Over two weeks, jot down every time you catch yourself pulling your hair. Document what happened just prior to the hair-pulling, as well as your feelings. Also, note the time of day and the activity.
Knowing this can help you cope because the next time you feel anxious, you can try to find another coping strategy that brings you relief and work to make that your conditioned response to anxiety or your go-to coping strategy rather than hair pulling. There are three distinct phases for sufferers of trichotillomania. Not all sufferers go through each of the three phases. You may experience one or more of these phases:[5] X Research source 1. You initially experience tension accompanied by a desire to pull out some hair. 2. You start pulling out hair. It feels really good, like a sense of relief, as well as some excitement. 3. Once the hair is pulled, you might feel guilt, remorse, and shame. You might attempt to cover the bald patches with scarves, hats, wigs, etc. But eventually the bald patches become obvious to everyone and you tend to start hiding at this point. You might start to feel intensely humiliated.
One way to work on this trigger is to re-frame your perceptions of those hairs. No hair is inherently bad–all hair serves a purpose. Attempting to change your thought patterns about these hairs can help reduce the urge to pull.
One study has shown that over two-thirds of sufferers had experienced at least one traumatic event in their lives, with a fifth of them diagnosed with post-traumatic stress disorder. [7] X Research source This has led to speculation that it is a form of self-soothing for some sufferers, a way to cope.
When you tally up the amount of hair you’ve pulled out, this can serve as a reality check on how much hair you’re removing; is the result surprising to you? What about the amount of time spent on it, was it more than you thought?[10] X Research source Snorrason, Berlin, & Han-Joo, 2015
Taking a few minutes to clear your mind. Drawing or scribbling on paper Painting Listening to music that relates to your emotions Calling a friend Volunteering Cleaning Playing video games. Stretching
You might even have Post-It notes placed in areas where you tend to pull your hair a lot. These can act as other physical reminders to stop.
Of course, for many, the triggers aren’t as simple to identify or get away from; for some, change of schools, abuse, newly realized sexuality, family conflict, the death of a parent, or even pubertal hormonal changes are behind compulsive hair-pulling. These triggers are very hard - if not impossible - to get away from. If it is the case that you can’t get away from a trigger for any of the above or other reasons, continue to work on self-acceptance, retraining your habits and enlisting social support to help you cope with your disorder.
Try a cooling or numbing hair product to work as a “competing response” during Habit Reversal Training with your therapist. There is no quick fix to trichotillomania, but with training, patience, and practice, you can reduce your hair pulling behavior. You can also talk to your doctor about a prescription numbing cream to use on your head, but some are not safe. There are new cooling hair products that are also safe to use on the scalp and eyebrows such as Prohibere and a hair product by Lush with menthol. This may be useful if one of your triggers is an “itchy” or “urge” to pull hair strange feeling in your hair. In a case study of a 16-year-old girl, it was found that temporary use of numbing cream in combination with psychotherapy was successful in eliminating hair pulling behaviors. [12] X Research source Dia, D. A. (2008). “I can’t stop pulling my hair!” Using numbing cream as an adjunct treatment for trichotillomania. Health and Social Work, 33(2), 155-158.
To do a mindfulness exercise, sit in a quiet, comfortable spot. Take deep breaths. Breathe in for a count of four, hold for a count of four, and exhale for a count of four. As you continue to breathe, your mind will likely wander. Acknowledge these thoughts without judgment and let them go. Return your attention to your breath.
Remember, you are a wonderful and unique person. You are loved, and your life is precious. No matter what anyone else tells you, you should love yourself.
Say you have a thought such as, “I don’t have anything interesting to say, so I can see why people think I’m pathetic. ” Catch unkind thoughts like this and make a conscious effort to change these thoughts by correcting yourself. Tell yourself: “Sometimes I don’t have much to say, and that is okay. I don’t have to keep others entertained or take on the entire responsibility for this conversation. ” Replace critical thoughts with productive thoughts. For example, here is a critical thought: “There is no way I am meeting everyone for dinner. Last time I went, I was so embarrassed at my off-topic comment. I am so stupid. ” Replace this with a productive thought: “I was so embarrassed at the last dinner, but I know that I make mistakes and that is okay. I am not stupid. I just made an honest mistake. ” As you practice catching these thoughts and changing them, you will notice that your self-esteem will increase along with your confidence. [16] X Research source Jongsma, A. J. , Bruce, T. J. , & Peterson, L. M. (2006). The complete adult psychotherapy treatment planner. Hoboken, N. J. : John Wiley & Sons, Inc.
