TRICHOTILLOMANIA – Identifying and Coping With.
Trichotillomania is an irresistible urge to pull out hair, usually from the scalp, eyebrows or eyelashes, but also other areas of the body. Hair pulling from the scalp will often leave patchy bald spots, which people with trichotillomania can often to go to great lengths to disguise. People often start compulsive hair-pulling around the early teenage years, though some people may start earlier or later than this.
People may feel helpless when they get caught up in a bout of hair pulling but it is a condition that can be treated, and with great success. Hypnotherapy can be particularly helpful to break the habit and the compulsions that lead to hair pulling.
Here is some information and suggestions that may be helpful to those people suffering from this often distressing condition:
Recognise the signs.
Trichotillomania is officially classified as an impulse control disorder, in common with kleptomania, pyromania, and pathological gambling. Hair pulling can occur both deliberately or without even noticing it is happening. If you think you have trichotillomania then look out for the following signs or symptoms which might be an indication of this disorder:
Recurrent pulling out of the hair resulting in noticeable hair loss, and patchy or bald areas on the scalp or other areas of the body
Sparse or missing eyebrows or eyelashes
Itchy areas and infected hair follicles
Chewing or eating pulled-out hair, or rubbing pulled out hair across the lips or face
Having some type of ‘bad thought’ or bad feeling,’ possibly about yourself prior to pulling
An increased or building sense of tension immediately before pulling out the hair, or when resisting the behaviour
Pleasure, gratification, or relief when pulling out the hair
When the habit of pulling causes significant distress or impairment to social, occupational, or other important areas of functioning
Be aware of the pattern of trichotillomania and its different phases.
Not all sufferers are aware of three distinct phases, but many experience phases that are similar to this:
1. An initial feeling of tension, anxiety, or some other ‘negative’ or uncomfortable feeling accompanied by a desire to pull out some hair.
2. Hair is pulled out. It can feel really good and there is an accompanying sense of relief. I usually point this out to my clients as a good feeling counteracting a bad one.
3. Once the hair is pulled, the sufferer often experiences more negative feelings of guilt, remorse, and even shame. Attempts may be made to cover bald patches with scarves, hats, wigs, etc., but they eventually becomes obvious and sufferers may start hiding away at this point, and feeling worse about themselves.
Acknowledge that there is a problem.
The first thing to realise is that this is a problem that can be treated; there are differing therapeutic approaches and your GP may refer you to a CBT therapist. Hypnotherapy is extremely successful in breaking the compulsion either on its own or as a complement to another therapeutic approach.
Trichotillomania is a disorder, and stopping pulling is not simply dependent on willpower. The disorder arises as a result of many differing factors including moods, background, levels of stress, self-esteem, and how you think about yourself. When it takes over it is a condition in need of treating, not something to beat yourself up over.
On the other hand do not convince yourself that nothing is wrong, or that your hair pulling is ‘normal.’ Trichotillomania can be considered a form of self-harm. Like all forms of self-harm, trichotillomania can become an addictive behaviour. With time, it can become harder and harder to stop; that is why it is best to seek professional help and bring it under control as soon as possible.
Is trichotillomania the only thing affecting you?
Compulsive hair pullers may suffer from depression, OCD (obsessive compulsive disorder), Tourette’s syndrome, bipolar disorder, phobias, personality problems, and in some cases, have suicidal tendencies. Some hair pullers may find that they bite their nails and compulsively scratch or pick at their skin. Often individuals who are affected by this condition also have low self-confidence and low self-esteem.
Drugs or alcohol abuse can stem from trichotillomania, in an attempt to feel better and to get away from the feelings of guilt, shame, and general unhappiness.
Identify the triggers.
The initial cause of trichotillomania could be genetic and/or environmental. There are similarities with the triggers for OCD and chaotic, distressing childhood experiences or disturbed early relationships with parents or carers might contribute to the development of this disorder. It may be viewed as a form of self-soothing for some sufferers, and a way to cope. Regardless of these it is important to know and identify what kinds of situations, and particularly what feelings cause you to resort to hair pulling. Do you only do it when you are feeling low or depressed? Being hard on yourself and putting yourself down? Worried or anxious? Angry, frustrated or confused? Whatever it is for you, understanding what triggers a hair pulling episode can help you to find other, more positive ways of coping.
What’s the plan?
Working with a professional will usually entail you identifying the triggers that create the compulsion to pull. However you could start to develop a plan to stop for yourself.
Be aware and notice what your triggers are. Then with practise you can become aware of them just before you pull. This is the critical time when you can pre-emptively ‘interrupt’ your existing pattern of behaviour.
