When they pull out their hair

Dealing with the stress of trichotillomania


Jennifer Burklow

Trichotillomania. Unless you’re a linguist, it’s a word that’s likely to send you to the dictionary in search of a definition and pronunciation (trick-oh-till-oh-mania).

Known as "trich," it’s an impulse control disorder that causes people to pull out their hair, eyebrows, eyelashes or other body hair. Unlike cutting, this is not considered a self-mutilation disease. People with trich don’t mean to hurt themselves. Rather, they start pulling hair when they get bored, worried or nervous.

The result, however, can lead to feelings of self-hatred once the hair-puller looks in the mirror. Then comes the effort to hide the damage.

"For most kids it is so hard to disclose; they feel terrible shame and they hide it," says clinical psychologist Karen Cassiday, owner and clinical director of the Anxiety and Agoraphobia Treatment Center in Northbrook.

Doctors are just beginning to understand trich. What they know is: Trich affects up to 4 percent of the U.S. population, it can occur at any age, though it usually appears between ages 9 and 14—puberty—and it affects boys and girls about equally.

Once established, trich becomes a powerful habit. Those affected pull out their hair, play with it and, often, chew or ingest it. The severity may fluctuate. Research also indicates that trich may be hereditary and that it’s often accompanied by obsessive-compulsive behaviors.

"The best academic understanding is that [trich is] some kind of biologically based behavior that the person gets caught up in doing and they can’t help themselves," Cassiday says.

No one profile

Cassiday says people who pull their hair are a mixed group. Some do it to relieve stress or boredom; others do it to help themselves relax. Some even do it while sleeping.

Emily, now 16, started pulling her eyelashes in seventh grade. She was dealing with a difficult family situation; and this provided brief relief.

"I would get really, really tense right before and during [the hair pulling] … especially if I couldn’t get the exact hair I wanted," says Emily, who asked we not use her last name. "I would be obsessed until I got that hair. Then I would feel really relieved. Then I would feel angry at myself and ashamed."

That’s typical of people who pull hair, says Cassiday. "There’s an absorbing quality to it; it’s very self-enforcing … [pulling causes] the feel-good hormones to get released when you do it." But those feelings are quickly followed by shame, she adds.

Treating trich

Treatment involves a combination of therapy, medication and support groups. Cognitive behavior therapy, in which patients identify what triggers the pulling and then find ways to keep the hands busy—such as playing with a squeezable ball—is the "best bet," Cassiday says. For infants and younger kids, it’s suggested children use gloves, mittens, bandages and other barriers.

John Calamari, a clinical psychologist and director of the Anxiety and Obsessive-Compulsive Disorders Treatment and Research Program at Rosalind Franklin University in North Chicago, encourages patients to delay giving into the urge. The hope is that, over time, the urge will diminish, he says.

Attitude also plays a part in coping with trich. At Cassiday’s center, doctors let kids know they aren’t the only one with trich and take a step-by-step approach to treatment. Some patients, Cassiday says, stop pulling completely while others learn ways to pull less and use cosmetic devices (wigs, makeup and false eyelashes or eyebrows) to feel better about their appearance.

And, Cassiday adds, as long as hair follicles haven’t been damaged, the hair grows back within a year or so.

Alternative behaviors

Because depression often accompanies trich, some doctors prescribe antidepressants. Cassiday doesn’t recommend that as a first step, though.

Medication didn’t work for 12-year-old Vinny Roman of Orland Hills, says his mom, Diane. Vinny started pulling his hair in fifth grade. His first doctor prescribed Zoloft and kept increasing the dosage when the pulling continued. Roman took Vinny off the medication and found a support group that helped Vinny realize he wasn’t alone. Vinny now sees a licensed social worker and uses a variety of alternatives when he feels the urge to pull.

His advice to other kids with trich: "Every time you feel like pulling, talk to someone who makes you feel comfortable. When you’re about to pull, think about what will happen. The next time you feel like pulling, go listen to your favorite band or go write in a journal or type something on a keyboard." He also recommends counseling, saying it’s helped him "very much."

For parents, Cassiday says unconditional support for kids with trich is the best medicine.

The bottom line, says Cassiday, is that trich has "nothing to do with will power, discipline or being impulsive. It really has a life of its own; it’s something that happens. No one would pick to do this."

Jennifer Burklow is the Chicago Parent copy editor; she lives in La Grange Park with her husband and two daughters.

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