Ugly Girl

Tuesday, December 03, 2013


Dear Patrick: For years I have hidden the fact that I pull out my own hair. My mother was very intrusive so I don't know how I managed to convince her I just had a vitamin deficiency. I used to look at myself in a mirror and figure out where I could take the hair out and just make it look thin instead of like a bald spot. I got my grandmother to teach me how to crochet so I could start making my own hats. And for a while I had a business making hats when I was in high school.

            Now I am in design school and everyone is very conscious of their appearance. I was wrestling with a friend one day and my hat came off, and everyone saw that the crown of my head was bald. I think he was startled to be so close to me because he was staring at my face, and I think he realized that I paint my eyebrows on. When the hair pulling is really bad, I take out all of my eye lashes as well. The whole group was laughing until that happened, then they all fell silent. I grabbed my things and ran away, and I haven't been able to go back to school since.

            I don't want to flunk out of this program. But I am humiliated. I have researched this problem and I don't think there is any cure. Just a long name: trichotillomania. Who wants to have THAT? It sounds like a poisonous spider. I've never dated or been intimate with a guy because I don't want people to see me up close. The group of friends I have now at this college are the only people who have loved me for who I really am. They were my family. It is breaking my heart to give them up.

            One of my friends especially keeps on calling me. She wants to have coffee. I don't know if I can face her without falling apart. What should I do?



I'm sorry, I don't like arguing with a reader right off the bat. But I can't let you be so mean to yourself. You are in a lot of pain. I want to give you some comfort and some help. It's true that the problem you have is difficult to treat. But I have had therapy clients bring up this issue. It's not as rare as you might think because almost everybody who has trichotillomania is very sharp at hiding it. Many of my clients learned how to live with this issue and went on to have a better self-image. With that came friends, relationships, jobs, and a better life with much less fear.

            It's a matter of taking baby steps. Each small change you are able to make will improve your life. Let's start by adding up all the things you have to celebrate. You grew up strong enough to resist your mother's control. You started your own business at a very early age. You learned a lot of coping skills so you could have privacy and autonomy. You got into a college where you can be supported as an artist, and where there are a lot of compatible people who are a chosen family. Even if NOTHING changes about your life, you have so much to be grateful for.

            Pulling your hair out is a compulsion perhaps caused by anxiety and probably by a bad chip in your brain. It is like having migraines, washing your hands too many times a day, having acne scars, suffering from cerebral palsy, or getting panic attacks every time you need to get into a car. Some people who have this problem have other issues as well. They are likely to feel depressed (because they feel like flawed or unattractive human beings), and they may have problems with food (eating either too much or too little). These problems can make it harder to have a realistic, positive body image. Some folks with anxiety problems were also traumatized. If there was child abuse or sexual molestation in your history, you need help for that too, so give yourself some more credit for surviving despite these scary and hurtful events.

            Mental-health professionals are still figuring out how to treat hair-pulling. Because we don't know exactly what causes the issue, treatment now consists of a bunch of different things that hopefully have a positive effect. You have to be patient while you work through several different interventions until you can figure out the best combination. It usually helps to have a good doctor, psychiatrist, or therapist who is your advocate throughout the search for a solution, so they can give you feedback and help you keep track of what works and doesn't work. Be aware that the more stressful your life is, the more likely you are to pull out your hair. So anything you can do to love yourself and have pleasure is good. Many people with serious flaws or obstacles decide to be happy anyway. There is no rule that says you have to be perfect to deserve happiness. In fact, the opposite is true. The happiest people are the ones who tell themselves, “It's okay if I can't meet all of my goals. It's okay if I make mistakes. I will just figure out what went wrong, and if I can do anything about it, I'll try again.” Being punished or criticized does not help people to remain optimistic, nor does it help them to figure out how they could rearrange things to increase their odds for success.

            There are better and better medications every year to treat anxiety and compulsions. People are not so far removed from the animal kingdom. If you put an animal in a situation that causes stress, it may harm itself or engage in compulsive behavior. Medication can help you to have a fighting chance against anxiety or depression, or both. Cognitive-behavioral therapy is very helpful for most people with trichotillomania. It helps you to separate out thinking that is helpful from thinking that is irrational and not helpful. By changing how you think about a problem, you are empowered to seek out solutions. These changes also help you to feel better, and positive emotions help reduce anxiety. Instead of being stuck in a vicious cycle, you are creating a cycle that gradually improves everything. Another helpful thing is appropriately paced therapy. It would be a big mistake to attack all of the trauma of the past, because you risk being overwhelmed. Therapy that stays in the present will create a stronger self. As you get stronger, you will be able to tell when you need to break off a little bit of the poison cake from the past and burn it up so you are rid of it.

