Trichotillomania is an irresistible urge to pull hair from the scalp, eyebrows or other parts of the body. Pulling hair will cause bald areas, which people with trichotillomania try to disguise. About one percent of the general adult population is diagnosed with trichotillomania, with the majority of sufferers being women. Some people usually start pulling hair in their early teens, but some don't. If the sufferer is also depressed, hair pulling can lead to decreased functioning in social and work situations. You may feel like you can't stop once you start pulling your hair out. Fortunately, this disorder can be cured.
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Part 1 of 6: Identifying Distraction Triggers
Step 1. Make a note of every time you pull your hair out
Think about the type of situation that caused you to vent by pulling your hair out. Do you do it when you are depressed? Angry? Confused? Frustration? Understand what your triggers are so you can find other more positive ways to deal with them.
For more than two weeks, write down each time you find yourself pulling your hair out. Take note of what happened just before that, as well as your feelings
Step 2. Record how you feel when you pull out your hair
When investigating the trigger, describe what might reinforce the behavior. If you're pulling your hair out because you're anxious and this reduces your anxiety, pulling your hair out is definitely a relief. Pay attention to how you feel during and immediately after you pull your hair.
- Knowing this will make it easier for you to cope with the disorder because when you are feeling anxious, you can try to find other strategies that make you feel relieved and try to channel your response to the anxiety or adopt a coping strategy instead of pulling your hair out.
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There are three stages that exist in people with trichotillomania. Not all sufferers go through all of these stages. You may experience one or more of these stages:
- 1. Initially there is tension with the desire to pull out a few strands of hair.
- 2. You start pulling hair. It feels really good, like a sense of relief, as well as causing pleasure.
- 3. After the hair is pulled, you feel guilty, sorry, and ashamed. You try to cover up baldness with a scarf, hat, wig, etc. But the bald areas are already clearly visible, and you tend to start hiding. You may start to feel very humiliated.
Step 3. Look at the hair you pulled out
Do you pull out your hair because you don't like a certain type of hair? For example, some people pull out their hair compulsively when they find gray hair because they don't like gray hair, so "all gray hair should be thrown away".
One way to deal with these triggers is to reframe your perception of hair. There are no ugly strands of hair, everything has a purpose. Change the way you think about this hair to help reduce the urge to pull it out
Step 4. See your childhood influences
The initial cause of trichotillomania can be genetic and/or environmental. The researchers saw similarities in the triggers of obsessive-compulsive disorder and thought that bad and distressing experiences in childhood or disturbed early relationships with parents or caregivers could be the cause of the disorder.
One study has shown that more than two-thirds of sufferers experience at least one traumatic event in their life, whereas one-fifth of them are diagnosed with post-traumatic stress disorder. This led to speculation that pulling hair is a form of outlet for some sufferers to calm down
Step 5. Look at your family history
When tracing the source of trichotillomania, see if you have a family history of hair pulling, obsessive compulsive disorder, or anxiety disorders. The risk of developing trichotillomania is significantly increased if the disorder is in the family history.
Part 2 of 6: Developing Strategies to Stop Pulling Hair
Step 1. Develop a plan to stop yourself
"Notice, Interrupt, and Choose Plan" is one strategy to help break the habit of pulling hair. This plan consists of: noticing when you feel like pulling your hair, interrupting the connection of feelings and the urge to pull your hair by listening to positive reminders in your mind. Then, choose to do something else, one that will relax you and calm you down.
Step 2. Keep a record of each time you pull your hair out
With these notes, you can find out the amount, trigger, and impact of hair pulling. Record the date, time, location, and amount of hair you pulled, and what you used to pull it out. Also write down your thoughts or feelings at that time. This is a useful way to let out shame, and reveals how hair pulling has an impact on your life in general.
The amount of hair you remove can tell you how much hair you have removed; are the numbers surprising? What about the amount of time you waste pulling your hair out?
Step 3. Choose an alternative to express your emotions
Once you've identified the signs and triggers, write a list of alternative behaviors you can do instead of pulling your hair out. Either way, the alternatives should be easy to work with and easily accessible. Some alternative suggestions for expressing your emotions and feelings include:
- Take a few minutes to clear your mind.
- Draw or write on paper
- Paint
- Listen to music that relates to your emotions
- Calling friends
- Volunteer
- Cleaning up
- Playing video games
- Do stretches.
Step 4. Try a physical reminder to make yourself stop
If you accidentally pull your hair out, you may need a physical reminder to help yourself stop it. As a physical barrier, use weights on the arms you pull out, or rubber gloves to prevent you from pulling hair.
You can also stick Post-It paper where you tend to pull out a lot of hair. This can be another physical reminder to stop
Step 5. Put some distance between yourself and the trigger for this distraction
While you may not be able to eliminate all the triggers that force you to pull your hair out, you can reduce some of your exposure. Is your lover the reason you mostly pull your hair out? Maybe it's time to reconsider your relationship. Is your boss causing you stress? Maybe it's time to look for a new career opportunity.
