Here is another great blog post from Trichotillomania therapist and 20 year pull-free trichster, Claudia Miles (my role model).
As a psychotherapist who’s worked with hundreds of hair pullers, and as someone who personally suffered from daily hair pulling until I was 27 and has been pull free for 20 years, I know all too well the pain, shame and despair that pullers experience. I also know firsthand the frustration and hopelessness of trying *everything* to stop with no success. Or worse, having short-lived success–a day, a week, maybe even a month–and suddenly without warning you find yourself pulling again.
Maybe you pull your head hair, or your brows or lashes, or other body hair. My clients tend to be equally divided in that nearly half pull head hair and nearly half pull brows and/or lashes, a small number pull both, and the remainder pull from various areas on the body.
For those who don’t have Trich, also known as a “body focused repetitive disorder” (BFRD, and don’t understand it, but are close to someone who does, their own frustration and sadness about their child’s, friend’s, sibling’s or partner’s suffering may lead them to make constant suggestions (have you tried __ or ___), say to you, “Stop pulling, Honey,” if they see you do it, or try to “convince” you to stop by “reminding” you: “But Honey you have such pretty
hair..” “You don’t want to be bald, do you?” “Remember how upset you were about your lashes when you went to that dinner party, school dance, work, saw yourself in a picture, your friend asked you about it?”
As if you don’t already more desperately want to stop than anyone else could ever imagine. What’s hard to explain even to yourself is why you keep doing it, or why you do it at all. Why stopping seems so impossible when the behavior itself makes no sense. It just seems “crazy” or “gross” or you may feel “weak” and “pathetic”.
What others don’t know, and what you may not know, is that for people with Trich, hair pulling is a self-soothing mechanism (not an attempt to cause harm to yourself), and it feels pleasurable. It’s not an addiction to pain. The other even more important thing is that you are being prompted to pull by a physical urge that can best be compared to an itch. When people have an itch, they tend to respond to it without thinking or even being aware they are doing so. That’s why, if you have poison oak or chicken pox, you may not want to scratch, the doc may even say not to scratch, but the moment your attention is diverted (you’re watching TV or you’re on the phone), you “find yourself scratching.” And at that point, the need to “complete or finish” scratching is extremely compelling, even if you don’t want to. This comparison may help your spouse or parent or even you yourself to understand a little better what it is that causes you to start pulling in any particular moment. Either a physical or neurological urge occurs in a split second, as if you had an itch, and without conscious awareness you respond automatically. That’s why you may not have any idea of a precipitating factor.
Now, if it were that simple, it might well be easier to treat. But it’s important for pullers and their families to understand that this is not a willful behavior. Most people know what it’s like to respond to an itch and begin scratching, sometimes for a minute or more, before you realize what you’re doing. And most people also understand that, once you start scratching, poison oak for example, the craving to do so can overtake you, even though you know you shouldn’t. Most folks also know that, when at its itchiest, you may find yourself scratching, stop doing so, tell yourself, OK, I’m not going to scratch anymore, go back to
your movie, and find yourself scratching again and again. Imagine if this urge was daily and constant. Imagine if it resulted in hair loss. Yet no matter what you did, you would suddenly and repeatedly “find” yourself doing it. That’s, in short, what is happening to pullers. And because it as relieving to someone with Trich as it is for anyone to scratch an itch, you continue the behavior even when you’re aware. It is extremely important to understand that you (the puller) are not “crazy.” And anyone who experienced these urges, which occur in a microseconds, would respond the same way.
There are however, two other factors that come into play. I believe these urges have a cause that goes beyond that physical urge, and that are psyche comes to play a part in the constancy and intensity of these urges. Most people describe hair pulling as occurring in or even causing a “trance-like” state. This trance-like state kind of numbs one out emotionally, just like using a substance of some kind and also much like eating excessive amounts of carbs and sugar. This is why lots of people who have issues with weight may be engaging in what is called “emotional eating.” One may crave carbs and sugar in a way that feels like “regular” hunger. You may feel like you have to have a muffin or donut or cookie or hunk of sourdough bread. Yet underneath that craving, outside your present awareness, it may be fear or loneliness or shame that in a sense causes those cravings to happen. And once fulfilled, the emptiness or loneliness or shame is covered up.. Numbed out. So people tend to think that “their only problem is overeating.” Otherwise everything is fine. And this is exactly the same for hair pullers. The act of pulling numbs the longing or dis-ease, so it’s easy to believe that if I could just stop pulling, everything would be fine.
I work with people to get beneath this fallacy, generally dealing with issues like perfectionism, a lack of self love and self acceptance, or rather, a self-acceptance that is conditional. If they make a mistake, don’t finish their endless to do lists, aren’t thin enough, productive enough, accomplished enough or smart enough (which they rarely if ever think they are), they see themselves as unworthy, “lazy,” weak or just not good enough- And self love or acceptance is undeserved. That’s why many clients I see who have Trich and who generally also have this overly harsh, critical, perfectionistic attitude toward themselves tend to seek external validation since they are unable to give it to themselves. And this causes a pattern of people pleasing behaviors that also lead to living an inauthentic life, a life where one is not true to one’s self (since others’ opinions of their lives tend to be more important than their own.
Once my clients are able to access some of the painful feelings beneath the urges, and begin to experience greater self-acceptance and self love, two things happen: They begin to lead lives that are more authentic and true to themselves, and their urges to pull begin to diminish. And using mindfulness and learning to embrace gradual reduction rather than instant total cessation of pulling, they are able to slowly let go of some, most or all of tbeir hair pulling.