Looking for answers to hair pulling
Pandemic sheds light on condition affecting more than 150 million people
On a sunny Friday last month, 10 days into Australia’s coronavirus lockdown, Jayde Beaumont put her toddler daughter down for a nap, closed her bathroom door and started to shave her head.
It was a decision she had wrestled with for years, although it had little to do with how she looked. Beaumont, 27, has had trichotillomania — a condition that has caused her to pull out her hair compulsively — since she was eight. For almost two decades, she would fall into a daily trancelike state and systematically tug the hair from her head, strand by strand, a small pile forming next to her in minutes or even hours while she watched television or drove her car.
Anxiety and boredom have become common complaints in the coronavirus pandemic, triggering existing behaviours with potentially harmful effects. Beaumont said she picked up the razor after weeks of stress from frightening news headlines coupled with spare time from being cooped up inside. Although she had experimented with a range of treatments over the years, nothing had ever fully broken the cycle. Shaving her head had always felt like a last resort — until now.
“I just thought, ‘What have I got to lose?’ ” Beaumont said. “It is now or never. If I don’t have hair on my head, then I can try to train myself out of this. Maybe then the relapses and shame spirals would finally go away.”
What is trichotillomania?
A lot of unknowns surround trichotillomania. It’s hard to say (trik-o-till-o-MAY-nee-uh) and difficult to recognize or neatly define, despite having been classified as a disorder more than 30 years ago.
In recent years, experts have come to believe that it is caused by a combination of genetic, biological and behavioural factors. There is no one-size-fitsall diagnosis of either triggers or treatments, which can range from cognitive behavioural and habit reversal therapies to attending support groups or even trying to replace the pulling with another action like plinking an elastic band on a wrist.
“Trichotillomania has never been taken seriously enough,” said Dr. Fred Penzel, who is one of a handful of psychologists who specialize in the field, and is the executive director of Western Suffolk Psychological Services in New York. “For years it was simply seen as a bad habit or quirk, and this has meant it hasn’t been subject to the same research or widespread studies as many other disorders. It needs a great deal more attention and funding.”
Penzel said studies show that trichotillomania affects roughly two per cent of the global population. That implies that there are more than 150 million sufferers who pull hair from their scalp, eyebrows, eyelashes, pubic area or elsewhere on the body.
“I just felt so embarrassed and that no one understood,” said Beaumont, who kept her pulling secret for years until balding gave her away. “But no one really knew how to deal with it other than to tell me to just stop, which felt like the very thing that was out of my control.”
Hair-pulling is often miscategorized as a form of obsessivecompulsive disorder, which is defined by recurring irrational thoughts and the repetitive acts meant to neutralize those thoughts. Although they have similar characteristics, trichotillomania is a type of impulse control disorder that belongs to the group known as body-focused repetitive behaviours, or BFRBs. Unlike OCD compulsions, BFRBs — which include skin-picking and nail-biting — tend to feel soothing in the moment. Sufferers rarely suffer from obsessional thoughts. Many describe entering a “trancelike” state where they aren’t fully aware of time or their actions when they pull or play with their hair.
Reported female hair-pullers outnumber males 4:1, according to a study published by the American Journal of Psychiatry, with some links drawn to puberty hormones as well as anxiety and high intelligence.
Jennifer Raikes, executive director of the TLC Foundation, stressed that the true gender ratio isn’t known and could be more balanced, given that most men do not seek treatment or medical help. The TLC Foundation for Body-Focused Repetitive Behaviors is the most highprofile of the scientific evidence-based non-profit groups committed to improving public awareness and understanding of BFRBs in everyone from medical professionals, hairdressers and teachers to parents and sufferers. “Quite honestly, nobody knows the exact answers yet to a lot of basic questions,” Raikes said. “Anyone who says they definitely know is probably making it up.”
Sometimes trichotillomania can be triggered by a traumatic event, she said, or related to high levels of anxiety or depression. Just as often, however, people can be contented — save for their compulsive habit.
What is it like to have trichotillomania?
The psychological and emotional toll of hair-pulling can be significant. While few sufferers report feeling physical pain from pulling, when repeated thousands of times it can result in bleeding, skin infections, permanent hair loss or scars.
Constantly hiding these consequences can also be exhausting.
“Middle school was a rough time for me,” said Taylor O’Connor, 21, a psychology major from near Kingston, N.Y.
She started pulling at her eyelashes and eyebrows when she was seven, around the time her father was given a cancer diagnosis. When she moved to a larger middle school, she pulled out most of the hair on her head while lying awake at night.
“I had some good friends who stuck by me, but there was bullying, too. Swimming classes were nightmares,” said O’Connor, who started wearing a wig daily from seventh grade on.
Although sometimes uncomfortable, a wig didn’t just hide her thinning hair and allow her to feel more at ease in social situations; it prevented her pulling. Therapy and transitioning to college, where she was able to be more open about her disorder, also helped. Despite strong urges during the lockdown, with nightly pulling sessions of about 15 minutes — “it is my coping mechanism,” O’Connor said — her natural hair had recently started to grow back. In some places it now went past her shoulders, a milestone that filled her with pride.
“It’s like chasing a high,” said Beaumont, who estimates that at her worst she pulls for four to five hours a day. “As soon as I have played with what was the perfect hair, I need to start looking for the next one.”
Can trichotillomania be treated?
According to Dr. Jon Grant, a professor of psychiatry at the University of Chicago who has studied BFRBs for 20 years, self-grooming connects humans to other creatures in the animal kingdom. All animals are primed to groom themselves, he said last week, with sliding scales of gratification.
“There is keeping your eyebrows shaped, or plucking out a few grey or ingrown hairs. Lots of people do that. Then there are those who start and then can’t stop pulling hairs compulsively,” he said. “Some people manage to keep control of those urges or have mild cases. But for others it can be life-altering in terms of mental health and selfesteem, with parallels to addiction.”
Researchers are exploring treatment goals. Should people expect to completely stop, for example, or just reduce their behaviours? Trying to establish what percentage of people respond to behavioural therapy, medication or over-the-counter remedies also remains open questions.
“Sadly, one thing we can say is that people feeling unable to come forward has impacted our abilities to fully understand BFRBs, and the amount of specialists and resources put toward tackling them,” Raikes said.