“Mum, you’re doing your bad habit again.”
I follow the stare of my five-year-old daughter to my desk, where a pile of loose hairs I’ve pulled from my head mount in a heap next to my laptop. With a sweep of my hand I scoop up the evidence, then wind it into a knot before stuffing it in the bottom of the garbage can. My daughter is remarking on these piles more and more these days, and often stops me before they’ve even formed.
“Mummy, why are you always playing with your hair?”
Five-year-olds are quick to exaggerate—”You always give her the bigger piece”—but in the case of my hair-pulling, she’s entirely justified. Why? I haven’t a clue. It’s a habit I’ve sustained since my 20s and kept at semi-consciously and semi-secretly for more than 15 years, even as I write this.
I don’t remember it being a problem until my mid-20s, when a friend confronted me one evening at her apartment. Whenever I visited, she said, I left behind clusters of brown curls on her carpet and she’d have to rake the fibres with her fingers to get it all out. I’ll never forget the feeling of shame…not that it stopped me. Pulling just feels so good. Fingering my curls, identifying the one hair that’s a bit thicker, wirier, knottier, and then tugging it out, relaxes and focuses me. And then it disgusts me. The disgust makes me want to stop. But then I do it again, and it’s like home. What should sting in reality relieves a sort of inner itch, like a lover scratching my back. Frankly, I’d rather be pulling out my hair than pretty much anything, any time. I should have that printed on a T-shirt.
But admonishment from my own daughter—and the odd grimace from my husband—has made me think it’s time to deal with what I once shrugged off as a harmless tic. I’m in my 40s now. I have a family and a career. Yet pulling out my hair has come to define me in a way I’m determined not to be defined. And so, like a runner whose only hope of finishing a marathon is to announce to the world that she’s training, I pitched this piece to my editor in order to make my struggle public— and to motivate me to seek help.
What I learned almost immediately was that hair-pulling isn’t a habit at all, but an anxiety disorder classified on the obsessive-compulsive disorder (OCD) spectrum. There are websites, helplines, therapists and hair-replacement specialists devoted to trichotillomania, otherwise known as TTM or tricho.
The condition was first identified, and named, by the French dermatologist François Hallopeau, though these days it would appear sufferers keep good company. The actress Olivia Munn, for one, confessed last year to pulling out her eyelashes. She’s not alone: It’s estimated that one to four percent of the population regularly pull out their hair— including brows or lashes—from the body or head.
If ever there was a moment for OCD-related disorders such as trichotillomania, it is now. Last June, Dr. Peggy Richter—a psychiatrist at Toronto’s Sunnybrook Hospital who runs cognitive-behavioural therapy (CBT) groups for tricho sufferers—received a $10-million endowment to create the Frederick W. Thompson Anxiety Disorders Centre, which focusses on OCD and related disorders, including TTM. She says her 10-week-long CBT groups result in, on average, a 50 percent reduction in hair-pulling. And in May, DSM-5, the latest diagnostic manual from the American Psychiatric Association (APA), will mark a major change for tricho. “TTM was previously in the DSM, but as an impulse-control disorder,” explains Dr. Richter. The newly revised manual will now include TTM in the group of OCD and related disorders, which Dr. Richter says “reflects the growing relationship between these conditions.” Reams of new research into TTM since the release of DSM-4 prompted the APA not only to separate OCD into its own independent chapter, but also to explicitly recognize TTM, along with other anxiety disorders such as skin-picking and hoarding.
In the tricho world, I’m one of the lucky ones. I have a thick head of hair that can stand to lose a small pile of strands each day. I like to pluck casually from behind my right ear, while I’m at my computer, on a plane or sitting, talking, on friends’ sofas. It begins absent-mindedly but continues determinedly even after I’ve become aware of it. (If you’ve ever been a nail-biter, you’ll know what I mean.)
Few tricho sufferers are as fortunate. Some have Friar Tuck baldness at the crown. Others pull out their bangs or exterminate their eyebrows. Michael Twohig, a psychologist at Utah State University and co-author of a therapist’s guide to TTM, told me a third of his clients have their first experience as students, tugging out a strand to put under a microscope in science class, or plucking out an eyelash to make a wish.