If you’re having trouble coming up with a list, talk with a trusted friend or family member. This person can brainstorm some ideas with you. No accomplishment is too small for this list. Keep adding to the list.
Learn to say no. If people are making requests of you that you don’t want to fulfill, assert your own needs and wants by saying no. Don’t be a people pleaser. Don’t do things just to secure someone else’s approval. Figure out what is really important to YOU. Ask for what you want. Use “I” statements. These types of statements help you convey responsibility for your own emotions and reactions. For example, instead of saying, “You never listen to me,” you can say, “I feel ignored when you are looking at your phone when we talk. ”
Make a list of the things that stress you out. These can be large things, such as money or work, or they can be small things, like long lines at the grocery store. While you can’t avoid everything that causes you stress, you can minimize your exposure to some things.
Tighten your muscles for six seconds and then release for six seconds. Pay close attention to how each muscle is relaxing. Work from your head to your toes until you feel your body begin to relax.
To meditate, find a quiet spot and sit or lie down. Begin breathing deeply, taking slow breaths. You might even try guided visualization, wherein you imagine a calm place such as a beach, a rippling creek, or a woodsy area.
If you have trouble falling asleep, try listening to some soft music. Stop using any screen devices at least 15 minutes before you go to sleep.
You don’t have to pound the pavement for an hour every day. You can participate in exercising that you enjoy. This might include yoga, martial arts, or other activities. Even gardening can give you an energy boost.
You might also tell your friends and family what your triggers are. This way, they can help remind you when you may be at risk of pulling your hair. They can also help you find an alternative behavior. Ask your friends and family to provide positive reinforcement when they see you successful engaging in a healthy alternative to hair pulling. [21] X Research source Snorrason, Berlin, & Han-Joo, 2015
If you visit one counselor or therapist and you feel you are not being helped, find another one. You are not chained to one doctor or counselor. It’s important to find someone you feel a connection with, and who you feel is helping you. The types of therapy that may be of benefit to you include behavioral therapy (especially habit-reversal training), psychotherapy, psychodynamic psychotherapy, hypnotherapy, cognitive-behavioral psychology, and possibly anti-depressant medication. [22] X Research source
Seven Counties Services, Inc. has a free Trichotillomania support hotline you can call. The number is 800-221-0446. [24] X Research source Jacofsky, M. D. , Santos, M. T. , Khemlani-Patel, S. , & Neziroglu, F. (2015). Treatment recommendations for trichotillomania (Hair-pulling) disorder. Seven Counties Services, Inc.
Chewing or eating pulled-out hair. Rubbing pulled-out hair across your lips or face. An increasing sense of tension immediately before pulling out the hair or when resisting the behavior. Pleasure, gratification, or relief when pulling out the hair. Catching yourself pulling hair without even noticing (this is called “automatic” or unintentional hair-pulling). Knowing that you’re pulling hair deliberately (this is called “focused” hair-pulling). [25] X Research source Tung, E. S. , Flessner, C. A. , Grant, J. E. , & Keuthen, N. J. (2015). Predictors of life disability in trichotillomania. Comprehensive Psychiatry, 56, 239-244. Using tweezers or other tools to pull out hair. [26] X Research source Snorrason, I. , Berlin, G. S. , & Han-Joo, L. (2015). Optimizing psychological interventions for trichotillomania (hair-pulling disorder): an update on current empirical status. Psychology Research & Behavior Management, 8, p. 105-113.
Noticeable hair loss caused by recurrent pulling out of the hair. Patchy bald areas on the scalp or other areas of the body. Sparse or missing eyelashes or eyebrows. Infected hair follicles.
Keep track of these types of behaviors over several days to see if they are habitual. Notice when you’re doing them and how often you’re doing them.
However, it is complicated to say which disorder is causing which. Is the loss of hair causing the depression through the desire to isolate yourself from others and avoiding enjoyable activities because you feel deep shame? [28] X Research source Often, successful recovery from Trichotillomania requires treatment for any co-existing disorders as well. [29] X Research source Keuthen, N. J. , Altenburger, E. M. , & Pauls, D. (2014). A family study of trichotillomania and chronic hair pulling. American Journal of Medical Genetics. Part B, Neuropsychiatric Genetics: The Official Publication of the International Society of Psychiatric Genetics, 165B(2), 167-174. doi: 10. 1002/ajmg. b. 32218
Brain scans have shown that people with trichotillomania have differences in their brain from persons not suffering from the disorder. [32] X Research source
