Have you ever popped a pimple? Not methodical, with planning and gloved hands and clean gauze and sufficient light. I’m talking about the pimples you get because they feel urgent – the moments when you sit at your desk and feel a tiny bump on your cheek that shouldn’t be there. Go to the bathroom to inspect it and end up scratching it out with your fingernails. Even if you know it will leave a mark later, at the pop-up there is a post titled “Ahh This Is Better” that can be addicting if you need a way to deal with something stressful in the moment become. Skin picking is an example of body-focused repetitive behavior, or BFRB, a relatively new category in psychology. (More traditionally, BFRBs are classified as obsessive-compulsive disorder.) However, if you’ve ever had the uncontrollable urge to burst a pimple, even knowing you shouldn’t, you may be referring to another, less common, BFRB condition, which is referred to as BFRB is trichotillomania.
“Trichotillomania is a debilitating and frustrating condition in which people compulsively tear hair from the scalp, body, eyebrows and eyelashes,” said Columbia University neuropsychologist and professor Dr. Sanam Hafeez. Some studies found an overlap between trichotillomania and skin removal (24 percent of participants in this study experienced both physical problems). Other researchers have noted an increase in these numbers due to the COVID-19 pandemic. This study finds that a whopping 67 percent of participants saw an increase in both BFRB urges during that time. Similar to skin pecking during stress, an increase in anxiety can correspond with an increased urge to pull.
Sometimes it is described as a feeling of hyperfixation on a hair that is particularly wrong to the touch. In other cases, people describe the feeling of unconsciously scratching an itch – they may not even realize they’ve pulled until a bunch of hair has built up next to them. In both cases, Dr. Hafeez: “People with this disorder feel a surge of relief after pulling their hair out, causing them to continue the vicious cycle of hair-pulling.” She adds that there is no specific cause of trichotillomania, or Trich for short “Trick”) there. The urge usually emerges in the early teen years, and despite the even distribution between boys and girls in childhood, Dr. Hafeez adds that Trich affects “significantly more” women than men in adulthood.
The added stress of hiding bald spots caused by Trich (or explaining them to strangers) can heighten the anxiety that primarily triggers urges. And if you know, you know: the solution is not as simple as “just don’t pull”. Resisting the urge to help develop other coping mechanisms without help can feel like “[trying] a sneeze in … forever. ” And who wants that?
In addition to Trich’s psychological weight, it has very real physical effects that go beyond aesthetics. First of all, pulling the hair out repeatedly can permanently damage the roots. “Over time, people with trichotillomania see changes in their hair shafts,” says board-certified dermatologist Dr. Morgan Rabach. “The hair grows back thinner and more distorted and has a shorter growth phase than rest phases.” Repeated damage to the root in this way means that the hair no longer grows back at some point. In addition, open wounds caused by hair pulling can become infected and require serious medical attention. “To avoid permanent hair loss or infection, it is important to seek a therapist, even for minor trichotillomania,” adds Dr. Hafeez, who notes that while it’s great to be able to manage your trich yourself, the condition rarely goes away on its own without proper support. Start with a look at the TLC Foundation, which has a database of over 300 therapists who specialize in treating trichs.
Much like covering pimples with pimple spots can keep you from picking, covering your fingers or dragging spots can help keep your hands away from them. Similarly, bespoke extensions can act as a barrier between your fingers and your scalp. In New York, hairdresser Sheila Chung matches her trichotillomania clients with hairpieces that give the look of naturally thick hair while protecting new growth. You can also try using a stress ring, which is movable jewelry that you can fidget with when you feel like it. They can be as cheap as $ 11 and as expensive as $ 1,300. (This comprehensive list of trich management techniques is from another subreddit community on the same topic if you’re looking for more.) “I’ve had trichotillomania since elementary school,” shared beauty editor and Starface founder Julie Schott on her top Shelf with. She added that she “has a rotating system of things that help me not to pull [my brows and eyelashes] out.”
And once your trich is managed, you can focus on growing new hair. You can cover bald spots with eyebrow powder or root spray, or even try false eyelashes. (Loveseens are made for people who don’t have natural eyelashes in mind.) For eyelashes, Dr. Rabach also plans to try Latisse. “The active ingredient is a prostaglandin analogue that makes hair grow back faster.” Or, you can lean into what you already have by shaving your head completely and accentuating bare lids with a colorful liner.
Photo via ITG