GUEST POST: Trichotillomania and Self-Image

This week's post is a guest article from Ariel Taylor from Trich Stop is an online therapy programme for trichotillomania sufferers, but also features useful blogs and articles as well as an open forum on which you can discuss all elements of hair-pulling. I think it's such a great resource for us BFRB-ers out there!

Compulsive hair pulling, or trichotillomania is a body-focused repetitive behaviour that falls into the obsessive-compulsive spectrum of mental health disorders. People with this disorder engage in a behaviour that those with no experience of the condition do not understand, and those with trichotillomania are acutely aware of how others perceive them. With modern Western culture being so obsessed with image, it is difficult for those who do not feel as though they ‘fit in’ with the norms.  The stigma of a mental health disorder combined with the physical effects of pulling hair creates a negative cycle of emotions that tears down the self-image of sufferers.


People with trich keep to themselves. Whether others judge them or not is irrelevant; the fear of judgment, the fear of questions they don’t want to answer can completely overpower all other thoughts. The person is left to deal with the disorder alone, internalizing the fear, anxiety, loneliness, and depression.

Cycle of negative emotions

As negative emotions take over, hair pulling behaviors tend to worsen. It’s a vicious cycle. Increased anxiety results in more pulling, which leads to increased shame and feeling worse about oneself, which results in increased anxiety which means more pulling and so on.

A person who compulsively pulls their hair also spends a considerable amount of time covering it up. They feel unattractive, ashamed of the work they have to do to blend in. Often, they fear the covering up won’t work. Therefore, sometimes it is better to avoid people and not go out in public altogether. What if someone sees? What if the work to cover up bald spots fails? Other people may not know what caused this, but they are looking. A person with trich is highly sensitive to the reactions of others; hyper-focused on whether someone is looking at them, assuming people “know” and internalising nonverbal cues. They feel further and further away from “normal.” The further one separates from “normal,” the more difficult it becomes to hope that “normal” is achievable.

Physical effects

The physical complications that arise from trich complicate the cycle of negativity. Bald spots on the scalp, missing eyelashes or eyebrows, and hair that regrows in unusual patterns and textures are only a few of the physical effects seen by others. Sometimes, these physical effects result in scalp damage, hair follicle damage, or other types of physical illness which mean going to a health provider. Avoidance of doctors is typical because of the fear of discovery and the shame of having to explain how it happened.

When people with trich hide and don’t seek help, the situation gets worse. The physical and psychological effects worsen and become more complicated.

What to do

  • Understand that trich is a treatable mental disorder. Qualified experts in body-focused repetitive behaviours guide clients through therapies that increase awareness of behaviours, create other things to do instead of the behaviours, treat underlying or co-occurring mental health issues, and connect clients with supportive resources. People deal with trich their entire lives, but they can learn to manage it successfully to make day-to-day tasks easier
  • Separate the person from the behaviour. Internalised negative emotions wear down one’s self-esteem. Those who struggle with mental health disorders live a life centred around the “problem.” Eventually, they internalise to the point where they feel like they are the problem. It becomes a significant part of their identity.
  • Practice self-care. Trich does not define a person. Build internal resources by practicing activities that build on strengths and boost self-confidence. Learn relaxation and stress reduction techniques. Pamper yourself every once in a while and celebrate recovery victories.
  • Connect with supportive others. Social support networks can provide empathy, support, encouragement, and advice. Connect with others online or in person to learn how other people get through recovery. Emotional burdens are easier to deal with when shared.
  • Treat yourself how you want others to treat you. Use person-first language that separates people from the things with which they struggle. For example, referring to someone as hair-puller limits who they are and projects a message that the disorder is in control. In reality, the person may be an activist, a chemist, a teacher, or a volunteer who has a mental disorder called trichotillomania. Choose to project an image of confidence.

People who struggle with trichotillomania experience a cycle of debilitating negative emotions. Therapy, self-care, supportive others, and separating self from the disorder are empowering ways to improve self-image. 

I'd love to hear your own experiences of self-image and trich. Would you add any other snippets of advice to the list?

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