Trichotillomania
Trichotillomania
Trigger Warning- Some images or descriptions in here may be triggering to trichotillomania sufferers.
Disclaimer- I am not a doctor or medically trained in any way. Everything from this article is based upon my own experience, and the sources linked at the bottom of the piece :)
Every day that goes on, I have further to fall. When the strands hit the floor, I know it will take them about 6 years to grow back fully. If I say ‘oh today I feel like shaving my head, its because if I did that, the growth I would effect would be so little. This is something I will most likely have to deal with for a long time, and I know that. Trichotillomania is not something that can disappear overnight, but I am trying my hardest to not let it control me. Speaking about this is something I just needed to do. Sorry for cluttering your timelines, just I know this week isn't going to be easy.- My facebook status, 31st January 2015
No mental health problems are easy. None are simple, or ignorable. For me, for a long time, trichotillomania ruled my life. But it no longer does.
Trichotillomania (also known as trich or TTM) is defined as a condition where a person feels compelled to pull their hair out. It is a Body-Focused Repetitive Behaviour disorder (BFRB). Other examples of BFRBs are dermatillomania (skin picking), nail biting, and lip biting.
According to the TLC Foundation, approx 2 to 4% of people experience trichotillomania in their lifetimes- it usually begins in the early teen years, and in childhood occurs equally between the genders, but by adulthood, 80-90% of sufferers are female.
People can pull from anywhere- scalp, eyebrows, eyelashes and the pubic region are all common areas, but any hair can be pulled. Some people use tweezers, and others just use their hands. The hair loss is in irregular patches, unlike alopecia (an autoimmune disorder that causes hair loss) in which hair loss is in more regular shapes.
Trichotillomania has a related disorder, trichophagia, which involves eating the pulled hair. This can cause hair balls called trichobezoars, which can be fatal. Along with the trichobezoars, it may additionally cause repetitive stress injuries, and carpal tunnel, simply from the repeated action.
Trichotillomania also has a large crossover with other disorders - in the DSM-V (the American list of all mental illnesses and their diagnostic criteria), it is classed as a subset of OCD, which is itself a subset of anxiety. These disorders often are present alongside trichotillomania and other BFRBs. The physical hair loss can also cause low self esteem and related disorders, such as eating disorders and body dysmorphia.
Triggers for hair pulling can range from stress, to boredom, to nothing - some people even pull in their sleep. Trichotillomania can be described as feeling like youre allergic to your hair - an urge that you cant control without the pull and that pop of pulling it out.
Regrowing the hair can also cause issues - it can be oddly textured or coloured as the pulling can damage (and even kill) hair follicles. Regrowth can also take a very long time; some people with trichotillomania choose to shave their heads or cut their hair short - I myself got a long bob to quicken the time to regrow - growing it out to my waist would have taken years and years. Having shorter hair can also reduce pulling, as the hair is harder to hold on to - head shaving can however become a crutch, and render people unable to grow out their hair at all as they pull it all when it gets long enough to grab.
I myself have suffered from trichotillomania on and off for all of my life. My friend Ella has distinct memories of me pulling my hair out in reception (first year of school, aged 4-5). I lost a lot of my hair in year 4 following some stressful family drama, and lost a lot more following my fathers suicide in February 2014. Since seeing a therapist in March 2016 and being put on medication, my pulling has significantly decreased - I now dont pull from my scalp, and rarely pull other areas. My scalp hair has since grown back, albeit damaged and a completely different hair texture (very curly ringlets versus my lightly waved hair).
This all seems very scary, I understand. But trichotillomania is not some terrifying beast out to get you - it can be tamed.
Currently there are very few treatments that doctors can provide that will assist with trichotillomania. Cognitive Behavioural Therapy (CBT) is currently the foremost recommended treatment for trichotillomania - it allows people to reverse their ‘habits and ways of thinking to stop the pulling. Some may use anti-depressants, while others use an amino acid called N-acetylcysteine, which has not been proven clinically to help, but the benefits of it have been spread via the internet.
If you cant access a doctor, here are some things you can do to help yourself or others suffering from trichotillomania-
One tip for overcoming trichotillomania would be to see how long you can push it before you need to "fix" whatever is out of place or irritating your compulsion. See how long you can last; think of it like a game; see how long you can do it and try to beat your score every time. Train your brain to last longer and longer, and longer, until it's not a problem anymore.
