Trichotillomania is the uncontrollable desire to pull hair from the skin or hair from the eyebrows or other parts of the body. Pulling out your hair often leaves bald patches on the head, which can cause people with this disorder to feel the need to cover up. About 1% of the adult population shows symptoms of trichotillomania and the majority of those affected are women. This compulsive hair pulling tendency often begins in the early teens, but can show up later or at a younger age. When combined with depression, trichotillomania can lead to social and workplace difficulties. You may feel hopeless if you have this disorder, but it can be treated with great results.
Steps
Part 1 of 6: Identifying the Triggers
Step 1. Pay attention to when you pull your hair out
Consider in which situations you do this most often. Does it only happen to you when you are depressed? Angry? Confused? Frustrated? Understanding what triggers this compulsive behavior can help you find other, healthier ways of dealing with problems.
For two weeks, write down all the times you pull your hair out. Record what happened right before the event and how you felt
Step 2. Make a note of how you felt when you pulled your hair out
When trying to understand what triggers your disorder, try to identify what reinforces this behavior. If you pull your hair out when you are anxious, and this calms you down, the action finds a positive reinforcement in the feeling of relief. Write down how you felt during and immediately after the episode.
- Understanding this can help you cope with anxiety, as you can try another strategy that can make you feel relieved and avoid pulling your hair out.
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There are three different stages for those with trichotillomania. Not all patients go through every phase and you will find a description below:
- 1. You initially feel tension, accompanied by the desire to pull your hair out.
- 2. You start pulling your hair out. The feeling you get is very nice, a mixture of relief and excitement.
- 3. After pulling out your hair, you may feel guilt, remorse and shame. You might try to cover bald areas with bandanas, hats, wigs, etc. Eventually, however, your baldness will be evident to everyone and you will begin to hide. You may feel humiliated.
Cope with Trichotillomania Step 3 Step 3. Examine the hair you are pulling
Do you do this because you don't like a certain type of locks? For example, there are some people who compulsively pull their white hair out, because they find it unsightly and don't want to have it.
You can work on these kinds of triggers by reframing your perception of that hair. No hair is inherently harmful - they all have a function. Try to change your thinking to reduce the temptation to pull your hair out
Cope with Trichotillomania Step 4 Step 4. Consider the factors that influenced your childhood
The initial cause of trichotillomania can be genetic or environmental. Researchers have found similarities with the triggers of OCD and believe that chaotic and stressful experiences in childhood or unhealthy relationships with parents or caregivers may be at the root of this disorder.
One study showed that more than two-thirds of those suffering from this disorder had at least one traumatic experience in their life, and one-fifth of them were diagnosed with PTSD. This has led to speculation that hair pulling is a way to deal with these difficult situations
Cope with Trichotillomania Step 5 Step 5. Consider family history
When looking for the cause of your trichotillomania, find out if there is a history of hair problems, OCD, or anxiety problems in the family. The risks of developing trichotillomania are much higher if this problem has already occurred in the family in the past.
Part 2 of 6: Developing Strategies to Stop Pulling Your Hair
Cope with Trichotillomania Step 6 Step 1. Develop a plan to stop yourself
One of the strategies you can use is called "Notice, Stop and Choose". The plan is to notice when you feel like pulling out your hair, then stop the chain of thoughts and the temptation to do so with positive mental reminders. Then, you can choose to do something else that can relax and calm you down.
Cope with Trichotillomania Step 7 Step 2. Keep a journal or a chart of the episodes in which you pull your hair out
Thanks to your notes, you will be able to have a clearer idea of when the disorder occurs, its triggers and its impact. Record the date, time, place, number of hair you pulled out and the tool you used to do it. Also write down the thoughts and feelings you felt. This is a great way to get rid of shame and to express the impact the disorder has on your life.
When you count the hair you plucked, you will have a realistic idea of how much hair you are pulling out of your head; Does the result surprise you? How much time do you spend doing this? More than you thought?