Interrupt the pattern and do something different. Almost anything you choose to do differently will help to interrupt your pattern of behaviour. Thinking about something more positive can be a great help, particularly coupled with relaxing and practising some form of calming deep breathing exercise. Conversely some people like to do something energetic like going for a jog, for example. I also suggest hopping on one leg or skipping as this will definitely change how you feel! Also see the rubber band exercise below.
Maximise the effect. Once you have done something different and changed how you feel make sure you keep that change going. Whatever you find works for you do lots of it until the compulsion to pull has passed.
The important thing to remember is you need to change how you feel, particularly for the better.
You get out what you put in.
There are several ways that you can approach dealing with trichotillomania. Be aware it does take a little effort but the more you put in, the better the result will be. Here are some exercises I give my clients
Keep a journal and log your hair pulling episodes. By keeping a written record (or chart if you prefer) you can get a good idea of the times, the triggers, and the impact of your hair pulling. Record the date, time, location, and number of hairs you pull, and the way in which you pull them.
In particular keep a note of your thoughts and feelings at the time, as well. Information in the log can be used as a means of identifying the triggers and those things that cause you to pull. However a log is also a useful tool for charting progress once you are on the road to recovery too.
Express your emotions. Talk out your feelings with a friend or family member, or at least get them out by writing them down in your journal. I know I just mentioned this but it’s an important point. Understanding and also expressing your emotions will go a long way to helping you understand why you are trying to make yourself feel better by pulling. If you have no trusted friend or relative to talk with, then talking with a counsellor who will listen in a considerate and non-judgemental way to what you have to say could be the way to go.
List the pros and cons. Write out a list of the consequences you have experienced as a result of the hair pulling. Do this for school/work, home, social events, etc. –
It might include infections caused by touching your eyelashes so much.
The discomfort of having bald patches (both physical and emotional). Perhaps the lengths you have to go to find head coverings, etc.
It should also include the relationship consequences, such as not going out and spending time with people because you are afraid they will find out about or comment adversely on either your appearance or your hair pulling episodes.
Comparing this with what you get out of pulling i.e. usually only a feeling of gratification or relief may help motivate you to stop, as long as you do not use it as a non-constructive way of piling on more guilt.
Try wearing a thick rubber band around their wrist and when they feel a compulsion to pull they simply snap the rubber band against their wrist. The resulting sharp pain helps to distract you and interrupt the pattern, and also helps generate the relief usually experienced by hair pulling.
Learn ways to calm and focus your mind, such as meditation, yoga, relaxation or self-hypnosis exercises. Take some time out each day to practise.
Try drawing, painting or even scribbling as a means of expressing or releasing tension and pent up emotions.
Listen to music. Chose what you listen to based on how it makes you feel
Do something active, even cleaning will do if you don’t want to go to for a jog
Play a game. Many young people enjoy the absorption of a video game. I must admit I find them fairly addictive myself…
Reduce your stress levels.
Stress often triggers the desire to pull hair out. Do whatever you can do reduce stress in your life and learn how to manage stress with better coping techniques. Identify the things that stress you out and practise relaxation exercises on a regular basis. A progressive body relaxation exercise such as the Body Scan will help.
As already mentioned meditation can be a help; also consider yoga, martial arts, and any form of aerobic exercise that you enjoy.
Ensure that you are getting enough sleep every night and that you have a regular sleep pattern. There are several aids to restful sleep on the downloads shop page here.
Improve your self-esteem.
Improving your confidence and self-esteem can be a great help with your stress and feelings of inability to cope. In addition, practising better self-assertion techniques can help you to overcome situations in which you feel challenged by other people. Remember that you are a wonderful and unique person and you have a right to be happy. No matter what anyone else tells you, you should think well of yourself.
Get professional help.
Although I have suggested some ways to help cope with the symptoms of trichotillomania it is treatable and the best way to solve the problem is to get professional help. Talk to a counsellor, therapist or initially your GP. They can help you find ways of coping, and address any depression or other problems that may be contributing to your condition. If you go to one source, and you feel you are not being helped, then find another one. When meeting your therapist or counsellor for the first time it is important that you feel comfortable and able to trust them.
There are many different forms of therapy available and you can choose whatever appeals to you personally, so do a little research before hand. Oh, and did I mention hypnotherapy? Hypnotherapy can be both helpful and effective to help beat the compulsions and break the habits and otherwise deal with the symptoms of trichotillomania…
Please give me a call if you would like any more information, or for an informal chat about how hypnotherapy can help you.
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