“After that, it’s about the feeling,” says Twohig. “What we tend to see clinically is people’s urgency, and feelings of unfairness that they have to stop when they enjoy it so much.” Twohig practises what he calls “acceptance and commitment therapy,” a form of CBT that “deals with urges in a way that’s relatively simple and straightforward, in the hope that when your mind is out of the way, you’ll have an easier time doing simple behavioural things.”
If you caught a trichotillomaniac unawares you might recoil at the sight, but chances are you’ve never had the pleasure. Tricho sufferers are brilliant at covering up with scarves, comb-overs, eyebrow pencils. That is one reason TTM has managed to keep a low profile all these years.
Of course, hiding it doesn’t help. Abby Leora Rohrer, a Colorado-based spiritual healer, hid her TTM for 27 years, even from her husband. “I loved pulling out my hair and it was also destroying me,” she says. “On the one hand it’s your best friend, and on the other it’s sucking the life out of you.”
TTM can be “very interfering,” adds Dr. Rami Nader, a psychologist and director at Vancouver’s North Shore Stress and Anxiety Clinic whose MO is to make hair-pullers conscious and mindful through a method of CBT he calls “habit reversal.” “People get very creative about ways of covering it up, and there’s shame associated with TTM generally. It’s… a ‘dirty little secret’ some would say.”
It is perhaps inevitable that trichos often—but not always, and not in my case—sink into deep periods of TTM-induced depression. Anne Thornton-Patterson, a London-based hypnotherapist whose bread and butter is helping hair-pullers, tells me that aside from damaging the psyche, pulling can also impair physical health: “People won’t go swimming, or to the gym, for fear of their patch showing.” She once treated a client who allowed her partner to believe she had alopecia. When the client finally got up the courage to admit she was actually pulling out her hair, the relationship collapsed.
Before I meet with Lucinda Ellery, whom many consider the patron saint of hair-pullers, I try to watch Girls on the Pull—a documentary about tricho sufferers who visit Ellery’s London hair-loss consultancy. I am viscerally repulsed by the tearful women yanking off turbans to reveal chasms of baldness. They are not me, I think. And yet.
I listen to these women verbalizing the same feelings I’ve struggled to articulate for nearly half my life. “My fingers are sore in the joints where I’ve been pulling all day,” says one. Oh, don’t I know. Others speak of the “irresistible urges,” the utter despair when some so-called therapist asks: “Why don’t you just stop?” And the insupportable assumption that “it’s my own fault.” That’s the hardest thing to overcome when you’re the architect of your own destruction, whether subconsciously or by unassailable habit: the feeling that it’s your fault and that you’re too weak to stop it.
“TTM is not your fault,” Ellery says, hugging me hello in the foyer of her eponymous clinic, a nondescript townhouse two tube stops from anywhere, decorated with chintz loungers, scented candles and eight-foot amethyst crystals.
Tossing back her lush blond waves (all extensions, she says), she leads me to her office, past a skylit salon where women—largely young, largely attractive—sit “in various stages of undress,” as Ellery refers to the states of partial baldness. A platoon of smocked specialists tends to their ailing heads as ELO thumps on the stereo. At 11 a.m., two bottles of white wine chill in a bucket on the zinc-topped bar.
Thirty years ago, Ellery opened a hair-extension salon. Then she began noticing that some patients were balding in spots. She tells of orchestrating a dinner where she plied several of them with wine and broke the news that they all shared the same devastating secret—they all had TTM and none knew it.
Ellery has been bringing tricho sufferers together at events, bigger, but similarly wine-fuelled, ever since. She’s become a bit of a media darling in and around London, a go-to authority on hair replacement for TTM as well as for sufferers of cancer, burns and acid attacks. (She also offers run-of-the-mill extensions; Peaches Geldof and Rachel Hunter are both clients.) Physicians and psychologists refer patients to Ellery almost daily, and vice versa.
“TTM is my world,” she says from her desk, surrounded by corkboards pinned with thank-you cards. Still, she can barely bring herself to utter its full clinical name. “That crazy, stupid name,” she winces. “I’ve never met a maniac in all my life.”
