Trichotillomania

Hair Pulling Strategies

Trichotillomania (TTM) is a chronic hair-pulling disorder that can cause interference in daily functioning. TTM is characterized by the inability to resist repetitive urges to pull out your own hair.  Some common pulling sites include the scalp, eyebrows, eyelids or other areas of the body and can vary over time. TTM sufferers experience a great deal of distress with the observable hair loss, which can lead to avoiding many daily activities including dating, work, and haircuts. For some the pulling sensation relieves discomfort or feels interesting/pleasant, while for others pulling their hair is merely based on the way certain hairs feel-- coarse, thick, or curly. Common co-occurring conditions include depression, obsessive compulsive disorder (OCD), other anxiety disorders, and other body-focused repetitive behaviors.

The most important step in the treatment/recovery process is identify and becoming extremely aware of the factors “leading up to pulling, during pulling, and following pulling.” Building awareness of one’s triggers is key so that you can then address those emotional, behavioural, and sensory needs in ways other than pulling. Pulling behavior often canbecome less conscious and more automatic, sometimes hair pulling can go unnoticed until damage has occurred.

WHAT ARE SOME COMMON HAIR PULLING TRIGGERS?

TTM sufferers can be triggered by specific feelings, situations, and thoughts. Triggers can be internal to the person or external.

INTERNAL TRIGGERS:

1.  Emotions such as frustration, impatience, boredom, and excitement. Pulling can be triggered by both negative and positive emotion.

2.  Your physical state, such as being tired, hungry, or sick.

3.  Negative and perfectionistic thinking about oneself and one’s achievements. (Ex: Being hard on yourself for not being a straight A student).

4. Negative thoughts about pulling and one’s ability to stop can also lead one into a cycle of more pulling (“I pulled a few hair. It’s no use, I can’t stop so why try”). Also, setting oneself up for failure by setting unachievable goals or expectations (i.e., “I will not pull today”). When you’re unable to stick to your goal it can lead to increased pulling or something called “pulling binges.”

5. Sensory sensations around the common pulling areas (itching, burning, tightening feeling).

EXTERNAL TRIGGERS

1.  Being in certain stressful situations (Ex: math test, work meeting, waiting on line).

2.  Being in boring situations or engaging in monotonous tasks

3.  Pulling can be connected to certain times of day or situations (Pulling at night in bed, in bathroom or car when you have privacy, watching TV, being on computer).

4.  Being around particular people who cause you discomfort in some way

5.  Sitting in certain chairs where pulling is easier because your hand is closer to your face.

TIPS TO DECREASE PULLING

· Identify your specific triggers: tactile, emotional/physiological, and environmental. Develop strategies that directly match the trigger.

· Tactile: keep your hands busy- playing or using stress balls, string, fury or different brush bristle can help satisfy restless hands

· Finding soothing sensory activities can also replace and alleviate pulling urges. Similar to tactile, products that might stimulate or invigorate the senses such as a shampoo that tingles your scalp, ice or cold water, chew gum, stroking your face with a soft cosmetic brush are a few examples.  

· For the “less conscious and more automatic” pulling you can try wrapping or bandaging your fingers or hands or even wear light cotton gloves. Other preventative techniques include using hand cream continuously throughout the day, wearing a hat or towel, using face cream for eyes and eyelids, etc.

· If you have identified triggers in your environment, there are some simple tweaks to consider. Rearrange your seating or dim the lights, use different areas of your home for grooming purposes (i.e. put your make-up on in a different room or use a different bathroom)

· Address the emotional triggers. For example, if boredom at night increases urges, then develop a nightly habit of an interesting hobby or activity (puzzles, new hobby etc.).

· For anxiety and stress, try journaling, organizing yourself, use a weekly schedule, take up yoga or other suitable exercising, meditation, talk to a friend or see a therapist.

· Work on your perfectionistic tendencies and learn to ease up on yourself (decrease the urge to criticize and judge “You”)