The Tricky Habit of Trichotillomania

I have obsessive-compulsive behaviors characterized by plucking hairs off my arms, stomach, and eyes. I am 15 years old and have tried to counter the behaviors but lately it has proved too much. I was wondering if you could give me some advice on how to stop.

Trichotillomania is the compulsion to play with, tug, and pull at your hair. It serves a self-soothing function, especially during episodes of stress and worry. This sometimes results in having bald patches of skin where the hair has not had time to regenerate.

An important component of treatment: don't put yourself down for having this compulsion. You are not responsible for it; the compulsion has a biological origin and most people do behave impulsively in some area of their lives. It is likely that you appease your anxiety, however fleetingly, by plucking your hair. A tolerant but structured approach will help you deal with it.

Many interventions have been examined for trichotillomania, but the two that currently seem most promising include finding a support group with others who are fighting it, and record keeping. These approaches, combined with an understanding of your thinking patterns, improve your self-awareness and control over this behavior.

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Keeping a record of your pulling habits compels you to face your impulses constructively. Be patient with yourself until you master this technique, but start a hair collection envelope or container, and write down the time and the location of each hair you pull. This directs you to recognize your triggers. Common triggers are frustration and anxiety.

When anxious, we're motivated to "do something" or to take action. In the case of trichotillomania, your nervous energy is expressed by hair plucking. Trichotillomania is probably an ancient impulse, borne out of grooming behaviors gone awry.

For several reasons, I encourage people with trichotillomania to first attempt behavioral approaches before considering medications. Medications have side effects, and when combined with behavioral approaches, you might assume that any improvement is a result of the meds.

Improving awareness of triggers (frustration, worry, and so on), and the habit of plucking, plus collecting information, will help you to learn about yourself.

Remember, you don't have to be perfect at record keeping or identifying triggers. If you notice frustration, say things to yourself like: "I can choose not to pull at this moment." "If I start I can stop." Those moments add up, and so will your control over this tricky habit.

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