Cope with Trichotillomania Step 8 Step 3. Express your emotions in an alternative way
Once you've identified the warning signs and triggers, make a list of what you can do rather than pull your hair out. Whatever the alternatives, they should be simple and easy to access. Here are some tips for expressing your emotions and feelings differently:
- Clarify your ideas for a few minutes;
- Draw or scribble on paper;
- Paint;
- Listen to music in line with your emotions;
- Call a friend;
- Volunteer;
- Clean the house;
- Play video games.
Cope with Trichotillomania Step 9 Step 4. Try a physical reminder to be able to stop yourself
If you pull your hair out unintentionally, you may need a physical reminder to avoid doing it. As a physical barrier, you can try wearing a wrist weight or rubber glove on the hand you use to pull your hair out.
You could also post sticky notes in places where you have a tendency to pull your hair out more often. They can also act as physical reminders
Cope with Trichotillomania Step 10 Step 5. Step away from the triggers
While it's probably not possible to eliminate all the triggers that make you pull your hair out, you could at least reduce your exposure to them. Is your girlfriend the cause of many of the episodes? Maybe you should reconsider your relationship. Is the stress caused by your boss? Maybe you should find a new job.
Of course, for many people the triggers are not easy to spot or not avoidable; Often the causes of trichotillomania are school changes, abuse, breakthroughs in one's sexuality, family conflict, the death of a parent, or even hormonal changes that occur in puberty. It is very difficult, if not impossible, to get away from these factors. If that's the case, keep working to accept yourself by changing your habits and finding help from people close to you to deal with your condition
Cope with Trichotillomania Step 11 Step 6. Reduce itching or strange sensations in the head
Use a natural oil to moisturize the follicles and reduce itching, but especially get used to stroking and combing your hair instead of pulling and pulling it. Make sure you are using a completely natural product, such as a mix of essential oils and castor oil. Never use chemicals.
- Pay close attention to products that promise a quick solution to your problem. You shouldn't trust treatments that ensure results or instant cures, because there is no one-day cure for trichotillomania.
- You can ask your doctor for a prescription for an anesthetic head cream. This can help if one of the triggers is an "itch" or a strange sensation in the head. In the case study of a 16-year-old girl, it was found that the temporary use of an anesthetic cream, in combination with psychotherapy, led to the cessation of the habit of pulling her hair.
Part 3 of 6: Improving Self-Esteem and Self-Acceptance
Cope with Trichotillomania Step 12 Step 1. Think about the present
Often, you will pull your hair out when you are unwilling to accept negative emotions or unpleasant feelings. Use mindful meditation techniques to better accept these emotions as a natural part of the human experience. They don't necessarily have to be avoided. If you keep the need to avoid discomfort in check, you will be able to pull out your hair less.
Try this exercise to raise your awareness: sit in a quiet and comfortable place. Take deep breaths. Inhale for a count of four, hold your breath for a count of four, then do the same as you exhale. As you continue to breathe, your mind will likely begin to wander. Recognize these thoughts without judging them and let them go. Bring your attention back to your breath
Cope with Trichotillomania Step 13 Step 2. Increase your self-esteem
Many people with this disorder are not very confident or have low self-esteem. To accept yourself more and have more confidence, use ACT (Acceptance and Commitment Therapy), a therapeutic approach. This therapy can help you have clearer values and focus on your life goals. Building your self-esteem is an important part of recovery.
Remember, you are a unique and wonderful person. You are loved and your life is most precious. It doesn't matter what you hear from others: you should love yourself
Cope with Trichotillomania Step 14 Step 3. Replace negative thoughts with positive ones
Negative thoughts can reduce your self-esteem and make you tempted to pull your hair. Pessimistic thoughts, fear of failure, and other negative thoughts will lead you to believe that you are not up to it. Change these mental habits to increase your confidence. Here are some examples of how you can change the way you think about yourself:
- For example, if you thought, "I have nothing interesting to say, so I understand why people think I am pathetic," you should work hard to correct those feelings. Tell yourself, "Sometimes I don't have much to say, but that's okay. I'm not responsible for other people's enjoyment and it's not just me who has to carry on the conversations."