With her adrenalized banter, joyous whoops, empathetic tears and incessant necklace-tugging, she seems nonetheless close herself. Yet the woman isn’t a charlatan. Though not a puller, she watched her hair fall out in clumps after her father died, when she was nine. She wore her first wig in her teens and, at one point, had 127 in her closet.
Ellery—who now operates three consultancies in the U.K. and one in Beverly Hills—has pioneered a hair-replacement technique called the Intralace System, involving a mesh “lock,” like a bathing cap of net, woven onto the scalp with an “intralace” of the patient’s remaining hair and real-hair extensions. (Adult TTM sufferers are thought to be almost always “she.”)
“Here, pull it,” says Ellery, holding fast to one end of a sample Intralace prosthesis. It’s stiff, like a more intricate version of those green plastic strawberry baskets. And finger-proof, so that for the six months it’s in place, the patient is unable, physically, to pull out their real hair from the roots. Once the natural hair growth begins to push out from under the mesh lock, one of Ellery’s therapists removes it and the extensions are adjusted until they’re totally redundant. The patient then enters a course of reinforcement sessions and is monitored for relapses. But by that time, the urge to pull has often eased.
Ellery sees herself as a facilitator rather than a healer. “Getting the hair to come back is the easy bit. Keeping it is the hard part.” To her credit, sending home once-patchy patients with a full mane inspires house pride for the head, and goes a long way toward curbing destructive behaviour. Nonetheless, she refers some TTM clients in “remis- sion” to Anne Thornton-Patterson as a means of helping them maintain their success.
The hypnotherapist works either in person, on the phone or via Skype, with clients as far away as Australia. “I’m the reality check,” she says. “I’m the one bringing them back into their body to give their mind the rest.” In her calming, level voice, Thornton-Patterson trains her patients to unlearn the habit by exploring the origins and causes of pulling, and becoming intensely aware of it in times of anxiety. She also retrains the brain by replacing the pleasure associated with pulling with an alternative pleasurable outcome, such as being able to wear one’s hair down. Thornton-Patterson says most of her patients have overcome their compulsion after a course of eight face-to-face sessions, each of which is one to two hours long.
“I see people who’ve consulted everybody and there’s been no change,” she says. “The truth is, the younger you are, the more chance you have of stopping. One person may stop immediately, one may take 18 months. The difference is whether it’s time.” For most people, she says, motivation comes during the early stages of a relationship, or prior to a wedding.
Or when a child has become inquisitive. I’m heartened by Thornton-Patterson’s depiction of tricho sufferers as a highly motivated, determined and over-achieving class of women. I’m less encouraged by Rohrer’s take. The spiritual healer sees tricho as an addiction, and symptom of some deeper emotional issues. “There’s deep healing work that has to be done [in treating TTM],” she tells me. “Hair-pullers in my opinion are highly sensitive people and tend to suppress their emotions and be out of touch with them. There is potentially a part of them that’s dissociated—split off from their own consciousness.” Oh dear.
Though she emphasizes she’s neither therapist nor doctor, Rohrer offers a “road map” out of tricho, a 15-lesson program called TrichotillomaniaFree Women’s University, which begins with the student “experiencing pain, turning inward and dropping deep” and includes support calls and emails, plus online forums. This can last anywhere from 6–12 months, for $80 per month. She won’t share her success rate, but directs me to her website, where she’s published dozens of client testimonials.
As a long-time devotee of the shortcut, I’m a bit overwhelmed. Whatever happened to willpower? “It doesn’t work,” she insists. Instead it’s about uncovering the core—why you started pulling in the first place—and reconnecting with yourself. “I’m not sure that people understand that I do, in every sense of the word, mean ‘addiction,’” she says.
As much as I doubted this when I first spoke with Rohrer, I’m beginning to sense she might have a point. I successfully quit smoking at 30, but can’t imagine a day when pulling won’t be part of my life. What I’ve begun to work on is my awareness, being present in my actions and monitoring their intensity levels. When I’m in a good place—relaxed, well-fed and happy—I’m able to distract myself, put my hands to useful work or tuck them between crossed legs. But when I’m irritable and facing down a deadline, I catch myself pulling and simply don’t care.
Thanks to this article, my TTM is out there now, at least. But believe me when I say it’s hard, hard work to be free.