Approximately 1 in 20 people struggle with a compulsive pulling, picking, or biting disorder like trichotillomania (hair pulling), dermatillomania (skin picking), or onychophagia (nail biting). These BFRBs are listed under the “Obsessive-Compulsive and Related Disorders” heading in the DSM-5.
COVID-19 has had an impact on everyone. It has affected people’s mental, emotional, physical, social, sexual, financial, and spiritual lives. This year has been filled with ups-and-downs, uncertainties, sickness, loss and heartbreak, financial hardship, and social isolation. It is enough to cause anyone to struggle with anxiety, but even more so people with mental health conditions like trichotillomania (hair pulling disorder).
In this month’s TrichStop.com webinar with Dr. Vladimir Miletic, he talks about meaning and how meaning applies to therapy for compulsive hair pulling from the perspectives of George Kelly and Paul Watzlawick. In addition to talking about meaning, he describes the therapeutic process by describing his work with a TrichStop.com client. The full webinar is available on YouTube.
Every Person is a Scientist
Dr. Miletic’s discussion on meaning highlighted the work of George Kelly. For those unfamiliar with Kelly, he expanded on Freud’s approach to mental health by changing the premise. Freud’s psychoanalytic approach included a therapist interpreting what was going on with a client in an authoritative manner. However, how would a therapist know what a client experiences? There are myriad influences on a person’s thoughts, feelings, and behaviors, and there is no way for a therapist to know enough about this to be an accurate interpreter.
Internet therapy can be as effective, if not more effective than face-to-face therapy with the added bonus that it costs less.
The COVID-19 crisis and subsequent stay-at-home orders have caused numerous life disruptions, with people forced to switch to internet-based therapy. Many mental health providers agree that in-person therapy is by far the best because interpersonal contact is crucial for developing a trusting therapeutic relationship, but new research suggests that internet therapy is just as effective.
Everyone has a different experience with trichotillomania, and everyone has a different pathway to recovery. Some people do well by training themselves out of behavior patterns, while others require a new perspective. One person, who struggles with trich asked the question, “How would you feel if you were made to pull out someone else’s hair?”
The following are some excerpts from Latent Expressions by Incognito.
“Think about it rationally. How would you feel if you were made to pull out someone else’s hair? Would you like it? Would you feel pleasure in that? Imagine someone close to you. Your loved one – partner, spouse, parent, child – anyone who is close to you. Can you pull out their hair to feel better? You cannot.”
“…you cannot pull out someone else’s hair. Because you know it will be painful for them. Also, you won’t feel that pleasure that you feel when you pull out your hair. That’s precisely the problem then, I guess. I feel pleasure in something that I should feel pain in.”
Managing Trichotillomania, Anxiety and Isolation during the COVID-19 outbreakThe webinar will take place on Thursday, April 9, 18:00 PM EST (US Eastern Time)
Webinar will last about 1 - 1.5 hours (depending on the length of the Q&A), with a 45-minute presentation and about 15-45 minutes Q&A time, where we can discuss anything you might be curious about. All participants will get handouts and links to additional resources.
Isolation is a hallmark symptom of trichotillomania. People who pull don’t want to be seen because they don’t want anyone to notice how their hairline is different or that they no longer have eyebrows. In therapy, we encourage people with trich to get social support. Now everyone has to isolate.
The pandemic of anxiety
Governments around the world are locking down their countries, states, and cities. It’s bad enough that a super contagious silent virus prowls the air, but now we have to adjust to a new way of doing things by staying home.
Therapists call changes in lifestyle like moving or a relationship change a “significant life event” that contributes to very high stress levels. Often these stress levels go unnoticed because people view these events as “normal.” The COVID-19 pandemic sandwiches two very high stress level significant life events: threat of disease and a complete shutdown of life.
Compulsive hair pulling can be difficult to identify in children. It causes frustration, embarrassment, and shame not only for the child but also for the parent.
When does it start?
The typical age of onset for trichotillomania in children tends to coincide with the onset of puberty. Since the internal hormonal changes can be difficult to detect, a child could start puberty as early as 8 years old, which is why the typical age of onset for trich tends to be between ages 9 and 13. Some research links trichotillomania onset and severity with sex hormones, especially in girls which means the changing levels of estrogen, progesterone, and adrenocorticotropic hormone can create an environment ripe for developing trich or other BFRBs.
Anecdotal evidence suggests that trich follows a fairly predictable course over one’s lifetime. Most symptoms start around middle to late childhood with the onset of puberty and increases in severity during adolescence and twenties. However, most people experience lower symptom severity in their 30s and 40s. The changes later in life may result from a variety of factors including changing hormones, improved sense of self or learning to manage pulling behaviors through therapy. However, neurology points to something else.
One of the first things that occur in therapy for trichotillomania involves increasing awareness about pulling behaviors. The goal is to help a person become more aware of the triggers, both internal and external, that get the behaviors started. Once those triggers become known, then the person can make an informed choice about whether to pull or do something else.
This summary is a simplistic view of the beginning stages of habit reversal therapy, which is one of the most widely used evidence-based therapeutic interventions for trich. However, sometimes it is not as easy as identifying triggers.
Online Test for Trichotillomania
Find Out The Severity of Your Hair Pulling With This Free Online Test