Hair pulling is most often seen amongst girls and young women. So when Calvin* came to see me about his hair pulling he felt even more self-conscious. He’d been for conventional treatment but it had actually made him feel worse.
“I felt enough of a freak as it was for pulling my hair out” he told me, “without going to a clinic and being the only guy there. Sitting in a waiting room or a group was bad enough, but the therapists seemed to struggle with me as well because I’m a male and not in my teens.”
“Because I pull hair out at my crown people think I’m going bald. They make jokes about it and they don’t understand why I’m so sensitive over it. But it’s because I’m ashamed – ashamed of being weak, of having a thirteen year old girl’s habit. And because of that I can’t talk about it, and the only release for bottling things up is pulling my _____ hair out.”
“Even though I know it’s causing me all this damage and stress I still keep on doing it. I mean, how mad is that? How messed up is that of me?”
In fact what he was describing was behaviour a lot of people show – for instance using food to make themselves feel better about their weight gain, or using drink to cope with the stress of alcohol affected relationships. The problem wasn’t that Calvin was ‘messed up’. The problem was that he was trying to use logic and reason to deal with an emotional problem.
Hair pulling isn’t just a way for some people of dealing with stress and anxiety. It also releases dopamine, the chemical released by the brain’s reward centre. So there’s not just an emotional release, but an actual reward for the behaviour. Once Calvin saw that, he could start to give himself some credit for not being able to stop without help.
We used a two-pronged approach to manage and reduce his hair pulling.
On the one hand we looked at the habit itself, and learning to disrupt it. A lot of it was done almost unconsciously, and when he wasn’t consciously feeling stressed. I taught Calvin ways to become more aware of his habit at the time, and to find rewards to replace the dopamine reward from the hair pulling itself.
At the same time we looked at his everyday stress and anxiety, and ways to manage that. With not feeling able to talk about his trichotillomania Calvin had also stopped talking about other anxieties and concerns. The result was that even though he had friends he still felt quite isolated.
Encouraging him to open up was the hardest part – harder than getting him to break the unconscious habit. In the end though it was opening up that gave him the safety valve that he’d needed all along.
* Calvin’s real identity has been protected, and he is happy to share his story.
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