For many people, of course, these triggers are not easy to identify or avoid; for some, changes in school, acts of abuse, new sexuality awareness, family conflicts, parental death, or even the hormonal changes of puberty are causes for compulsive hair pulling. This trigger is very difficult - even impossible - to avoid. If this is also the case in your case, continue to work on accepting yourself, retraining your habits, and getting social support to help you deal with the disorder
Step 6. Reduce itching or weird feeling in your head
Use natural oils to soothe the follicles and reduce itching. And it's more important to change the behavior of pulling and pulling hair to stroking and stroking it. Make sure you use natural products such as a blend of essential oils and castor oil. Do not use chemical based products.
- Look out for products that promise a quick fix. Treatments or drugs that promise instant results cannot be trusted because trichotillomania doesn't go away overnight.
- You can also go to the doctor for a prescription numbing cream to use on your head. This may be useful if one of the triggers is an "itchy" or strange feeling in the hair. In a case study of a 16-year-old girl, it was found that the temporary use of numbing cream in combination with psychotherapy succeeded in eliminating hair pulling behavior.
Part 3 of 6: Increase Acceptance and Confidence
Step 1. Soak up the running time
Hair pulling is often the result of a refusal to accept negative feelings or emotions. Use mindfulness techniques to help yourself become more accepting of negative or uncomfortable emotions as a natural part of the human experience. These emotions need not be avoided. If the urge to avoid discomfort subsides, the act of pulling hair will decrease as well.
To do mindfulness exercises, sit in a quiet and comfortable place. Take a deep breath. Inhale for a count of four, hold for a count of four, then exhale for a count of four. If you continue to breathe, your mind may drift. Recognize this experience without judgment and let it go. Return attention to your breath
Step 2. Build your confidence
There are many people affected by this disorder who also have low self-esteem, or low self-esteem. To build self-confidence and self-acceptance, use Acceptance and Commitment Therapy (ACT), a therapeutic approach. This approach can help a person clarify values and focus on his or her life goals. Building confidence is an important part of recovery.
Remember, you are a beautiful and unique human being. You are loved, and your life is precious. Whatever people say, you have to love yourself
Step 3. Replace negative thoughts with positive thoughts
Negative thoughts about yourself will quickly undermine your confidence and make you feel like pulling your hair out. Ridicule, fear of failure, and other negative thoughts will make you feel as though you are worthless. Start changing these mental habits to start building yourself up and increasing your self-confidence. Here are some ways to start changing the way you think about yourself:
- Say you feel something like, "I don't have an opinion that is interesting, that's why people think I'm pathetic." Catch bad thoughts like these and make a conscious effort to replace these thoughts by correcting yourself. Tell yourself: "I don't talk much at times, but that's okay. I don't always have to entertain people or take responsibility for these conversations."
- Replace critical thoughts with productive thoughts. An example of critical thinking: "There's no way I'd run into anyone at dinner. Last time, I was so embarrassed by my pointless comment. I'm so stupid." Replace this with a productive thought: “I was so embarrassed at dinner last night, but I know the mistake didn't mean anything. I'm not stupid. It was an honest mistake.”
- If you practice capturing these thoughts and changing them, you will see that your self-confidence will increase along with your self-confidence.
Step 4. Write down your achievements and strengths
Another way to start accepting your emotions and boost your self-confidence is to write a list of your accomplishments and strengths. Refer to this often.
If you're having trouble coming up with ideas, talk to a trusted friend or family member. This person can give you lots of ideas. No achievement is too small for this list. Keep adding to the list
Step 5. Make an effort to communicate with others in an assertive manner
Practice self-assertive techniques to make it easier for you to cope with situations where you feel challenged by others. As an example:
- Learn to say no. If someone else asks you for something and you can't fulfill it, be assertive and say no.
- No need to please other people. Don't do something just to be supported by others. Find out what really matters to YOU. Ask for what you want.
- Use "I" statements. This statement helps you convey responsibility for your own emotions and reactions. For example, instead of saying, "You never listen to me," say, "I feel ignored if you keep looking at your phone while we talk."
Part 4 of 6: Reducing Stress
Step 1. Avoid multiple sources of stress
Many sufferers find stress triggers the urge to pull out their hair. Do whatever it takes to reduce stress in life, and learn how to manage the stress you encounter with better coping techniques.
Make a list of things that stress you out, from big things like money or work to trivial things like long lines at the supermarket checkout. While you can't avoid everything that causes you stress, you can minimize your exposure
Step 2. Relax your muscles through progressive muscle relaxation
You can reduce the stress you feel by using progressive muscle relaxation. This type of relaxation reduces muscle tension and sends signals to your body to relax. By tensing and releasing tension in your muscles, you slowly return your body to a relaxed state.
- Tighten your muscles for six seconds and then release them for six seconds. Notice how each muscle is relaxed.
- Work from your head to your toes, until you feel your body begin to relax.
Step 3. Meditate
Meditation can help you reduce stress. A regular habit of meditation, even 10 minutes a day, can help clear your mind and refocus your energy in a positive place.
