Having battled with trichotillomania for more than a decade, Stylist’s Ava Welsing-Kitcher opens up about the debilitating compulsive disorder and why fellow sufferers shouldn’t stay silent.
Anyone who knows me knows that my hair is my pride and joy: however, I’ve always had a troublesome relationship with it. When I was 13, I attended a sleepover and my best friend plucked out a strand of my hair and a strand of hers, before remarking, “Look: mine is delicate and thin, but yours is rough and jagged like wire.” After everyone else had fallen asleep, I spent hours searching for offending wiry hairs and pulling them out one by one, skipping the finer hairs. I relished the feeling that I was correcting some kind of mistake.
I’d continue to do this nearly every day for most of a decade. When I felt anxious or even just bored while watching TV, I’d absent-mindedly find my hand reaching towards my crown. The tension would build as I rifled through hairs to find the perfect one to pluck; once I had done so, the anxiety dissolved, only to be replaced with shame and frustration… but that wouldn’t stop me from repeating it. And so went the vicious cycle.
As a teenager, I saw my hair pulling as a freakish bad habit. Pulling sprees would span a couple of hairs to a couple of hundred in snatched moments of privacy. When my compulsion hit hardest during adolescence, I’d catch my mother staring at my sparse crown area with such intense worry that it hurt me more than anything. “By getting rid of the coarse hairs, you’re denying your African heritage,” she’d caution me, but it was never about race for me. The selected hairs just stood out, in the same way a lone grey might.
A far as me and my mother knew, I was the only person who did this to herself. And then we saw the 2011 film Young Adult, in which Charlize Theron’s character pulls out her hair alone in a hotel after a disappointing social encounter. Watching that scene, I felt like someone had dumped a bucket of ice water over me. It was as if everyone in the cinema knew about my dirty secret, and yet, struggling through the initial shame, there was a tiny shred of hope. If someone in Hollywood had written hair pulling in as a character trait, then surely I wasn’t alone?
That night I googled everything I could about hair pulling, and learned that Trichotillomania (TTM) is defined as a disorder which causes people to impulsively pull their hair, eyelashes, eyebrows, beard and even pubic hair. I found out that even celebrities like Justin Timberlake, Katy Perry and, yes, Charlize Theron have suffered from it. And, through a stark NHS page, I learned that hair pulling was symptomatic of anxiety, a chemical imbalance in my brain (similar to OCD), or self-harm. Anxious and potentially OCD? Yes – but I knew I definitely wasn’t pulling for the pain.
Through my research, I learned that I could treat my condition by “squeezing a fidget toy” or “taking a soothing bath”, and that there was no cure. Yet I still wanted more human proof that TTM was a thing. This led me to hair loss specialist Lucinda Ellery’s 2010 documentary Girls On The Pull, where I watched as she gently consulted women of all ages and fitted them with a hair piece called an Intralace to physically block them from pulling their hair out. Online forums educated me further, and through reading accounts and anti-pulling strategies, from cognitive behavioural therapy (CBT) to knitting.
And, as I learned more about TTM, I found myself experiencing a strange kind of euphoria: this was an actual condition and people seemed to be finding ways to manage their symptoms long-term. I excitedly shared my findings with my mum, but I’d soon learn that there wasn’t enough scientific research available to the public. Which is what inspired me to conduct my own research…
What is trichotillomania?
“Trichotillomania is part of a set of body-focused repetitive disorders (BFRD), the umbrella term for impulse-control behaviours that result in damaging your physical body including onychophagia [nail biting] and dermatillomania or excoriation disorder [skin picking],” clinical psychologist Dr Douglas Wood tells me.
A study in Molecular Psychiatry suggests that a mutation in the SLITRK1 gene (linked to Tourette’s syndrome) could explain the urge to pull, but more research is needed. Dermatillomania (DTM) involves similar traits as TTM. “People with dermatillomania have the urge to pick when they feel anxious or depressed,” says skin expert Dr Rekha Tailor. “However, the behaviour frequently becomes more of an unconscious habit, with people picking at skin with tweezers or fingers even when there are no negative feelings. They feel like they’re tackling a problem, but always end up causing even more damage.”
DTM and TTM are often referred to as ‘cousin’ disorders, and in some cases cross over. “After chopping my hair off into a pixie cut to stop myself picking split ends and pulling, the urge transferred over to my nails and lips,” Kayleigh, 30, tells me. “If I’m having a bad day, I pick at both incessantly until they bleed – they’re permanently chapped and cracked.”
Although precise statistics of DTM and TTM vary, out of the 2-5% of the worldwide population affected, the majority of sufferers are female, with the behaviours usually starting in early adolescence.
“Victims will often avoid pulling or picking in social situations and prefer to do it alone or while engaged in sedentary activities,” explains Dr Wood. “Many suffer in silence, so not many people are aware of it and therefore it hasn’t been perceived as such a serious problem as it should be. It seems like a voluntary behaviour, so people assume victims can just stop, but they can’t.”
This all sounded very familiar. I posted an Instagram Story asking people to message me if they struggle with a BFRD. It prompted a shocking number of young women to confide that they’d been picking their skin or tugging their hair for years (some of whom hadn’t told anyone until now), and the stories were astoundingly similar. A few had been diagnosed with other mental health conditions.
