The Urge to Pull

When most people say, “I want to pull my hair out!” it is associated with frustration.  For some, it is not a saying to illustrate their frustration; it’s an uncontrollable urge they cannot ignore. If you or someone you care about is suffering from trichotillomania or dermatillomania, you may be looking for answers - What it is, if it’s a real disorder or not, what causes it, and what's the treatment.   First, you should know that whether you’re a loved one or someone suffering from either of these, you are not alone.  These disorders are classified as obsessive-compulsive and related disorders (OCD-R) and described as body-focused repetitive behaviors (BFRB).

What is Trich?

Trichotillomania is the act of pulling one’s hair out.  It can be hair located anywhere on the body.  Most often it is hair on the head, eyebrows, or eyelashes.  Dermatillomania is a repetitive picking at the skin on any area of the body.  Often, the focus is the face, fingers, or arms.  People with either of these disorders will hair pull or pick to the point of causing visible damage.  For example, pulling out all of their eyebrows, eyelashes, or creating a bald spot on their head; or picking to the point of creating scabs, picking at those and creating scars.

What Happens

There are different ways this disorder begins, but it often is tied back to an initial state of internal stress that is relieved with a picking or pulling behavior.  The person will become obsessed with one thing, such as a hair out of place, and then they will think about pulling it out until they cannot resist the urge to pluck it, and then they feel a sense of relief.

Once a sense of relief is tied to the behavior, it quickly becomes a habit.  The person may spend hours thinking about not doing the behavior, yet wanting to feel the relief.  This is the obsessive part of the disorder.  They will then reach a point that they are literally unable to stop themselves from doing the behavior, which is the compulsive piece.

You are Not Alone

It is so important to realize that it's real and you are not alone.  Many people suffer from these disorders.  Al Riddell, a student at the University of London, posted The Urge, a sound clip of a documentary that explores the BFRB’s through personal accounts.  If you have trichotillomania or dermatillomania, you will immediately identify with the young women talking about their experiences.  If you want to understand the person you care about with a BFRB, this clip reveals the internal torture of living with the urge to pull or pick. 

Daphne is a young woman who suffers from trichotillomania.  Daphne talks about how the urge to pull a hair out will take over anything else she is doing at the time until she cannot focus on anything else until she pulls it out.   When Daphne pulls hair out, she experiences a popping sound, a rush of relief that brings calm and satisfaction.  Samantha suffers from dermatillomania and picks at her face.  Samantha talks about the relief she feels when she squeezes a spot on her skin, and then two or three hours can pass before she realizes how much time has passed or how damaged her face is.  Both discuss their feelings of shame, guilt, self-loathing, and irrational, uncontrollable behaviors that contradict their rational thoughts.

Treatment

There are treatments that can help to decrease or stop the thoughts and behaviors.  Medications used to treat anxiety or even depression will often contribute to reducing the obsessive thoughts that lead to the compulsive behaviors.  Counseling with a cognitive-behavioral focus is helpful, and this with medication shows the most success rates.  Understanding that you are not alone helps to normalize the behavior and decrease the shame, guilt, and loneliness.