Find a quiet place to meditate, then sit or lie down. Slowly take a deep breath. You can even try a visualization guide, by imagining a quiet place like a beach, a rippling river, or a lush forest
Step 4. Get enough sleep
Make sure your sleep pattern is regular and every night you get enough sleep. Get at least seven or eight hours of sleep every night.
If you have trouble sleeping, listen to soft music. Stop using gadgets at least 15 minutes before going to bed
Step 5. Do exercise
Studies show that stress can be significantly reduced with regular exercise. Your body will increase the production of endorphins which help make you feel more positive.
You don't have to run for an hour every day. Do a sport that you enjoy, such as yoga, martial arts, or other activities. Even gardening can provide an energy boost
Part 5 of 6: Seeking Support
Step 1. Talk to a trusted friend or family member
Find someone you trust and tell them about your trichotillomania. If you can't get it right in person, write a letter or email. If you are afraid to talk about your struggle with the disease, at least state how you feel.
- You can also tell your friends and family what triggered it. In this way, they can help alert you when you feel like pulling your hair out. They can also help look for alternative behaviors.
- Ask friends and family for positive reinforcement if they see success with healthy alternative activities.
Step 2. Talk to a mental health professional
A counselor or therapist can help you find ways to deal with this disorder. This person can also deal with depression or other problems that might be contributing to your self-harm.
- If you visit one counselor or therapist but you don't find it helpful, find another one. You don't have to be tied to one doctor or counselor. It's important to find someone who is connected to you, and who you feel can help you.
- Types of therapy that may benefit you include behavioral therapy (especially habit-reversal training), psychotherapy, psychodynamic psychotherapy, hypnotherapy, cognitive-behavioral psychology, and antidepressant medications.
Step 3. Ask your doctor about medication
Several medications have been shown to be effective in treating trichotillomania. Fluoxetine, Aripiprazole, Olanzapine, and Risperidone are medications that have been used to treat cases of trichotillomania. This medication helps regulate chemicals in the brain to reduce symptoms of anxiety, depression, and other emotions that can trigger the act of pulling hair.
Step 4. Join a support group online or over the phone
If you can't directly access counseling, there are other resources you can access. The Trichotillomania Learning Center has many online support groups.
If you are in the US, Seven Counties Services, Inc. offers you free Trichotillomania standby line support. Call 800-221-0446
Part 6 of 6: Diagnosing the Disorder
Step 1. Monitor actions or reactions that signal this particular disorder
Trichotillomania is officially classified as an impulse control disorder, as is pyromania, kleptomania, and pathological gambling. If you have trichotillomania, you may act or react in certain ways when you pull your hair out, including:
- Chewing or eating pulled hair.
- Rub the pulled hair on the lips or face.
- Increased tension immediately before the hair is pulled or when resisting this behavior.
- Pleasure, satisfaction, or relief when pulling hair.
- Find yourself pulling hair without looking (this is called "automatic" or accidental pulling).
- Knowing you're pulling your hair out on purpose (this is called "focus" pulling).
- Use tweezers or other tools to pull out hair.
Step 2. Recognize the physical signs of this disorder
There are several signs that people with trichotillomania may display covertly, including:
- Visible hair loss caused by hair pulling behavior.
- Bald areas on the scalp or other areas of the body.
- Eyelashes or eyebrows are sparse or missing.
- Hair follicle infection.
Step 3. Notice if you have any other compulsive body problems
Some hair pullers may find themselves biting their nails, sucking their thumbs, banging their heads, and compulsively scraping or picking at the skin.
Record this behavior for a few days to see if it has become a habit. Pay attention to when you do it and how often you do it
Step 4. Notice if you have any other distractions
Determine if trichotillomania is the only disorder affecting you. Compulsive hair pulling can suffer from depression, obsessive-compulsive disorder, Tourette's disorder, bipolar disorder, phobias, personality disorders, and in some cases, show suicidal tendencies. See a doctor or mental health professional to determine if you have another disorder.
- However, determining what causes this disorder is difficult. Is hair loss causing depression through wanting to isolate yourself from other people and avoiding pleasurable activities because you feel very shy?
- Successful recovery of trichotillomania requires treatment for other accompanying disorders.
Step 5. Talk about hair loss with your doctor
A person who believes he or she has trichotillomania should be examined by a qualified doctor to rule out other hair follicle disorders. Some of these disorders include alopecia or tinea capitis which both cause hair loss. When your doctor examines you, he or she will look for evidence of hair breakage, curly hair, and other hair disorders as signs of trichotillomania.
Step 6. Understand that trichotillomania is a disorder
The first thing to realize is that this disorder (not something to be desired or not) is treatable. Disruptions arise as a result of your genetic structure, mood, and background. When these disorders occur, treatment is needed instead of more self-destructive actions.
Brain scans have shown that people with trichotillomania have different brains than those without the disorder
Step 7. Understand that this distraction is a form of self-harm
Don't convince yourself that there's nothing wrong with this; that hair pulling is a "normal" action. Trichotillomania can be considered a form of self-harm, although it is not expressed as other forms of self-harm. And like other forms of self-harm, trichotillomania can be addictive. Over time, this disorder becomes increasingly difficult to stop. That's why the best course of action is to get it under control as soon as possible.
