Pulling Your Hair Out? For Some, the Struggle Is Real

For some people, “pulling my hair out” isn’t just an expression — it’s a legit concern. Compulsive hair pulling is a type of body-focused repetitive behavior (BFRB) that affects 1 to 2% of Americans, mostly women. The uncontrollable urge to pull hair can result in bald spots on the scalp, eyebrows and lashes.

Experts don’t know what causes the intense desire to pull hair, but there may be a genetic link. Thankfully, recovery is possible. Preventive medicine physician and wellness expert Sandra Darling, DO, offers her insights.

Q: What are the reasons people experience hair pulling?

A: People who compulsively pull their hair often feel shame and embarrassment yet continue pulling anyway because the behavior:

• Is tough to resist.
• Provides calm and relief.
• Gives a sense of gratification or pleasure.
• Is automatic, so the person isn’t even aware they’re doing it.

People with a hair-pulling disorder (also known as trichotillomania) may have triggers, like boredom or fatigue. Emotional triggers include feeling anxious, stressed or overwhelmed. 

Q: What emotional toll can a hair-pulling disorder have?

A: People who chronically pull their hair become very good at hiding the behavior if they feel weird or abnormal about it. They may feel like they’re the only person who has this urge, which could lead them to experience emotions such as:

• Shame and embarrassment.
• Low self-esteem.
• Depression and suicidal thoughts.
• Anxiety.

In some cases, the impact of hair pulling goes beyond cosmetic and psychological damage. Some people eat their pulled hairs. The hair can get matted in the digestive tract and create a hairball, which can be life-threatening if it causes a blockage. Surgery may be necessary to remove it. 

Q: What are some strategies to successfully overcome hair pulling?

A: Some people can completely stop hair pulling behavior. For others, trichotillomania is a lifelong disorder that ebbs and flows with life’s events and stressors. Well-meaning friends and family members should avoid telling their loved ones to stop pulling — trichotillomania is a disorder that requires professional help.

A person who pulls can learn to control the urge through a combination of treatments, such as:

• Behavioral training: A therapist experienced in treating trichotillomania can help increase trigger awareness and decrease the urge to pull. Therapists may use different approaches, including habit-reversal training or hypnotherapy. Behavioral therapy also helps lessen the negative emotions someone feels and improves self-esteem. 

• Medication: People who experience chronic hair pulling may benefit from medications to help quell the urge to pull or to address related conditions like depression or anxiety.

• Self-care: Prioritizing self-care, including regular meals, exercise and sleep, are essential for the road to recovery. Meditation, yoga and journaling are relaxation techniques that can reduce anxiety by creating a sense of calm, increase confidence and resiliency, and improve self-awareness to better recognize triggers and urges.

• Social connections: A person trying to stop this behavior benefits from the support of friends and loved ones. Connecting with others who have the same struggles is also helpful. The TLC Foundation for Body-Focused Repetitive Behaviors offers a directory of support groups and educational events.

Q: How can people avoid drawing attention to their bald spots?

A: To hide the condition, many people use hair extensions called crown toppers. They may also use false eyelashes or eyebrow pencils to disguise areas of hair loss. Hats and headscarves are typical as well.

But while you may want to hide the effects, don’t hide the disorder. Be open and honest. Confide in a friend or loved one so you can start on the path to recovery. And you can find inspiration from those who have publicized their struggles with hair pulling, like Megan Fox and JessiKate Riley (Miss Utah 2017).