Bear in mind that trichotillomania isnt necessarily a bad thing. Its just a different way of thinking. Dont beat yourself up about it.
Reward yourself. Some people have bracelets which they put beads on for every day pull free, and when I had enough hair, I got a really nice haircut, so I could feel better about my hair!
Finding alternative coping strategies can help. For example, some people twiddle elastic bands, or spinner rings, or special tangles (like the one in the picture on the left).
Using scalp masks or dandruff shampoos - this can prevent the itchiness that can trigger pulling (this REALLY helped me, and I still use it sometimes).
Dont be overly focused on being pull free. Set realistic expectations. These disorders are so so hard to get over! Video related here
Join facebook groups to find like minded people! The main trichotillomania facebook group can be found here
A great video for support can be found here
And a few questions for you all!
What are your experiences with trichotillomania? Share your story!
How have friends and family reacted to your disorder?
Do you chose to hide the bare areas, or rock them? Why?
What coping mechanisms do you use to help control the compulsions?
Sources used-
"What Is Trichotillomania?" The TLC Foundation for BFRBs. N.p., n.d. Web. http://bfrb.org/learn-about-bfrbs/trichotillomania
"Trichotillomania." NHS Choices. NHS, n.d. Web. http://www.nhs.uk/conditions/trichotillomania/pages/introduction.aspx
"Trichotillomania." Wikipedia. Wikimedia Foundation, n.d. Web. https://en.wikipedia.org/wiki/Trichotillomania
A big shoutout to @Hope @NixNixels @WonderfulPumpkin71 @Teagan and everyone else I haven't credited here for the help with my honours project!
Also a shoutout to @Amelia for helping me with juggling the internship with self care and real life :)
And an interesting note- all the images of hair loss used here are actually photos of me in late 2015, when I lost most of my hair :) It has all since grown back, and I have a full head of hair at last :)
Thanks for reading!
@Lucy
Thank you so much for this informative article and for sharing your own experience. 
@Lucy wow this was my first time hearing about trichotillomania and I was really interested while reading your post. This all sounds a bit scary and like a tough thing to deal of but I am so proud of you for being brave enough to share your personal experience in order to educate others! Thank you so much
Congrats @Lucy you did awesome on this!! I'm sure some of it might have been hard to get through due to your own experience, but I'm glad you made this post, it's an important topic that people should not be ashamed of :) (also, super proud of you for reaching out to get your own trich under control!!)
What are your experiences with trichotillomania? Share your story!
I think I have 2 ways to answer this: my only real experience with trichotillomania is a friend from high school, one day she randomly opened up to me about how she had been dealing with this for the past few years. It was my first time really hearing about it, and I (maybe stupidly) asked "but doesn't it hurt?"--I'll never forget the blank, annoyed face she made! 
At the time, I didn't realize my question was insensitive and didn't understand that it was a compulsion, not something she actually wanted to do. But she was patient with me :)
The second way to answer is: I don't think I have this BFRB, but often when I am stressed I pull the hairs out of my eyebrows. So many come out, and I usually can't stop until nothing else comes. But since I had learned about trichotillomania from my friend much earlier, I feel like I was better able to address what I was going through, and try my best to stop myself and do other things to express my stress. Luckily, I have never really had bald spots because of this, and I really thank being educated about it for that!
How have friends and family reacted to your disorder?
(I'll answer this based on how I reacted to my friend) After my initial not understanding, I think I reacted with kindness. I never knew she was going through this, and I wanted to be there for her. I was really glad that she felt comfortable enough to open up to me :)
Do you chose to hide the bare areas, or rock them? Why?
My friend often hid the bare areas, but sometimes she would just be herself, bald spots included :) I know that it was hard for her to rock them, but I felt so proud of her when she did!
What coping mechanisms do you use to help control the compulsions?
I had never asked my friend what coping methods she used, she didn't like to talk too much about it and I never wanted to push her. But she does seem to be in control of her compulsions lately! For myself, when I thought I felt the little urges, I would try to just distract myself until the urge passed, or I would cut little strips on paper and rip them off (sort of simulating the motions I would use on my eyebrows).
This is fantastic and super informational! Thank your for all the hard work you put into it
Thank you so much for sharing your story! You are an amazing and strong person! I can only imagine how difficult it is to have this condition but I commend you for taking control and wanting to take the step of not letting it control you anymore. You are so brave!