In a society where long, shiny hair signals sex appeal and desirability, I am a woman with a bald spot. Worse, it is one of my own making: I tear out my hair, strand by strand, or sometimes in clumps. I do it to deal with stress or boredom, and I’m not alone. About 2 percent of the U.S. population, mostly women, suffers from this psychiatric condition, called trichotillomania (from the Greek words for hair, pull and more than normal). Some pull out eyebrows or eyelashes; others go for arm or leg hair; men may pluck at their beards. I pull from the crown of my head. At one point after college, I worked my way to a palm-sized bald spot.
It started when I was 7 years old as a way to cope with moving, changing schools and having a new sister. My doctors assured my parents I would grow out of it, but I didn’t. While there are promising new therapies, trichotillomania has long been difficult to treat. Although one type of therapy may work for a while, symptoms return — a lesson I’ve learned several times over since my late teens, when I began actively trying to stop. (I’m now 27.) I’ve tried medication, behavior modification, talk therapy and several nontraditional approaches (wearing Band-Aids around my fingers, snapping a rubber band against my wrist, donning wigs and gloves). I’ve taken vitamin B and antidepressants to reduce stress, done yoga and meditated. I’ve even considered smoking to keep my hands busy, but I figured if it didn’t help, I’d be stuck with another problem.
The urge to pull feels like an itch I need to scratch. My scalp tingles invitingly, and my hands get antsy. If I resist, scalp is all I think about, feel, sense. Sometimes I bargain with myself. Just two hairs and I’ll feel better. Then six. Then two more. The behavior is so satisfying that nothing replaces it. I’ve heard some people get a jolt of adrenaline from pulling, but I feel relaxed, like each sharp tug and release on my scalp also releases anxiety. I pull at night while reading or watching TV, in the car and occasionally at work. In movie theaters, my hands instinctively find their way to my head, especially during suspenseful scenes. When I’m busy, social and happy, I pull less; the few unemployed months after college were bad.
What’s the harm?, you might ask. True, hair pulling won’t put me in the hospital, but my thin areas make me self-conscious and exhausted. In desperation, I’ve taken drastic steps. During a fit of college-finals-week frustration, I cut off all my hair with desk scissors. The shorter hair was harder to pull, but I looked awful. A stylist “fixed” my home cut with a military-style buzz. But once my hair grew a little, I had enough traction to pull again. Still, the fact that I was partially bald didn’t really register until a few weeks later, when a dressing room mirror revealed every angle of my head. I fled, feeling overwhelmed, and started wearing a scarf, hat or wig every day.
After two years of hiding my head, I paid $800 to have extensions sewn in that would cover the spot. For the first time in my life, I had thick hair and didn’t worry about looking bald. Plus, the extensions’ tautness quelled the pulling urge. But when they loosened, I picked at them until they fell out.
I now wear my hair up, and it stays up almost all the time. An artfully orchestrated ponytail hides the bald spot, but I can’t forget about it. My boyfriend knows what my hair looks like down, and he’s supportive, but I get anxious when he touches my head. I don’t want him to see or feel what I consider my biggest flaw. During a conversation about our future, he said he worried that I would pull out our children’s hair. I was shocked and hurt; I had certainly never pulled out his hair.
But that’s part of the reason I wanted to try again to stop pulling. I did worry that my children could learn this compulsive behavior from me. (They may inherit it, as it turns out; trichotillomania is related to other impulse-control disorders and may be genetic in at least a small percentage of people, according to a study from Duke University Medical Center in Durham, North Carolina.) So I reconsidered treatment options — and when I had the opportunity to start from the beginning with a new doctor and therapy, I took it. Acceptance and commitment therapy, a treatment I’d been reading about, is a form of cognitive behavioral therapy psychologists use to treat all kinds of conditions, including overeating and obsessive-compulsive disorder. One preliminary study indicated that ACT, when used in combination with other therapies, showed promise with trichotillomania, and that was enough for me. Unfortunately, most of the ACT practitioners near my Chicago home hadn’t treated pullers and weren’t ready to start. After about eight calls, though, I found Patty Bach, Ph.D., assistant professor of psychology at the Illinois Institute of Technology in Chicago and licensed clinical psychologist at MidAmerican Psychological Institute in Joliet, Illinois. She had worked with only one puller but had treated similar problems and thought she could help.
ACT maintains that trying to avoid distress can actually magnify it — and keep people from meaningful pursuits. So patients are taught to notice the presence of difficult thoughts or feelings without struggling or arguing with them. That’s the acceptance portion of the name. The commitment part refers to a willingness to move in the direction you want your life to go, whatever unwanted thoughts or feelings arise. In the case of trichotillomania, a key goal is to accept the hair-pulling urges without having to give in to them. And the very act of going to therapy is deemed a committed step in the right direction.
Getting to my first appointment was a disaster. I tore at my hair for the entire, 40-mile drive to Bach’s Joliet office. Surely she’d order me to stop for good in a matter of hours.
Ready to let hair down again
But she didn’t. After asking some get-to-know-you questions and talking about my history, Bach gave me homework to make me more conscious of my behavior: I was supposed to write down when and where I pulled, what I was doing at the time and how I was feeling. I knew that I went at my hair when I was stressed or bored, but I also tried to ignore the pulling because it made me feel ugly and out of control. The assignment forced me to quantify the damage and think, I really do that to myself? During session two, we simply discussed what I had written. The third session, however, got serious. Bach suggested that although hair pulling might temporarily make me feel better, it added stress to my life overall. Surprisingly, I had never considered that the negative effects of pulling might be greater than the attendant relief. Then came the moment I’d been dreading: “Try not to pull,” Bach said, as if it were the easiest thing in the world. “Be aware of the stress, and let yourself feel it.”
She said I had to consciously face the extra emotional discomfort and deal with it, rather than rely on a quick fix (the pulling). I couldn’t choose my urges, but I could choose not to obey them automatically. Until that moment, pulling was something I had felt helpless to change. As hard as this is to believe, I hadn’t considered that I could just decide to stop. Somehow, the revelation terrified me. My breath shortened, and I tugged at the pillows on Bach’s couch. I almost cried. My chest tightened. I wanted to hide.
But the feeling subsided over the next few weeks, as we worked on another essential part of treatment: I had to separate the behavior from my identity and see myself as a person who was choosing to pull when I had the urge, rather than a puller at the core. The desire would still be there, but I’d get used to believing I had power over it.
As with any recovery, I’ve had success and setbacks. Some days, I’m so stressed from work, I don’t even realize I’m pulling. And sometimes I let myself pull because it’s comforting. But I am doing better. “You’re growing some hair back here,” my hairdresser said recently, gesturing to my fuzzy thin spot. “It’s even kind of long.” Long is relative (about 2 to 3 inches for me) but exciting because no hair on the crown of my head has reached more than 2 inches in six years. The hard part is waiting to see progress. At the rate hair grows, it will be months before the area doesn’t look like the hair has been singed off.
My biggest success, though, can’t be measured in length. A couple of months post-ACT, for the first time in years, I wore my hair down for a whole day. I didn’t worry; I just let go. And although I still have some difficulty imagining myself as a nonpuller, I’m working on overcoming that block. I am ready to let my hair down again, if only for a day at a time.
For trichotillomania information and resources, go to Trich.org.