Tasneem Abrahams

Mastering Hair Pulling

Why Do Some People Pull at Their Hair When Anxious?

We explore the relationship between trichotillomania and anxiety

Posted Jun 29, 2017

jovibingelyte/pixabay
Source: jovibingelyte/pixabay

Trichotillomania is a disorder that affects 1-2% of the population, a majority of them female. The main feature is the recurrent compulsion to pull out one’s hair. Hair is pulled from any area of the body, the most common being scalp, eyebrows, and eyelids. Episodes of hair pulling vary over time, but the key features of the diagnosis include hair loss, recurring attempts to stop, and the behavior causes significant distress. 

Reasons for hair pulling

There are many reasons to pull hair. In some cases, hair pulling gives an emotional release, a way to focus on a different type of pain, or a way of soothing. For some, pulling hair leads to gratification or pleasure. Not all who pull hair do so consciously. While some pull hair with full awareness, there are others who do it without noticing what is happening. 

Emotional effects

Compulsive hair pulling is a stressful disorder often hid from family and friends. A cycle of negative emotions goes with the behavior including guilt, shame, and embarrassment. Many people who suffer from compulsive hair pulling prefer isolation, withdrawing from social interaction for fear of judgment. A person is left to deal with the disorder alone, internalizing negative emotions and often struggling with depression and anxiety. Not only do those feelings spark anxiety, but anxiety can worsen hair pulling activity. 

Anxiousness and Anxiety

Anxiety can be a normal human response, but it can also take over if unresolved. The physical symptoms of anxiety, such as restlessness and muscle tension, are the early stages of the body’s fight, flight, or freeze response activating. This is an oversimplification of years of research on how the body reacts to stress and trauma, but when the stress response activates, it is necessary for that energy to be discharged.

Hair pulling and Anxiety

There are healthy ways to discharge stress energy, and then there are not-so-healthy ways. Many people who struggle with trichotillomania, or compulsive hair pulling, associate hair pulling with anxiety. One study found that out of 894 people struggling with trichotillomania, 84% of them said anxiety was associated with it. Others report that hair pulling gets worse when anxiety increases. 

Masimba Tinashe Madondo/Pixabay
Source: Masimba Tinashe Madondo/Pixabay

One explanation for hair pulling worsening with increased anxiety is that pulling hair out relieves stress and tension. When one is anxious, tension in the body increases. The slight pain associated with pulling out hair and the immediate feeling of release may help to discharge stress energy. The focused activity of pulling out hair also serves as a mindful activity, where one focuses on the activity at hand allowing for anxiety to dissipate. 

Another explanation is that increased anxiety interferes with one’s ability to control impulses. Without anxiety acting as cognitive interference, our brains can be trained to control impulsive behavior through such therapies as habit reversal training. As anxiety increases, think of it as the “white noise” in your brain becoming louder. The louder it is, the less energy the brain has to make decisions. Therefore, the impulse control mechanism becomes drowned out by the “white noise.” 

More research needed

Research barely scratches the surface regarding the vicious cycle between anxiety and hair pulling. While anxiety is not the cause of compulsive hair pulling, it has been found to be a common trigger among those who do have trichotillomania. Often times people seek help for anxiety, but do not address hair pulling in therapy, thinking it is a separate issue. However, when the 2 are intertwined it is essential that therapy take on a holistic approach. Often times being aware that anxiety trigger pulling, and consciously taking steps to address the anxiety before the urge to pull occurs, can drastically reduce hair pulling as well. Keeping a daily records of your pulling and /or anxiety patterns can help you in this regard. If anxiety is a trigger for hair pulling for you, the best way to manage the hair pulling would be to find alternate, healthier ways to manage the anxiety. Activities like deep breathing, meditation, mindfulness, or sometimes even just talking to a supportive friend can be helpful. The key is to explore and find what works for you as an individual.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, Fifth edition. Arlington, VA: American Psychiatric Association. Grant, J. E., Redden, S. A., Leppink, E.W., & Chamberlain, S.R. (2017). Trichotillomania and co-occurring anxiety. Comprehensive Psychiatry, 72, 1-5. doi: 10.1016/j.comppsych.2016.09.005

Van der Kolk, B. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Penguin Publishing Group.

Woods, D.W., Flessner, C.A., Franklin, M.E., Keuthen, N.J., Goodwin, R.D., Stein, D.J. et al. (2006). Trichotillomania learning center-scientific advisory board: the trichotillomania impact project (TIP): exploring phenomenology, functional impairment, and treatment utilization. J Clin Psychiatry, 67, 1877–1888

About the Author

Tasneem Abrahams is an experienced CBT therapist who treats BFRB clients via online therapy programs. Her focus is skin excoriation disorder and trichotillomania.

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