In a world where a woman’s beauty is greatly linked to her hair across different cultures, women with trichotillomania have varying issues with self-perception and self-esteem. Trichotillomania (trick-o-till-o-mania) is a mental health issue where the affected person compulsively plucks their hair out. It has been linked to higher levels of anxiety, depression, stress, and substance abuse. Hair plucking is often associated with the feeling of relief or a sense of reward.
Mental health issues are not taken seriously in many parts of the world, especially in Africa, which makes it hard for women living with trichotillomania to speak out about their condition.
“Discussing mental health remains a challenging subject with my African parents. My dad constantly mocks my hair-pulling habit, despite being aware of its causes, and his comments consistently hurt me. Even though I still live with them, they struggle to comprehend the daily battle I face in trying to overcome this behaviour. Why is it so difficult for them to understand that this is a long-term struggle, not something that can be resolved overnight?”
While hair pulling can be a common but temporary phase among children of different genders, this disorder disproportionately affects adult women with a ratio of 9:1. Chronic hair pulling usually starts from adolescence and can be a lifetime illness.
“I started at age 14, and I am now 45. Of course, I had times I did it less and times where I didn’t have much hair.”
Women with this disorder may also be affected by trichophagia. This related condition causes them to eat the hair after plucking, which may cause severe harm to their digestive tract and overall physical health. People with trichophagia may need surgical interventions to prevent the swallowed hair from causing bigger problems ranging from stomach aches to death.
“I started about 3 years ago with pulling hairs; from there, it spiralled, and something about playing with the hard hairs in my mouth kept me going. I ate them in the beginning and then tried to spit out as many as possible because I found out that eating these hairs can do serious harm. Now I’m having a stomach ache… I’m a bit paranoid it could be a bezoar and I really don’t want a big scar from the operation”
The most common areas where trichotillomania manifests include the scalp, eyebrows, eyelashes, and pubic area. Affected persons usually pull out one strand of hair at a time but from the same spot, causing large bald patches. This may increase feelings of anxiety and shame in the person, eventually affecting their self-esteem and preventing them from seeking necessary treatment.
“When I was 15, I started pulling out my eyelashes without even paying attention to what I was doing. After a while, I finally noticed that I somehow managed to stop pulling but replaced it with obsessive touching and rubbing (which still causes the hair to fall out but less than the pulling action). I find it really hard to stop to the point where I cannot look at myself in the mirror.”
Researchers have been able to give educated guesses as to the causes: genetics, changes in brain chemistry, and coping mechanisms for stressful situations. Trichotillomania is not a contagious disease and is generally easy to diagnose. Treatment could be therapy, medication, or, in some cases, a combination of both.
Women living with trichotillomania may undergo physical group therapy, where they seek support from others sharing the same condition. For those who do not have physical support groups, some online forums may give them support and insight into the symptoms of trichotillomania and treatment.
Habit reversal therapy is another treatment method where the patient works with a therapist to understand the patterns and behaviours that encourage them to pull out their hair, with a focus on breaking the patterns. Habit reversal therapy has been the most effective treatment for women suffering from the disorder. According to a 2012 study, a woman who had been pulling out her hair for over 14 years started habit reversal treatment and attained complete remission after 12 weeks.
Medicative treatment solutions for trichotillomania include antidepressants, anticonvulsants, antipsychotics, and nutraceuticals. These medications often treat an underlying condition that causes trichotillomania, like depression or anxiety. They have several side effects and should only be taken under the consultation and supervision of a medical doctor.
3 Black Women Living with Trichotillomania
Living with trichotillomania can be an isolating and challenging experience, especially for women in cultures where hair is closely tied to beauty and identity. To shed light on this journey, we spoke with three Black women who bravely shared their stories of living with and managing trichotillomania. Their experiences underscore the importance of understanding, support, and the relentless pursuit of effective treatment.
1. Fola
I hate how much of an issue TTM has become in my life. I started pulling in the 8th grade, and now I’m a sophomore in college. It’s always been so difficult fitting in at school, and I guess I never wanted to admit that all the weird looks I got were due to my hair and not other physical reasons. Even now, I struggle to make peace with the way I look. I shower and run shampoo on my scalp and massage it, but all I feel are bald spots, which frustrates me. Why did I ever let it get this bad?
2. Sarah
I am a school teacher with numerous repetitive breakouts on my face because I cannot stop touching it and plucking any hair I find there. The hairs made me feel icky and unnatural… and this made me develop severe scarring on my face. I enrolled into habit reversal therapy, which helped me gain awareness and control my urges, and in a matter of four months, I was completely free from hair pulling and have not pulled since then.”
3. Amanda
I’m an African-American woman who has been pulling her hair since I was 8. I am now 35. I have been in psychoanalysis for the past 12 years. It’s been a blessing. I have tried everything before that, every medication, every therapy. But Freudian psychoanalysis has been amazing. It’s been a very difficult process. But for the past three years, I have had three pulling episodes, each of them lasting more every time. The last time I felt free from the illness, I spent four months without pulling one hair. And I’m not talking about taking extreme measures to stop pulling. I’m saying that the urge to pull went away completely. It’s amazing. I could go to the hair salon to style my hair as I wanted. I even forgot about the hair-pulling.
And my relapse has been devastating. But I’m trying to stay confident that that moment will come again. I felt like a different person entirely. I felt free from trying not to pull. I felt like myself ( whatever that means).
Women with trichotillomania need to understand that their hair does not define them and that it is in no way linked to their beauty or sense of self. It is a treatable and manageable illness that affects many women around the globe, and sharing your condition with like-minded individuals and treatment professionals can go a long way in salvaging your self-esteem and changing your perception of the illness. It is also important to note that, like with any manageable condition, women with trichotillomania may undergo a relapse in their condition, and having support is necessary.
