The Roots of Distress: The Relationship Between Trichotillomania and Anxiety Disorders

Trichotillomania is an impulse control disorder in which you feel compelled to pull out your hair. The most common hair pulling site is the scalp, but some pull out eyelashes, eyebrows, pubic hair, or any other body hair. For some, the pulling is contained to one location, while others pull out hair from multiple body parts. Once thought to be rare, trichotillomania now affects an estimated 2-4% of the population and typically emerges in childhood; the disorder is seven times more common in children than in adults, although many continue pulling throughout their lives. Symptoms include:

• Noticeable self-induced hair loss
• Increasing feelings of tension prior to pulling
• Feelings of pleasure or relief while pulling hair
• Close examination of pulled hair, such as inspecting the roots
• Specific hair-pulling preferences or patterns of pulling behavior
• Playing with, biting, chewing, or eating hair

For many people with trichotillomania, hair pulling is a deliberate, enjoyable, and ritualistic process, for others, the pulling is unconscious, and some engage in both intentional and unintentional pulling. Despite the emotional distress and functional impairment that commonly arise as the result of the hair loss, the satisfying nature of hair pulling often keeps you trapped in a cycle of buildup, release, and regret that mirrors other forms of addiction. Mackensie Freeman, who started pulling out her eyebrows in the fifth grade, told Cosmopolitan Magazine, “I like pulling hair and it’s a big barrier to overcome the pleasure of doing it. It’s calming. In the moment, I act on it, it feels good, but then I regret later.”

The exact cause of trichotillomania is not known. In fact, the disorder may have no singular genesis, but, rather, a collection of potential triggers, both nebulous and concrete. What is known is that trichotillomania often develops in concert with anxiety disorders and many experts now understand trich as a maladaptive attempt to cope with overwhelming psychological distress. In 2012, Alexandra Heather Foss, an abuse survivor who suffered from crippling anxiety, wrote a stirring personal essay for The New York Times about her own history of hair pulling:

The way I coped with circumstances outside my control was to grab onto something — my body, more specifically, my hair. I tried to marginalize my pain and dissatisfaction by uprooting the bad things that were making me anxious with tweezers, my fingers, nail clippers, safety pins, whatever tools were available during the desperate hours of my suffering. I would pull and pick and the destructive vortex of emotion that was threatening inside to sweep me away from life would stall, would recede, and for a while I could be calm, safe, even though that safety came at a painful price.

In moments of acute emotional pain, the sense of calmness imbued by hair pulling can be profoundly relieving and offer a path out of the suffering. Foss even credits her trichotillomania with saving her life in times when she had no other escape from her pain. However, this relief is short-lived; not only does the urge to pull return and often grow stronger with time, but your behavior and altered physical appearance can further fuel your anxiety and impair your ability to live a healthy and productive life. Often, trichotillomania creates new and specific sources of fearfulness that augment your pre-existing emotional pain; you may feel so ashamed of how you look that you self-isolate, withdrawing from family and friends, and it can impede your ability to attend school or work, removing you from the vital social supports you need to heal. For some, this can lead to the development of depression, as you are left vulnerable to ever-deepening emotional instability.