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.” 

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.  

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.

Good old-fashioned psychotherapy remains the most effective treatment for trichotillomania. A recently published evaluation of the research suggests that pharmacological treatments lag behind behavioral and cognitive-behavioral therapies.  

The Research Says

A meta-analysis looks at all the available research conducted within a subject area to determine if broader conclusions can be made. In the case of this meta-analysis, the researchers looked for psychological and pharmacological interventions for trichotillomania used with children under age 18. Although they found 129 studies conducted, only 6 met the criteria of being a well-designed study.