Although there is no scientific evidence that Trichotillomania is associated with any particular personality, perfectionism appears to be extremely common and often provides a real roadblock to recovery in a number of different ways. One common problem is the false belief that in order to stop pulling, all urges to pull must cease. It is highly unlikely that urges to pull will ever completely vanish. While one can attempt to decrease urges to a manageable amount (such as through medication or naturally over time with relative abstinence from pulling), the main goal is to manage the urges in a different manner than before. It is sometimes a giant leap in recovery when the hair puller realizes that they don’t have to pull whenever they have the urge.
Another threat to recovery comes when the puller experiences success with not pulling, then has a setback. The perfectionist in them says it is all-or-nothing, so they might as well give up. Virtually everyone successful in recovery from hair pulling has times, perhaps during periods of great stress or illness, some degree of relapse. It is hard for many not to feel that they are starting over again. One hour of pulling can mean the total loss of hard-earned lashes or brows-a bad week may result in a large bare area on one’s scalp.
The amount of hair one has at any given moment is not synonymous with the degree of recovery. It is important to realize that all that has been learned about how to stop pulling is not lost in that hour or week. Each setback is simply a new challenge to be figured out. Recognizing through trial and error that, for instance, premenstrual times are uniquely difficult or that studying for final exams inevitably leads to total loss of control allows one to build upon or add to the techniques learned or medications taken.
Yet another roadblock may come when hair starts to grow back. It is bound to be uneven, asymmetrical, stubbly, gray, or in some other way bothersome to the puller. These hairs are, after all, for many, what triggers the pulling in the first place. The urges then become stronger than ever and the tendency to feel or look at these “wrong” hairs has to be avoided in favor of changing the cognition that drives them in the first place. A number of techniques individualized for each puller can be used at that time. For instance, a person who craves symmetry may need to practice asymmetry in a number of areas to eventually tolerate asymmetry of hair (especially of eyebrows in many cases.)
Rather than hiding all imperfections as the hair puller generally spends much time doing, practicing appearing deliberately imperfect, and experiencing the real lack of importance this has in life, can be a helpful step. This needs to be done in hierarchical stages with the imperfections least important to the puller shown first and the hardest revelations put at the top end of the list.
Recovery, then, is a complicated process fraught with barriers-hidden or overt, real or imagined. Overall, it requires giving you time, effort, assistance, and forbearance. What does the recovered hair puller look like? A woman or man with imperfect hair, urges to pull, possibly occasional bouts of pulling, who has healthy relationships and a positive self-image and identity as a whole, worthwhile human being.
Full Article: Barriers to Recovery from Hair Pulling By Carol Novak
Carol Novak, M.D., is the founder of the Pioneer Clinic, specializing in the treatment of Trichotillomania and Obsessive-Compulsive Disorder. She has treated approximately two hundred hair pullers.