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What’s it like to compulsively pull out your hair?


trichotillomania
Photo: Freestocks.org/Pexels

There are approximately 200,000 cases of trichotillomania—an impulse control disorder defined by the compulsive desire to pull out one’s hair (be it from your head, your arms, even your eyelashes)—in the US every year alone. And yet, most people have never even heard of it. What’s it like to live with trichotillomania? Kera Bolonik, a writer and executive editor of DAME Magazine who has struggled with the disorder, shares her story.

It started with one strand and a mindless twirl at my school desk. I hadn’t meant to pull out my hair, but there it was, in between my index and middle fingers of my right hand, diverting my focus from my two snickering sixth-grade classmates and my language arts teacher’s homework announcement.

I examined it, the long, straight, mousy-brown hair with its grayish-white follicle dabbed at the end. It was at once repulsive and fascinating—I knew it was weird, what I’d done, so I stuffed it in my pocket. But a few minutes later, I pulled out another from near my forehead. It stung a little, but then it didn’t, because now my attention was completely trained on the oily follicle, which I worried was a louse egg. I’d never had lice, never even seen it before, but I thought if anyone in this classroom would get it, it’d be me.

“I hadn’t meant to pull out my hair, but there it was, in between my index and middle fingers of my right hand.”

I was the new kid at school and was out of my depths, completely unaware of the inner workings of the social strata there. My family had moved a mere two miles from our working-class Chicago neighborhood, but this upper-middle-class suburb felt many worlds away. Two months into the school year and I had almost no friends, my parents were fighting over money, I definitely wasn’t wearing the right clothes, and was secretly tormented by the growing awareness that I had crushes on other girls. So I must have been a misfit. I kept my eyes peeled for lice.

My mother checked my scalp—I was nit-free. Those white bits, she said, weren’t eggs, they were follicles. But still, I picked and pulled. First it was two hairs at a time. Then a few more. After a couple of weeks, I didn’t even realize I was doing it until I accidentally grabbed a full clump. I knew I’d crossed a line. I’d excused myself from class to go to the bathroom to dispose of the hair, but not before examining the follicles.

“Then I looked in the mirror and noticed I had a long bald patch down the middle of my head, like a middle-aged man.”

Except that there were fewer of them. The hair was breaking at the root. Then I looked in the mirror and noticed I had a long bald patch down the middle of my head, like a middle-aged man. There’s a word for what was happening, I didn’t know it then: I’d developed trichotillomania—a hair-pulling disorder, a body-focused repetitive behavior (BFRB) that one or two in 50 people may experience in their lifetime. It’s often brought on by stress, tends to present equally in females and males in adolescents, but by adulthood, 80 to 90 percent of reported cases of trichotillomania are women. It can be chronic and lead to tissue damage and infection if it goes untreated.

I pushed my hair over to the side, like a combover, and returned to my desk. I tried to stifle the urge to pull out more. I started pulling hair discreetly from the back of my head, which hurt until it didn’t—I found the pain narcotizing, hypnotic even. As I thought about the next tug, the next strand examination, I wasn’t thinking about the girls at the lockers who were snubbing me or telling me I was a loser. Or my parents yelling at each other or at me. Or that I was questioning my sexuality. Or that I felt my body was getting far ahead of me. Or the fact that the more I was yanking my hair out, the more I was sealing my fate as a misfit, low-hanging fruit for the meanest kids in my class. I just focused on the follicle.

“I wasn’t thinking about the girls at the lockers who were snubbing me or telling me I was a loser. I just focused on the follicle.”

My parents finally awakened from their stress-trance and noticed my hairline resembled Neil Young’s. My mother’s initial response was anger, driven by fear. It was 1982, and we didn’t have “trichotillomania” or obsessive-compulsive disorder in our lexicon just yet, so she sought out her hairdresser, a family friend. She wanted him to put the fear of God into me. Which he did, with kindness. He appealed to what little vanity I had when he made me look at myself in the mirror, told me I had beautiful hair, and warned that if I continued, my follicles would weaken and I’d be left with bald spots. I suspect there was some truth to that; it hardly mattered, the terror alone was enough motivation. But the promise he made to cut and color my hair after it grew out made it even more enticing.

I tried. It got a little easier every day. I developed a new obsession to ensure that I hadn’t permanently ruined my hair: I dutifully watched it grow back and fill in. It didn’t make me less neurotic, but I never tugged at my scalp again.

Struggling with something similar? Here’s how to help your hair grow back. And while we’re being honest, let’s talk about high-functioning depression.