Ruth Leiser, founder of mental health support site GRLCLB, also suffers from anxiety and OCD and has compulsively picked the skin on her face and hands since childhood. She told me how she was also inundated with messages after posting about her DTM. “It completely changed my outlook; up until that point I really did think I was completely alone and no one else understood.”
Amelia, 22, helps support the SLITRK1 gene study as a Tourette’s sufferer. “While I’ve never been diagnosed with dermatillomania, my Tourette’s syndrome and hygiene-based OCD mean I have certain ticks that become repetitive habits,” she says. “I can’t deal with anything on or near me which isn’t perfectly clean – it’s no wonder I compulsively pick at imperfections like spots.”
By nature, both TTM and DTM yield obvious side effects (permanent balding, wounds that won’t heal, infection and scarring), so sufferers try to hide telltale signs as well as the act itself. “Accidents with a knife, a cheese grater… name a kitchen utensil and I’ve blamed it for my scars,” confesses Anna, 27. “I never hold the rail on my commute out of shame that people will see what I’ve done to myself.”
Rebecca, 22, whose seven years of pulling kicked in as a sequel to her thumb-sucking habit, has employed a similar tactic. “I’ve switched my parting from centre to left to conceal my sparse spot,” she tells me. Perfectionism and appearance seem to play an important part as well.
“I’ve always been obsessed by skincare,” Harriet*, 28, tells me. “I’m known for my regimen amongst my friends; I’m never caught without SPF50 and I’m always popping amino acid supplements for glowing skin – but I pick away at every imperfection until it’s 50 times worse. I think it’s this obsession with my skin which led to my condition.”
Like so many others, I’ve spent a lot of time and energy on trying to control and conceal my TTM. I’ve had hypnotherapy, taken up knitting to keep my hands busy, been matched with a hair-pulling pen pal by charity Trichotillomania Support, binge-watched Netflix wearing gloves and a hat in the middle of summer, and spent entire Sundays with wet hair to make the act of pulling more difficult. I’ve also given up straightening my hair for up to a year at a time upon the realisation that I pull more when my hair is straight because coarse hairs stand out more, which has helped significantly. I’ve never stuck to any of the other things for more than a month, but for others they’ve helped suppress the compulsion until it (hopefully) rides itself out. The urge to pull is often there, especially in times of stress, anxiety and boredom, but I haven’t pulled for most of a year – and I put that largely down to the fact that I’ve been talking about it more openly. Connecting with others has done more for me than knitting ever did.
Scarce research has gone into finding a proper solution for BFRDs, but it can be managed through treatments such as hypnotherapy and CBT. “There are strategies that can help people manage their urges to pull or pick, and to develop tactics to use during times of stress and anxiety when they’re most prone to it,” says Dr Wood.
Leiser is undergoing CBT, and it seems to be working. “My therapist asks me to view the disorder like an addiction,” she says. “It does feel like gambling at times: if I squeeze something out of a pore I need to ‘win’ again; if not, then I deserve another go to make up for it. Seeing it as an addiction reaffirms that the only person who can make me stop is myself, and CBT helps me address the anxiety that causes the picking.”
While CBT is one of the most effective treatments, it’s not guaranteed to work for everyone. It’s what prompted Ellery to dedicate over 30 years of her career to helping young people with TTM.
“Before the word trichotillomania was in anyone’s vocabulary, I started noticing certain women who were coming to my salon with an unusual type of hair loss,” Ellery tells me during a consultation.
“It was always a sparse or bald area on the crown or behind the ears, and eventually someone confided in me that they’d done it to themselves and thought they were the only one. The lack of awareness and research around TTM astounded me, and it’s been my mission to rectify that ever since.”
I leave our consultation with Ellery’s tips to avoid pulling (see below) that have stopped the urge in many of her clients, and some priceless insight into my disorder.
“I see the same qualities in women who pull: highly intelligent, emotionally fluent and very sensitive. Use these qualities to try and shift your feelings of shame and secrecy into something positive,” she urges me. “Nobody was talking about this years ago; now I’m seeing victims speaking up and helping so many others realise that they aren’t alone, and that’s extremely powerful.”
At this, I burst into tears. I’d never considered my condition as a good thing until now.
So if you’re reading this, frustrated and isolated in your compulsion to pick, nibble, gnaw and pull, then believe me, you are not alone. There will be a time where the urge will weaken and your resolve, and your pride in yourself, will harden. I’m proof of that.
Investigate these tried-and-tested methods of curbing your urges
“Gently prick a blunt embroidery needle over your scalp to mimic the feeling of pulling hairs. It sends a message to the brain that you’ve done it,” says Lucinda Ellery. Fidget toys can also help TTM and DTM sufferers.
Control the stimuli
Physically stopping yourself in situations where you’re prone to picking or pulling (eg when home alone or watching TV) is an effective short-term help for many. Cover fingers with plasters or gloves.
Give therapy a try
CBT and hypnotherapy have proven to be the most effective forms in helping manage BFRDs, reprogramming negative thoughts and transforming your ingrained way of dealing with them. Book in an appointment with your GP to discuss your options.