- Replace critical thoughts with productive thoughts. Here is an example of self-explanatory criticism: "I'm never going to dinner with them. Last time I felt so embarrassed after my misplaced comment. I'm so stupid." Replace it with a productive thought: "The last time we all dined together I felt really embarrassed, but I know that making mistakes is normal. I'm not stupid. I just made a mistake in good faith."
- As you practice recognizing these thoughts and changing them, you will notice an increase in self-esteem and confidence.
Cope with Trichotillomania Step 15 Step 4. Write down your strengths and successes
This is another way to accept your emotions and build self-esteem. Review this list often.
If you can't find anything to put on the list, talk to a trusted friend or family member, asking them to help you come up with ideas. Don't overlook any results, not even the smallest ones. Keep updating the list as time goes on
Cope with Trichotillomania Step 16 Step 5. Learn to assertively communicate with other people
Practicing assertiveness can help you overcome situations in which you feel challenged by others. Eg:
- Learn to say no. If people ask you requests that you don't want to fulfill, state your needs by saying no.
- Don't be too accommodating. Don't do things just to get someone's approval. Find out what's really important to you. Ask what you want.
- Use first-person affirmations. These affirmations help you take responsibility for emotions and reactions. For example, instead of saying "You never listen to me", you could say, "I feel ignored when you look at the phone while we talk."
Part 4 of 6: Reduce Stress
Cope with Trichotillomania Step 17 Step 1. Eliminate some of the sources of stress
Many people notice that stress triggers the desire to pull their hair out. Do what you can to reduce stress and learn how to manage it by adopting better techniques.
Write a list of the things that stress you out. It can be important things, like money and work, or small things, like long lines at the supermarket checkout. While you can't avoid all stressors, you can minimize your exposure to some of them
Cope with Trichotillomania Step 18 Step 2. Relax your muscles with the progressive muscle relaxation technique
It will help you reduce stress. This type of relaxation releases muscle tension and tells the body to begin to relax. By contracting and releasing your muscles, you can slowly regain your calm.
- Contract the muscles for six seconds, then release the tension for six seconds. Pay close attention to the relaxation of each muscle.
- Start from the head and work your way up to your toes to relax your whole body.
Cope with Trichotillomania Step 19 Step 3. Try meditation
It can be very helpful in reducing stress. Meditating on a regular schedule, even for just 10 minutes a day, can help you clear your mind and focus your energy on positive activities.
To meditate, find a quiet place to sit or lie down. Start breathing deeply and slowly. You could even try guided visualization, which involves imagining a peaceful place like a beach, stream, or wood
Cope with Trichotillomania Step 20 Step 4. Get enough sleep
Make sure you sleep on a regular schedule and get enough sleep every night. Try to get at least seven to eight hours of sleep a night.
If you have trouble falling asleep, try listening to relaxing music. Avoid looking at any screen for at least 15 minutes before bed
Cope with Trichotillomania Step 21 Step 5. Try physical activity
Studies have shown that it is possible to greatly reduce stress with a regular exercise program. Your body will increase the production of endorphins, which will make you feel more positive.
You don't need to run for an hour a day. You can do other activities that you enjoy the most. Try yoga, martial arts or whatever you prefer. Even gardening can give you more energy
Part 5 of 6: Finding Help
Cope with Trichotillomania Step 22 Step 1. Talk to a trusted friend or family member
Talk about your condition with someone you trust. If you can't talk about it, write a letter or email. If you are afraid to talk about your difficulties with the disease, at least talk about your feelings.
- You may also be warning family and friends about what triggers your problem is. This way, they will be able to remind you when you run the risk of pulling your hair out. They can also help you find alternative behavior.
- Ask friends and family to give you positive reinforcement when they see you adopting healthy alternatives to your problem.
Cope with Trichotillomania Step 23 Step 2. Consult a mental health professional
A counselor can help you find ways to cope, overcome depression, and other issues that may be contributing to your self-harming behavior.
- If the first psychologist you talk to can't help you, find another one. You are not tied to a single professional. It is important to find a person you feel a connection with and who gives you the impression that they are helpful.
- Types of therapy that can help you include behavior therapy (especially habit control training), psychotherapy, psychodynamic psychotherapy, hypnotherapy, cognitive-behavioral psychology, and antidepressant medications.
