Surviving BFRBs in College

Although trichotillomania seems to be more common in children than adults, severity of presentation appears to be higher in adolescence and prognosis becoming poorer as onset age approaches adulthood. This means that adolescent to young adult sufferers usually has a more long-lasting form of the disorder and do not respond as well to treatment. The transition between adolescence and being a young adult is a very stressful time as there are many life stage transitions that occur during this period, one of them being the transition into college. This can be particularly stressful if you are moving away from home to attend college and are living in shared accommodation such as a dorm environment.  These sentiments were shared by a trichotillomania learning centre (TLC) member and DC areas trich support group facilitator, Ellen. In this post Ellen, who suffered from trich for many years and from a young age, shared her personal experiences of being a hair puller in college and offers some advice to others going through the same thing. Although posted a few years ago now, it is still very relevant today, so here is a roundup of some of the advice from Ellen as well as other sources:

Stand up for your rights

This is possibly the most difficult one to observe as most people with trichotillomania already struggle with low self esteem and anxiety, but is important that as a trich sufferer you do not have to endure the added burden of having being ostracised because hair pulling. Trichotillomania is a recognised clinical disorder, and like any other mental illness, has disabling consequences for the sufferer. And like any disability, it is your fundamental right to be accommodated in your school or work environment. It is also every person’s right not to have to deal with bullying and ridicule from others, so if you are being teased or ill-treated because of your hair pulling, it is important that you recognize this as an infringement on you human rights. As Ellen describes, “…if you are willing to do the work and stand up for yourself, you may discover a pool of support systems designed to help. Students attending an institution receiving federal funds are required to comply with Section 504, which is a federal law designed to protect the rights of individuals with disabilities in these institutions. Section 504 provides: "No otherwise qualified individual with a disability in the United States . . . shall, solely by reason of her or his disability, be excluded from the participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance . . . ." (US Department of Education). As such, every college is required to have an office for students with disabilities.

Be proactive

Recognizing the potential obstacles and challenges you may face being a compulsive hair puller in college is important, but even more important is then taking proactive steps to put strategies or support systems in place to help you overcome these. As such one of your first tasks when you first arrive at college should be to locate and visit the office for students with disabilities. To be protected under Section 504 mentioned above a student must be determined to: (1) have a physical or mental impairment that substantially limits one or more major life activities; or (2) have a record of such an impairment; or (3) be regarded as having such an impairment. Section 504 requires that school districts provide a free appropriate public education (FAPE) to qualified students in their jurisdictions who have a physical or mental impairment that substantially limits one or more major life activities. The difficulty for many of course would be the majority of compulsive hair pullers are un-diagnosed. There is still a vast lack of awareness of this condition and coupled with the intense shame and guilt that comes with the behavior, leads to sufferers often not seeking medical help and therefore never being diagnosed. However, diagnosis and seeking support is a fundamental aspect of managing trich. Therefore it is recommended, if hair pulling impacts negatively on your functioning that you seek help and have a diagnosis so you may gain access to help should it be required while you are at college.

Student Health Center/Counseling Services

Continuing on from the previous tip about seeking help and support, your college most likely has a low cost or no cost health center which should include counseling and therapy. Although it is not likely there will be professionals with expertise in body-focussed repetitite disorders, and the service most likely is mainly geared toward more acute crises, it is important that you make contact with the service and familiarize yourself with theor processes. Ellen mad a great suggestion that if the staff at the health centre do not know anything about trichotillomania, why not take them some literature such as brochures, which you can obtain from TLC. There’s a good chance there are others like you suffering with a BFRB of some sort at your college so helping the staff become more knowledgeable will be a benefit for everyone in the long run. Access to counsellors who are familiar with your condition can be a tremendous asset when you are going through additional stressors or pressures such as exam stress or anxiety.

Identify your triggers

Every person experiences compulsive hair pulling in their own unique way, so different people have different triggers. Triggers are situations or environments that either elicits the urge to pull hair, or signals to your brain that it is now okay to pull. It is important that you develop an awareness of these triggers so you can be proactive in either avoiding or controlling them to reduce the likelihood of pulling urges from occurring. For example if you find that you always pick when you are alone, but never when in the company of others, and that the stress of exams or the passivity of studying triggers the urge to pull, a stimulus control could be to make sure you always study in the company of others such as the library of a study group.

Finding balance

This is one of those tips that is really great advice for everyone, but is really much harder said than done. The amount of work in college can be overwhelming and you may find that you don’t have much time to pursue any other passions. For many college is a time to party and enjoy your independent youth, but work hard, party hard does not a balanced lifestyle make. It is critical that you get enough rest and sleep and take care of your body’s nutritional needs as the added strain of a tired unhealthy body can be a huge trigger for increased pulling behaviors. Remember your other passions too. One of the strategies employed in cognitive behavioral therapy treatment for BFRBs is the identification of activities that give you a similar reward as pulling does. For example if pulling is your response to stress, but you also find exercise and high impact activities exhilarating and stress-relieving then it is important that you engage in these enjoyable activities as often as you can. Similarly you may find yoga or socializing with friends relaxing, then make time for these meaningful pursuits.