Trichotillomania is a very complex hair pulling anxiety condition that consists of genetic, emotional, environmental, neurological and addictive factors. It is viewed as a coping mechanism that people have developed in order to bring some semblance of balance to their life. It shares great similarity with alcoholism, smoking/drug abuse, over-eating, and other detrimental and addictive escapes. Many of the reasons why trich persists are the same as smoking, over-eating – a genetic predisposition to addiction, emotional issues, low self-esteem, depression, anxiety, stress, boredom and an overall lack of proper coping skills. Many of these have a negative feedback loops that perpetuates the the habit
Emotional – Different emotional states trigger pulling: stress, boredom, anxiety, frustration, and tiredness. There might also be a combination of more deep seeded issues that may contribute to pulling. Things such as physical and emotional abuse, loss of a loved one, feelings of rejection, suppressed emotions, etc all linger in the subconsciousness. There is the potential for a negative loop to occur. Pulling leads to noticeable hair loss, which might lead to taunting and ridicule from peers, which in turn lowers an individuals self-esteem and causes stress which leads to more pulling.
Addiction – There are two addictive aspects to trich. The ritualistic aspect and the chemical dependence aspect. The ritualistic aspect is the searching for the perfect hair, the twirling of the hair, pulling out the hair, then rubbing the root against the lips. There is something remarkably soothing about the process. The chemical aspect plays a role here in that the small amount of pleasure derived from the pull becomes addictive. It could be likened to the same feeling a smoker has from the first drag of a cigarette in the morning. That pleasure a puller experiences grows into a chemical addiction much in the same way someone gets addicted to a drug. There is always that one extremely pleasurable pull that they had, and they are consistently going after that ‘high’.. its a craving. Now, imagine this positively reinforced action of pulling taking place hundreds of times a day and you can begin to see why it’s so difficult to stop. Even worse, the addiction doesn’t cost a penny and can be done virtually anywhere. The human brain is wired to crave instant gratification and with something as accessible as pulling a hair out to feel pleasure, it becomes the go to coping mechanism. The instant gratification that pulling provides is one of the major reasons why the illness perpetuates itself.
Genes – Your genes are the blueprint, the ‘biological code’, that programs everything about you. Some people are genetically pre-disposed to trich more so than others simply by the genes that were passed on to them by their parents. For trichsters, there is some code inside their genes that says: (IF under stress OR bored THEN pull hair to feel better). The urge to pull is hard coded into the genetic blueprint as one of posisbly several options to dealing with stress and other negative emotions. Once the behavior is learned it perpetuates itself through its addictive aspects and becomes the go to coping mechanism for the individual. Genetics play a relatively minor role in the reasons trich persists. It’s only contribution is that it is hardcoded as one of many ways for an individual to overcome negative feelings.
Isolation – The majority of pulling is done when alone. This is another one of the negative feedback loops that makes trich persist. The puller is in isolation when pulling, noticeable bald spots then causes shame, embarrassment and a reluctance to be seen in public, which leads to more isolation and pulling, and the cycle continues.
Neurological / Chemical – Pulling is used to regulate mood. Trichsters pull to relax when stressed out, pull to perk up when bored and pull to relax even more when going to sleep. Trichsters develop a craving for the the chemicals that are released in the brain every time they pull.
The key to overcoming trich is to interrupt the negative feedback loops that perpetuate trich. The two best methods available to accomplish this are currently Cognitive Behavioral Therapy (CBT) and the use of supplements / medicines. Both methods should be used in order to gain the quickest and longest lasting changes. The next article will begin to look at CBT and how it can be used help reduce pulling.