            Pulling your own hair is not an addiction, but some of the slogans or techniques that help people to stay sober can also help with compulsive behavior. For example, “one day at a time,” “progress not perfection,” and “let go and let your higher power help you.” If you are interested in having a spiritual life, paying attention to that aspect of things can be soothing. Meditation or prayer can reduce stress. So can being part of a faith community.

            When an alcoholic loses their sobriety and drinks, they can feel as if they have lost everything. It is tempting to let one binge turn into years of self-harm with alcohol. These days, addiction treatment specialists say that relapse is just a part of recovery. The important thing is to go back to the resources that helped you to stay sober. Instead of filling up with self-hate, fill up with hope. You can figure out why this happened and keep it from happening again. The same people who helped you before will still want to help you, because addicts know they are all vulnerable to relapse.

            Someone who pulls their hair can experience a “relapse,” too. You can leave your hair alone for days and then, without even being conscious of it, you pull out a bunch of it and have another bald spot. This can happen if you feel ashamed of your progress (for example, you hate the way your hair looks as it grows back in) instead of celebrating it and feeling proud of yourself. But it doesn't mean the interventions were not working. It just means the problem is very strong. It is not your fault that you have a compulsive behavior. You didn't do anything wrong or bad to make this happen. Nor does it mean that you are not a good person, or that you should be deprived in any way. A day without pulling hair is still a victory against the condition. A similar statement can be made about being able to refrain from swallowing the hair. Eating it can cause serious health problems, so if you are doing this, you need help to stop. We can't digest the substance that hair is made from. You need to be monitored to make sure the hair does not cause an obstruction in your digestive tract. Many people who share your situation avoid going to the doctor because they are afraid to have anyone else know about it. Simply being able to get help or describe your problem to someone who might be able to help you is another huge triumph over the anxiety.

            Don't give up on your friends so fast. Many of the people who go to art school have been told they were weird, and many of them experienced bullying as children. You are probably not the only member of your group who feels that this little family is their first real experience of friendship. They don't want to hurt you or make you feel bad. They just don't know what is going on. They lack information. A person who has a health problem needs to learn how to educate others about their issues. This is not easy, but it is very helpful. A person who is educated can become your ally, protector, and friend. If people know what you need, they can feel positive about themselves instead of blaming themselves for somehow hurting or embarrassing you. The guy who was wrestling with you was just feeling playful and flirtatious. I doubt that any of his feelings about you have become negative. He is probably more worried that you think he was too aggressive or mean. Maybe his feelings are hurt by your silence. You have the power to not only seek out comfort for yourself, but to be a source of information and comfort for other people.

            All human beings suffer, especially in the realm of intimacy and sexuality. We all want to be loved, and all of us are lonely. All of us have a fear that our bodies are not attractive, and we are not good enough to deserve love or pleasure. Focusing on your own challenges can isolate you from other human beings. Focusing on the fact that you are part of a shared experience of feeling inadequate and afraid can help you to feel more empathy with others and less afraid of them. There really are people out there who will not reject you just because you have an anxiety issue or unwanted behavior. Most of us know what it feels like to repeatedly do things we don't actually want to do. We all know what it is like to lose hope. Remember that there is a difference between ignorance and bias. Someone can have a really good heart and just not know anything about your situation. It can be very hard to educate others when you hate what you are going through, but it's the best way to sort out the caring and wonderful people from the selfish or opportunistic.

            See your friend and tell her what is going on. If you can't speak of it face-to-face, write a letter that she can read. Or show her this column. Ask her to help you to find resources. Two brains are better than one. You need a minimum of two professionals—a doctor or psychiatrist who knows how to work with anxieties and compulsions, and a cognitive-behavioral therapist you can like and trust. Such people should exist in any large city. There are also a lot of support groups on-line. If you can't see a doctor yet, maybe talking to other people who are coping with this obstacle can help you to feel better. And you are welcome to write back to me any time.


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