Trichotillomania Not OCD

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“I pull out my hair when I’m stressed, so I asked two psychologists what to do”
IMOGEN recently lost her job and a tic she had as a teenager resurfaced. She says she couldn’t stop herself.

I RECENTLY got laid off without warning, and was plunged into professional shock and serious financial stress.

An old tic resurfaced: I’d play with the hair on the top of my head, pull a strand or two out, fret about it, stop. Later, mulling over to-do lists while I fell asleep, I’d start again.

IT’S NOT A “BAD HABIT”

I’ve done this since I was 12. Gradually, I stopped (though honestly, I’m not sure why). At times of stress — work, difficult relationships, exams — I’d start again with a vengeance.

In my early 20s, I realised there was a name for it: trichotillomania (TTM), a body-focused-repetitive behaviour (BFRB) not dissimilar to nailbiting.

Imogen Dewey began pulling out her hair.

Imogen Dewey began pulling out her hair.Source:Supplied

IT IS EMBARRASSING, BUT IT SHOULDN’T BE

My immediate relief in discovering I wasn’t some kind of hair-pulling alien was cancelled out by extreme stories that made it look like a frightening pathology.

However, though there may be varying degrees of severity, it’s pretty common. Recent studies put it between 2-4 per cent of the population. Melbourne author and Principal Clinical Pychologist at Aruna Psychology Dr Deirdre Ryan says these are just reported cases.

The misconception it’s just a bad habit doesn’t encourage people to seek support.

“A woman’s husband said to me, ‘I quit smoking. Why can’t she just stop?” recalls Dr Fred Penzel, psychologist from New York State and science adviser to leading BFRB advocacy group The TLC Foundation.

“There’s no one thing about it that’s essentially true for everybody,” he says, “with the exception that these disorders involve a lot of shame and isolation.”

SOME ARE MORE LIKELY TO EXPERIENCE IT

TTM mainly effects women (10:1), and generally starts in pre-teen years (10-13); between 80-90 per cent of adolescent cases occur in girls.

Imogen’s trichotillomania started when she was around 12 (the same age she was in this picture).

Imogen’s trichotillomania started when she was around 12 (the same age she was in this picture). Source: Supplied

It’s not an anxiety, impulse control or obsessive-compulsive disorder, but can be triggered by any or all of these. It may also be genetic, learned, or as Ryan says, “occur for no apparent reason at all”.

“We often see TTM in personalities who internalise emotions,” she says, “who quietly become frustrated at themselves for challenges in their life they might experience, rather than with other people.”

HOW DOES HAIR-PULLING WORK?

Not everyone pulls from their head. They might pluck from arms, lashes and brows — anywhere inconspicuous. “People generally maintain around 70 per cent of their hair,” Ryan says. “It’s very easy to cover up and to not get noticed.”

Hair-pulling falls into two categories: automatic and focused. Penzel suggests both kinds are “an attempt to regulate levels of stimulation within the nervous system.”

This is a useful idea when you’re trying to hack your own behaviour.

To alleviate my stress-based pulling, for example, I should find ways to reduce stimulation, and basically to calm my nervous system.

To stop the hunt for “rough” hairs (something I did when I was younger), I can find other ways to focus on my senses: a head massage, a shower, a fidget spinner (yes, really).

HOW ELSE DO YOU FIX IT?

A combined approach grounded in behavioural therapy gets results.

“We work with the individual to help them recognise that there is a moment in between when you have an urge to pull your hair and when you act on that urge,” Ryan says. “That’s where all the work happens.”

WHAT ABOUT MEDICATION?

The short answer: No.

With the advice of a GP or mental health professional, it can play a role in addressing emotional triggers for TTM such as depression. But according to Penzel, medication has “a really poor track record” for hair pulling itself, due to the huge scope and variety of TTM triggers.

WHAT CAN YOU DO ON YOUR OWN?

“A first simple step is just delaying the urge,” says Ryan. “You’re training your brain to realise you don’t have to pull your hair; you can cope without having to do this.”

She helps people “become a good detective into themselves”: identifying triggers, building strategies. But both she and Penzel say if hair pulling seriously impacts your day-to-day life, get help from people who know what they’re doing.

WHAT ABOUT HELPING SOMEONE ELSE?

An ex once asked why my hair was “rough, not smooth like other girls’”. Another got visibly worried if he saw me touch my head. Neither was particularly helpful.

Families and partners commonly project anxiety, Ryan says. She recommends two words instead: curiosity and kindness.

“Be direct about what you’ve observed. That person may believe no one has noticed. You may be opening up a conversation about a lot of other things in that person’s life that they need support with, and that can be really life-changing.”

One day, a friend saw me pulling my hair. Gently, she asked about it. And now, if I go unconsciously back to these old coping mechanisms, she just smiles and holds my hand over the table.

Knowing she isn’t stressed out — or grossed out — by me is so soothing. And at least momentarily, the urge to pull my hair goes away.

RESOURCES TO CHECK OUT

The TLC Foundation, an advocacy and support network for those suffering from BFRBs

The Hair-Pulling Problem, by Dr. Fred Penzel

The Hair-Pulling “Habit” and You, by Ruth Goldfinger Golomb

Beyond Blue

Imogen Dewey is a writer and editor living in New York.

Blog Courtesy http://www.news.com.au/lifestyle/health/mind/i-pull-out-my-hair-when-im-stressed-so-i-asked-two-psychologists-what-to-do/news-story/988674d8dbd86197a0b451502c4bea96 
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