What's the Best Treatment for Hair-Pulling Disorder?I have absorbed countless articles, posts, and videos about trichotillomania (compulsive hair pulling) over the years, and most of them aggravate and concern me. After having trichotillomania for 13 years, I am finally standing up to this disorder and resisting urges. In the process, I have become awakened to the fact that what I’ve been reading for years has been reinforcing my pulling. I hope to offer a fresh take on trichotillomania and challenge beliefs you may have. If I’m lucky, this article might spark a much-needed conversation.

I have been pulling my hair since I was 12 years old. I am currently 25. I’ve been without eyelashes since age 15 and have been meticulously gluing on false eyelashes every day for the past 7 years. I draw on my eyebrows every day despite being months pull-free. Half of my eyebrows have refused to grow back. I started pulling my head hair 3 years ago. I have been completely bald, worn a wig for months, shaved my head every 2 weeks, worn headbands and head wraps, and painted powder on my head. I have had pulling trances that lasted 4 ½ hours long. I have gouged into my legs to dig out hairs. I have thrown out tweezers only to buy them again. I have crafted my own tools to pull.

I have been pulling and picking for half my life and I am absolutely exhausted. But for the first time, I am getting better. I have not pulled my eyebrows in months. My head hair pulling is in remission. I currently have short thick hair with one unnoticeable thin spot. My eyelashes are back, and I am able to wear mascara. I am on my way up. I have been kicked around by trich for years and I know what it is like to wrestle with it on a daily basis. Here is my take on trichotillomania:

People with trich ceaselessly gripe that others say “Just stop” or “Why can’t you just stop?” and the person with trich typically responds by saying that it is rude and “We can’t just stop and it’s not that easy.” But how can we ever expect to stop pulling unless we don’t actually stop pulling? It is as simple as stopping pulling. Yes, there are skills to develop and tools to employ, but I have learned that I will not have hair unless I stop pulling. I have told myself that it can be as easy as stopping pulling.

Young readers need to know that stopping pulling is very real and possible. If they read articles repeatedly stating “We can’t just stop,” that message will become ingrained in their mind. You can absolutely stop pulling. Absolutely. You CAN “just stop.” Maybe not on your first try, but you’ll get there. I hope other writers stop spreading the message that it is impossible to stop pulling. I received this message and it was entirely unhelpful.

I prefer to think of trichotillomania as a behavior, not an illness, disease, or disorder. I understand the benefits of it being classified as a disorder, such as insurance coverage of treatment. However, if I view trichotillomania as a choice that I make, then I have control over it. I firmly believe that I make the conscious decision to pull my hair out. I don’t have automatic/unconscious pulling that some do. Hair pulling is simply a behavior I perform. I don’t think of it as some complex psychological disorder in the Diagnostic and Statistical Manual with unknown etiology. It is within my realm. It is a behavior that I can choose to engage or not engage in. I like to keep it simple.

When I went to the Trichotillomania Learning Center conferences, I saw dozens of scientists and professionals presenting research. So much of it I didn’t understand. One look at a poster can make you think, “Holy shit. This disorder I have is way beyond me. Even the scientists don’t understand it. This must be out of my control. It’s probably some neurochemical/cognitive/neurobiological/sensory imbalance that I have no influence over. I’ll let the professionals handle it.” I felt this way. I felt that my “disorder” was not within my reach. All of the scientific lingo was over my head and I concluded that this disorder was out of my grasp.

After years of medications, research studies, CBT, ACT, ERP, HRT, and other acronyms, I asked myself, “Why am I not stopping pulling?” I realized I was being a passive participant and waiting for the therapy to do its work. I mistakenly believed that I couldn’t “just stop” and I placed the hope for a “cure” in researchers’ hands. I acted like a victim of this disease. I was so wrong. I take accountability for my behaviors now. Trich is a choice for me. I view hair pulling as a behavior that I like to do. I have the power to not perform this behavior. The past year, I have been resisting pulling urges because I dislike the consequences.

If a certain behavior (pulling) causes us to experience something positive (relief, pleasure), we will want to continue performing this behavior. This is called reinforcement because our behavior increases. If a certain behavior (pulling) causes us to experience something negative (baldness, shame, anxiety), we will want to stop performing this behavior. This is called punishment because the behavior decreases. In my experience, there is a balance between these two sides.

I kept pulling for so long because the positives outweighed the negatives. The feeling I got from pulling was worth the negative consequences. Eventually, after 13 years, the scales tipped the other way. The consequences began to accumulate. I was sick of wearing a head wrap every day. I was sick of gluing on eyelashes every day. I was sick of drawing on my eyebrows every day. I hated the itchiness and hotness of wigs. I hated not looking like myself. I hated covering up. I hated how my hair littered the floor and car. Hair pulling wasn’t worth it anymore.

I don’t want to sound callous, but we need to have negative consequences of our behavior in order to stop. I don’t want others to shame or punish hair pullers, though. However, feeling uncomfortable with my appearance in public was the impetus that led me to stop pulling. It’s basic behavioral science. If there are minimal negative consequences to pulling, it is unlikely that the pulling will stop.

Some people with trich state they are glad that they have it because they are a better person because of it or have met friends in the process. If they could go back in time, they wouldn’t change a thing. In my experience, trichotillomania is an awful disorder and I absolutely wish I never had it. It has eaten hours, days, weeks, months, years of my life. It has torn me apart and broken me down. I feel for every person with trichotillomania because this disorder is a vicious, soul-sucking, son of a bitch. I can’t wait to be fully free from it.

I feel I might hit a few nerves on this next point, if I haven’t already. I found great solace at my first Trichotillomania Learning Center conference after meeting hundreds of people with trichotillomania. However, I later realized that our common thread — trichotillomania — kept us united. Without it, what would we share? Would I still feel included if I no longer pulled? I am not saying that being friends with other hair pullers reinforces the behavior, but I am telling you to tread carefully.

When I felt greatly supported by other hair pullers, I felt less desire to stop pulling. There was less incentive because trich was now associated with camaraderie, fun, and acceptance. I have found the appropriate distance to place myself from the community because my ultimate goal is to not be controlled by this behavior. The more I associated with the community, the more I thought about hair pulling and the more it became a part of my identity. The community does not exclude recovered individuals, but I felt in some way that hair pulling was an implicit requirement to stay in the club. Some hair pullers wish to dedicate their lives and careers to this cause and it makes me sad because I see this as trichotillomania still defining their lives in a way.

Final Words:

  • I’ve been through the mental health system and I’ve finally learned I am the only one who can stop my pulling.
  • I refuse to accept this behavior I perform. I refuse to be tormented by hair any longer. I will never “accept my illness.” I rise above this behavior.
  • I hope I challenged people’s beliefs and helped them extract themselves from self-defeating thoughts. I hope I lit a fire in some.