Sometimes I dream that I’m looking in my bathroom mirror, and most of my hair has gone. I’m staring at raw, pink scalp speckled with a few dark strands of hair, and I’m sick with the realization that I have finally gone too far and turned myself into a freak.
And waking up doesn’t bring relief. Because the dream is based in reality.
I have trichotillomania. This means I pull out hair every day—from my scalp, my eyelashes, and my eyebrows. The condition is cyclical, and sometimes I only pull a little. Then my lashes and brows grow in, short and stubby, and I feel normal. Even pretty.
Sometimes though, especially when I’m anxious or premenstrual, I go on wild, reckless binges. I loathe myself even as I do it, knowing that I’m wiping out weeks of self-control in a single hour and resort to my various covering-up tactics.
I pulled out my hair long before I learned that escape could also be found in a bottle of wine, but in many ways the motivation was the same.
These include: getting up before my husband, so that I can re-draw the penciled brows and lashes that have rubbed off on my pillow overnight; wearing a hat to disguise the gaps across my crown, the short tufts of hair that stick up at odd angles; and ducking my head to avoid meeting people’s eyes, as if by not looking properly at them, I can stop them from seeing me.
Unlike “real” addictions, there are no treatments available for trichotillomania. The condition is so little understood that there isn’t even medical consensus on how it should be classified. Along with its companion, dermatillomania (compulsive skin-picking), trich is defined by DSM-5 as a “body focused repetitive behavior,” or BFRB. But what does that mean?
Is it an anxiety disorder? A form of obsessive compulsive disorder? A self-harming behavior akin to cutting? Nobody seems to know for certain, any more than they know why people do it. But the little research that has been done suggests that at least a quarter of those who pull their hair out or pick at their skin are also addicted to a substance or other behavior. And some therapists specializing in BFRB’s have argued that the condition itself should be treated as an addiction.
I pulled out my hair long before I learned that escape could also be found in a bottle of wine, but in many ways the motivation was the same. When I am playing with my hair, preparing to pull, I get the same sense of ritual and escape.
Unlike with alcoholism and drug addiction, there are no glamorous trich sufferers, no rehabs, no redemption stories. The number of adults with trichotillomania has been estimated as anywhere between 0.6 percent and up to four percent of the population, and 80-90 percent of those who seek treatment are female (the gender discrepancy may be due to the fact that men are more able to hide the condition by shaving their head).
The condition remains, by and large, untreatable. The largest study of its kind, the Trichotillomania Impact Project of 2006, examined the efficacy of various treatment regimes on 1,700 sufferers. A mere 15 percent reported any reduction in symptoms, even a mild reduction, and for that lucky 15 percent the reduction lasted between three and six months. The condition is commonly treated with a combination of cognitive behavioral therapy and anti-depressants, with sufferers advised to employ distraction techniques—like fidget toys—to stop them from pulling.
Pulling out my hair provided my first escape from reality. At 10, I was being bullied by a girl in my class, and I felt as if I was walking around without a layer of skin to protect me from the world. Then one day, my hand went to my eyelashes, and without meaning to I plucked one out. It was a short, sweet shock, followed almost immediately by a compulsion to do it again. The pain felt like a release.
Hair pulling offered me a feeling of control. I would stroke the tip of my thumb along my lashes, searching for the one that felt different so that I could target it like my bully targeted me. By my 11th birthday, my eyelids were red and bare.
When I was 13, at a new school in a new country, a friend asked me in a whisper if I knew that I had a bald spot. I didn’t know. I had started pulling the hair from my head in an attempt to stop pulling my lashes, like an alcoholic switching from wine to beer in a doomed attempt at moderation. But I never let myself look at the damage, and so I didn’t know that I wasn’t hiding it from others.
It is hard to be a teenage girl, and even harder when you have a bald spot and no eyelashes. I had long, dark, thick eyelashes as a child. Mascara-ad lashes. I was throwing them away like trash.
But I couldn’t stop. When I was a teenager, my mother hired a hypnotherapist with money she didn’t have so that I could sit in an office after school once a week. It worked for a couple of months and then I went back to hair-pulling.
In my early twenties, I discovered a way to halt the habit, accidentally. I was a nail-biter, so I decided to mask my chewed-up stumps with false nails. The chemicals stung my ripped cuticles. But it was worth it, because the fake nails interrupted the feedback loop of pleasure between fingertip and hair. I stopped pulling and my hair grew back. For the first time in my adult life I looked like everyone else. My fiancé was delighted. I bought my first mascara, and experimented with eyeshadow colors.
A year passed before the compulsion found its way back. My honeymoon was over and I was pulling again. My husband hid his disappointment.
Trichotillomania circumscribes my life in a hundred ways. I love swimming but avoid water, because when my hair is wet it exposes my bald patches. I never leave the house without make-up, and I constantly check mirrors in case my eyebrows and eyeliner have rubbed off. I own 30 hats. My car, my pillow, my favorite reading spots are all covered with long hairs. Going to the hairdresser is humiliating. I try not to think about what they are seeing, and I tip well.
It’s like drinking, in that once that first ruby drop passes my lips, I am lost. But with hair pulling, the hangovers last months, while I skulk under a wig and wait for the damage to repair itself.
To manage my condition takes constant vigilance. At least with my alcoholism, I can avoid alcohol. I can’t avoid my own hair. I can exert all the will in the world, but all it takes is a momentary lapse in concentration, and my hand goes upwards. It’s like drinking, in that once that first ruby drop passes my lips, I am lost. But with hair pulling, the hangovers last months, while I skulk under a wig and wait for the damage to repair itself.
My family feel sad and helpless about my hair pulling. It affects the rhythm of our lives just as my drinking used to, creating tension when I’m in a bad phase. It affects my husband the most. At home, he can’t relax, watching me out of the corner of his eyes, ever prepared to alert me when my hand creeps to my eyes. Over the years, he has suggested that I try fidget toys, meditation, therapy, and keeping a “pull diary.”
He compliments me when the condition recedes and my eyelashes grow back, and is carefully silent when they disappear again.
He never said a single word of reproach back when I was drinking. Drinking he could understand. Everybody likes a drink. But this is just wanton self-destruction.
It may not technically be an addiction, but it sure feels like one. Just as I used to do with drinking, I long for pulling, even as I dread it. Sometimes I make excuses and retire for the evening, just so that I can pull, away from my husband’s searching, sad eyes.
Like with drinking, it’s a cycle of remorse followed by a renewed determination to stop, followed by relapse. After a long period of self-denial, I experience that euphoric exhilaration of saying to myself fuck it before I swan-dive into disaster.
Trichotillomania has destroyed more of my beauty than alcohol ever did, and caused me more pain. If I knew how to quit, I would do so in a heartbeat.