Vijai P. Sharma, Ph.D
It is amazing that a disorder, which afflicts as many as eight million Americans, could exist in almost total secrecy! Because of the embarrassment and shame experienced by afflicted patients, very little is known about the cause (or causes), the course of the development or regarding the effective treatments, if any, for this disorder.
This disorder is so stubborn and persistent that one feels like scratching one's head.
The name of the disorder is "Trichotillomania," (trich, in brief) or hair pulling in common parlance.
Thanks to the anonymity of the Internet, patients afflicted by this disorder have finally started talking about it. I was one of the first few therapists who posted information about Trich on Internet just a few years ago. Since then, I have heard from hundreds of patients who have suffered from it for ten, twenty or even thirty years without knowing that the disorder has a name. They didn't know there are other people suffering from the same problem, either! However, the secrecy part of the problem has begun to diminish somewhat. To this date, there are three books on this subject.
The ration of women to men suffering from trich is 2 to 1. Thus, out of 6 million trich patients, four million are women and two million men.
Consensus among therapists appears to be that trich falls under the broad umbrella of the Obsessive Compulsive Disorder (OCD). When we refer to OCD, we tend to think about someone who washes hands dozens of times a day or somebody who can't touch a doorknob for fear of germs. In trich, the act of hair pulling generally occurs without any conscious thought regarding the hair. It is generally an automatic, compulsive and repetitive behavior.
Among the automatic, compulsive and repetitive behaviors, hair pulling is a behavior that is focused on the body. Some therapists have begun to view that such "body focus disorders" as the chronic and habitual skin picking, nail biting, thumb sucking, eye gouging, scratching, itching or hair pulling have something in common. We have an inbuilt tendency for body behaviors.
When some people experience a negative physical or emotional state such as pain, hunger, tension, frustration, helplessness, agitation, excitement, boredom or anger, they tend to act upon their own body, rather than upon the environment (or upon the body of someone else!).
Acting upon one's own body during a negative physical or mental state is one of the most basic of human behaviors. You can even call it as "instinctual behavior.". Have you noticed babies crying out of hunger or other discomfort sometime bite their own hand or bang their head?
Babies raised in institutions, deprived of caregiver attention and social stimulation, sometime discover ways in which to use their own body for comfort and stimulation. They increasingly engage in such body behaviors as rocking, skin picking, thumb sucking, etc.
I give these examples simply to make the point that body behaviors are hard wired into our brains. They are universally found, across the cultures and even across the species of the primates. Grooming among the monkeys is a good example.
Some people keep brushing their hair with fingers or putting a fallen tress back into place. Lovers can groom each other for hours (I exaggerate!).
The only time I notice that there is a gray hair or a thread on my jacket is when the person conversing with me picks it off with such apology as, "Sorry! Couldn't help it!" They pick the hair before they notice it! It's a substitute for instinctual grooming behavior. Grooming is more common in women. No wonder that the incidence of hair pulling is twice more common in women.
Sometimes, body behaviors are accidentally discovered or learned. For example, some babies are born with thumb sucking habit already in place because they happen to "discover" their thumb and mouth in close proximity to each other while they were inside the uterus.
I have received emails from parents who noticed that their babies, just a few months old, were losing their hair. They couldn't detect the reason for it until one day they happen to see the baby pulling his or her own hair! It does not mean they were bad parents or were neglecting their child in any way. It just so happened that their baby accidentally happened to make an association between the hair and the hand and the hair pulling began to occur over and over again.
Most children outgrow such automatic habits in just a few years. Unfortunately, others don't. They carry it into their adulthood. That does not mean that hair pulling always begins in childhood. It can start at any stage of life.
Ours is a society that puts a high premium on hair. Look at how much money we spend on hair saloons and hair products. So when we develop the habit of hair pulling and are unable to stop it, we try to cover it up in a variety of creative ways. We are too ashamed to talk about it with our loved ones or to seek professional help.
Actually "coming out of the closet" regarding this disorder with the family and friends might be one of the most important step in recovery.
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Copyright 2003, Mind Publications
Posted July 2003