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Hair pulling: a secret compulsion

  For Yvonne, it began with a single stray eyebrow hair.

She was 14 when the girls in class started to tweeze their brows into fashionable arches. She remembers plucking that first wayward hair. The next thing she knew, the bathroom counter was covered in tiny brown hairs, and all that remained of her eyebrows were bald red welts.

She felt shocked and disgusted, but mostly disappointed there were no brow hairs left to pull.

Soon went the eyelashes. Then her fingers crept to her scalp.

Yvonne asked that her last name not be used. Today, at 47, the Bellevue woman wears a full wig and artfully applied eye makeup to hide her secret: It's called trichotillomania.

Experts say compulsive hair pulling, or "trich," is one of the most shrouded, least understood psychological disorders. It's thought to affect 1.5 to 3.5 percent of people — more often women — at some point in their lives. For some, especially young children, it's a passing bad habit; for others, it's a lifelong struggle.

The Trichotillomania Learning Center will hold its annual trich retreat in Auburn Sept. 8-11, 2005. For more information, visit: trich.org, e-mail info@trich.org or call 831-457-1004

This goes far beyond overzealous bikini waxes and snapping out grays. These are people who are overwhelmed by the urge to pull out strand after strand of hair, usually from the head or face, until significant patches are missing. The word trichotillomania (trick-oh-till-oh-mania) literally means "hair-pulling frenzy."

Little research has been done in the area, and many doctors and therapists are treating by trial and error. "It's where anorexia was in the '60s or '70s," says David Kosins, a Seattle psychologist who's worked with dozens of pullers.

But there are signs trich is coming out of the closet. Last month, scientists, psychologists and advocates convened at the National Institute of Mental Health to share notes on the disorder. Web sites with names like www.StopPulling.com have popped up. And in the November issue of GQ, actor Colin Farrell admitted to being "a hair puller-outer."

Seattle receptionist Alyssa, 24, has been pulling from her scalp since she was 14. The worst thing about the palm-sized bald patch that she covers with a wide headband, she says, is that she did it to herself and doesn't know why.

That's what makes the behavior so baffling. Why would anyone want to pull out their hair? When a typical person tugs out a strand of hair, it smarts.

But for people with trich, "it fills some need that's not easy for the rest of us to understand," says Charles Mansueto, a psychologist who specializes in trichotillomania around Washington, D.C.

Alyssa says pulling soothes her when she's stressed and occupies her fingers when she's bored.

Five-year-old Julie, of Mukilteo, who plucked herself bald in the first months of kindergarten, doesn't even know she's doing it. She absentmindedly tugs her hair then rolls it into cocoons between her fingertips as she watches TV or lies in bed. It seems to calm her, the way thumb-sucking does other kids, says her mom.

Others, like Yvonne, report intense pleasure from pulling. She grows mesmerized looking at the roots and often nibbles on the hair. (About a quarter of pullers do something oral with the hair, like rub it on their lips or chew on it.) The craving has left her with only a Friar Tuck fringe under her shag wig.

A recovering alcoholic, Yvonne compares trich to a fierce addiction. She hasn't had a drink in 11 years but is unable to stop pulling.

A "behavioral prison"

Christina Pearson, who heads the Trichotillomania Learning Center in Santa Cruz, Calif., calls the condition a "behavioral prison."

"The conscious part of me was trying to stop but all the while my body felt like it was doing what it needed."

For many, the consequences go well beyond the cosmetic, she says. Some feel helpless, out of control, consumed by shame and ever fearful that a gust of wind will expose their secret. They avoid mirrors, skip swimming and boating and push away loved ones for fear that they'll be deemed crazy.

The impulse to pull often begins around puberty and multiplies teenage self-consciousness a hundredfold.

"The depression, anxiety and self-imposed social isolation can spoil a person's experience of life," says Mansueto.

In the psychiatrist's standard handbook, trich falls in the catchall category "impulse-control disorders not elsewhere classified" along with kleptomania, pyromania and pathological gambling.

At the trich meeting last month, most experts agreed the disorder doesn't belong in that chapter. Some think it's closer to an anxiety disorder — a cousin of obsessive-compulsive disorder. Some think it's a kind of tic like Tourette's syndrome.

Others think it belongs in a new category called body-focused repetitive disorders that would include compulsive nail biting and extreme skin picking. No, this doesn't mean the occasional blemish popper has a psychiatric diagnosis.

"We've all got these nervous habits we do, like nibbling the rough edges of nails, but we're usually able to disengage from it," explains Craig Sawchuk, a clinical psychologist at the University of Washington who specializes in anxiety disorders. "But for some people the habit seems to take on an energy and momentum of its own, and they just cannot stop themselves from doing harm."

Therapy can weaken urge

Alyssa was in college when she learned there was a name for her secret urge. She searched the Internet for hair pulling and found the Trichotillomania Learning Center. "For the first time in my life, I cried with relief, here was proof it was something; other people did this, too, I wasn't just a freak," she says.

Then it hit her. She had a psychological disorder — one without a cure. And all the research told her something she already knew, quitting was extremely difficult. Six years later, she feels better about herself and isn't so ashamed. But she still pulls.

Studies of a variety of antidepressants show mixed results in reducing hair pulling. None have been effective for large numbers of people. Kosins, a therapist who leads a trich support group, says antidepressants can reduce anxiety or motivate people to make changes, but the drugs don't get to the bottom of the behavior.

For now, standard treatment is cognitive-behavioral therapy, which focuses on practical steps to change habits, says UW's Sawchuk, who also uses the technique for nail-biters and skin-pickers.

Patients are taught to recognize triggers that cause them to pull, things like creeping anxiety or boredom or being stuck in traffic. They may be instructed to wear gloves, a jangly bracelet or Band-Aids on their fingers so they're aware when they start to pull. Then they're trained to substitute another behavior for pulling, like squeezing a stress ball, twirling a piece of string or a routine of muscle relaxation.

The approach is different for the youngest pullers, like kindergartner Julie, from Mukilteo. First, Mansueto urges parents not to panic and not to punish — that will only make things worse. It's not always a sign of some deep-seated problem, and small children often outgrow it. Instead, parents should make sure the child always has a soft blanket or favorite object at her fingertips at times she's likely to pull. Julie, for instance, has permission to keep her blanket at her school desk, which seems to help.

"Over time, we starve the habit and weaken their urges," says Mansueto, whose steps for treating trich have been published. The problem is there are few therapists who specialize in treating the disorder, he says. And it's no quick fix; it can take three weeks or six months for some and a lifetime for others to quit pulling.

Pearson spent more than 15 years trying biofeedback, hypnotherapy, medication and cognitive-behavioral therapy before she stopped pulling. She still feels the urge but can finally control it with relaxation exercises.

Yvonne has tried some of the methods, such as driving gloves or little stop signs placed in areas of her home where she usually pulls. But for more than three decades, she's never been able to stop pulling for longer than a few weeks. "I just don't put the gloves on," she says, twirling the wig at the nape of her neck. "I guess there's a part of me that doesn't want to stop, a part of me that just needs to pull."