), 13-21. Retrieved from https://doi.org/10.1111/j.1529-8019.2008.00165.x, https://onlinelibrary.wiley.com/doi/full/10.1111/j.1529-8019.2008.00165.x, and https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/j.1529-8019.2008.00165.x.