Thank you for your column. I really enjoy it. I am a teenage girl who bh has many things going for me; I have a great, loving family, plenty of friends, good grades and all in all I am very happy. I do suffer from trichotillomania (I pull out my hair). But just to make it clear those who don't know would not be able to tell. My friends know and really don't think about it—it really has no effect on my life. Do you think it is necessary to go for therapy or do whatever it takes to stop (after all iyh I will get married and cover my hair anyway)? Thank you.

Response:

I wonder what led you to ask this question. Is it because of something completely external to you that doesn’t relate at all to your feelings and beliefs about the trichotillomania? For instance, are you asking only due to feedback that you received from others, or because of something that you read? After all, you stated that it has no effect on your life. In other words, does your trichotillomania not bother you in the slightest, but you’re simply curious about what a therapist might think?

If this is not the case, is there something about this that bothers you (however slightly)? If so, it’s important to acknowledge what this is. Even if you don’t wind up changing your behavior, understanding what bothers you can help you to better deal with your feelings toward the trichotillomania.

Major issues aside, there are two basic reasons for maladaptive actions: force of habit, and underlying emotions.  Although one can make the case that there is an underlying cause for everything, this doesn’t mean that we need to identify the root cause for everything that we think, feel, and do. (If we did, we would have no time for anything else—and would succeed in identifying only a very small portion of our unconscious feelings and impulses.) However, certain habits are externalized manifestations of unconscious issues. When this is the case, identifying and dealing with the underlying emotion can help to both resolve the issue (i.e., anxiety, low self-esteem, etc.) and reduce the external manifestation (in your case, trichotillomania).

Perhaps there are no significant underlying factors, and the trichotillomania doesn’t bother you. Nonetheless, you might want to ask yourself whether it can cause problems for you in the future. Will your future husband, for instance, have a problem with it? Will it begin to bother you? Might your hair pulling extend to your eyebrows or eyelashes? Or might it evolve into skin picking (excoriation)?

If you have been pulling out your hair in the same way and at the same rate for years—and you’re certain that it’s simply a habit—asking yourself the above questions may be enough. However, it’s often difficult for us to identify the causes of our impulses on our own. If part of the reason that you asked this question is a niggling sense of unease, a couple of sessions with a therapist might help you to identify and deal with it—or put it to rest.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

 Brooklyn, NY   |   Far Rockaway, NY

 author of Self-Esteem: A Primer

 www.ylcsw.com / 718-258-5317

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