Cope with Trichotillomania Step 24 Step 3. Ask your doctor about drug therapies
Many drugs have been shown to be effective in treating trichotillomania. Fluoxetine, Aripiprazole, Olanzapine and Risperidone are the most commonly used drugs. They help regulate the chemical reactions of the brain and reduce the symptoms of anxiety, depression, and other emotions that can lead to hair pulling.
Cope with Trichotillomania Step 25 Step 4. Consult a support group online or by phone
If you don't have the opportunity to meet a psychologist, you can take advantage of other resources. The Trichotillomania Learning Center, for example, offers online support groups (in English).
Unfortunately, in Italy there is no support number for those suffering from trichotillomania. However, if you are in the United States, you could call the free number offered by Seven Counties Services, Inc.: 800-221-0446
Part 6 of 6: Diagnosing Trichotillomania
Cope with Trichotillomania Step 26 Step 1. Pay attention to certain actions or reactions that may be symptoms of this disorder
Trichotillomania is officially classified as an impulse control disorder, such as pyromania, kleptomania and the pathological tendency to gambling. If you suffer from trichotillomania, you may act or react in a few ways when you pull your hair out, including:
- Chewing or eating your torn hair
- Rub the torn hair on the lips or face;
- A feeling of increasing tension that precedes hair pulling or trying to resist temptation;
- Pleasure, gratification, or relief at the time of the tear;
- Notice that you pull your hair out without realizing it ("automatic" or involuntary pulling);
- Awareness of pulling your hair voluntarily ("concentrated" pull);
- Use tweezers or other tools to pull out the hair.
Cope with Trichotillomania Step 27 Step 2. Learn to recognize the physical symptoms of the disorder
There are some signs that a person is suffering from trichotillomania. These include:
- Visible hair loss caused by continuous pulling;
- Patchy bald patches on the skin or other areas of the body
- Missing or sparse eyebrows or eyelashes
- Infected hair follicles.
Cope with Trichotillomania Step 28 Step 3. See if you have any other compulsive problems
Some people who pull their hair also notice that they are compulsively biting their nails, sucking their thumbs, banging their heads, and scratching.
Take note of these behaviors over the course of several days to see if they are habitual. Notice when they happen and how often
Cope with Trichotillomania Step 29 Step 4. Evaluate if you have any other ailments
Try to understand if trichotillomania is the only ailment that afflicts you. Compulsive hair pulling can suffer from depression, OCD, Tourette's syndrome, bipolar disorder, phobias, personality disorders, and in some cases, suicidal tendencies. Consult your doctor or psychologist to determine if you have any other medical conditions.
- It is difficult to establish the right cause and effect relationships between disorders. Does hair loss make you depressed and do you feel the desire to isolate yourself from others, avoiding fun activities, for the deep shame you feel?
- Often, in order to successfully recover from trichotillomania, it is also necessary to treat all coexisting disorders.
Cope with Trichotillomania Step 30 Step 5. Ask your doctor about ailments that cause hair loss
Those who believe they have trichotillomania should undergo a specialist examination to rule out other follicular problems. There are other disorders that cause hair loss, such as alopecia and ringworm. Your doctor will examine you for signs of unevenly broken hair, curling hair, and other abnormalities.
Cope with Trichotillomania Step 31 Step 6. Remember that trichotillomania is an obsessive-compulsive behavior disorder
The first thing you need to understand is that it is treatable; it is a pathology, not a problem of willpower. The disorder stems from your personal history, your genetic background and your mood. When it shows up, all you have to do is heal yourself, it's not something to get down on.
Studies on the brain have shown that those with trichotillomania have a different brain than those without the disorder
Cope with Trichotillomania Step 32 Step 7. Understand that trichotillomania is a form of self-harm
Don't convince yourself that everything is fine and that pulling your hair out is "normal". This disorder can be considered a form of self-harm, even if it is not as well known as others; as such, it can become addictive behavior. Over time, it will become increasingly difficult to stop it; that's why it's best to get treated as soon as possible.
