Hey all, my partner is a trans boi and he asked me to post here on his behalf to ask about trichotillomania, which is compulsive hair-pulling. He pulls hair out from his pubic area, particularly from his labia, and it leaves a lot of ingrown hairs that sometimes then become painful. He says he finds it soothing and enjoys the pain (and yes, we do enjoy a bit of S&M in the bedroom, but I don’t think that this is directly related). From what he’s said and from what I’ve read about it, it seems that this is related to anxiety, and he deals with a LOT of stress on a daily basis. He wants to stop the hair pulling but doesn’t know how, and I don’t know either.

Has anyone else dealt with this before? Any strategies for dealing with it? We live in Kenya and don’t have much access to medical services, let alone mental health services, so personal experiences or links to useful resources would probably be most helpful.

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17 Responses to trichotillomania/hair pulling

  1. Hteall says:

    I can only offer sympathy — and a post, so people will look and perhaps make a follow-on comment, heh. I also have a tendency to yank hairs, though not enough to get any which aren’t about to shed soon anyway, and not enough to get ingrowns.

    Are there any other self-soothing behaviors he could engage in, that might ease the stress? If he can find something else that works, then… Hm. Maybe you could trim his pubic hair enough that he can’t actually get a grip on it, while he transitions to the new stress-soothing habit? (But not shave entirely, as that might cause ingrowns as well. …it very well may make him kinda scratchy down there, though, so be warned!)

    Good luck to him!

  2. RedNope says:

    Thank you! He does some crafting that is very fiddly, so I’m thinking that might be a useful replacement…

  3. Sssne says:

    I found myself pulling hair from my head while studying for exams and other stressful school-related assignments on a regular basis. I now keep a hair elastic on my wrist, and will take it off and play with it instead, or I’ll drum my fingers on my leg in a particular pattern. For me it was all about conscious choice, I would catch myself doing it and would then purposefully force myself to do the new ‘acceptable’ behaviour for a few minutes in order to build an association in my brain and to create a new habit.

    It takes a little bit of work. I’d also recommend maybe him maybe wearing a belt with his pants, but one hole too tight, so in order to get his hand into his pants he’d find it a little bit difficult to do without focusing, and once he noticed he’d be able to substitute the new behaviour. If the sensation of hair is what’s satisfying, perhaps try twisting hair on the head between the fingers, or if it’s the little sting, perhaps try snapping an elastic against the leg. The main point is to substitute one behaviour for another.

  4. RedNope says:

    Thanks! He likes to be naked in the house a lot, which definitely facilitates the whole thing. We’ll try to figure out something else to replace it.

  5. SseFriut says:

    I suffered with trich for a lot of years. By the time I sought medical treatment, it had progressed from pulling eyelashes and eyebrows to pulling pubes and having a noticiable bald spot on the crown of my head. I was quite clearly at a point where I could not stop on my own (I often pulled unconsciously, only realizing what I’d done afterwards when I saw the pile of hair sitting next to me). My personal treatment was weekly therapy sessions and mega-doses of Zoloft but I realize that this probably isn’t feasible for your partner at this point in time.

    1. Find the triggers. If it’s stress, do what you can to help him formulate a plan to reduce or eliminate stress in his life. You can also work on a contingency plan for how to handle the stress without pulling (because entirely eliminiating stress is obviously impossible).

    2. Trich is very tactile. There is an immense sense of relief and release when you find the “right” hair and you pull it out. Try finding something to keep his hands busy. My personal favourites were a string or elastic around my wrist to play cat’s cradle with when I wanted to pull and silly putty. Silly putty is good because it keeps hands busy and has the added bonus of making them sticky and less likely to put in hair. Those koosh ball thingys are really good as well, as are stress balls/balloons and taking up a hobby like jewelry making or knitting/crocheting to prevent idle hands.

    3. If there are specific times when he pulls that can be identified try to avoid them, or make sure he goes into them prepared to consciously think about alternatives to pulling.

    Things like having you gently remind him to find an alternative if he’s pulling in front of you or somthing as simple as having him sit on his hands when he feels the urge to pull can be helpful. Continue to be supportive, anger and frustration will make him more self conscious and probably more likely to pull. Offer up suggestions and distractions to help him keep from pulling and make sure that he and you both understand that it can be a long road to remission for someone with trich.

    Finding an online support group may also be helpful (the one I was a part of has disappeared unfortunately).

    Best website out there: www[dot]trich[dot]org

    If there’s anything else I can help you or him with, just let me know!

  6. RedNope says:

    Thanks so much for your advice, this is very helpful!

  7. RedNope says:

    Also, he used to pull his eyelashes too — for some reason I never made the connection between the pubic hair pulling and eyelash pulling! He did stop the eyelash pulling because he started to get a lot of stuff in his eyes and small cysts on the eyelid. I’ll ask him how he managed to stop that, and whether any of the same techniques can be applied to the pubic hair pulling (though that is probably less ‘harmful’ in the long term). Thanks again!

  8. DleRa says:

    I’ve had trich for years and years now, to the point where at least a quarter of the hair on my head was gone. It’s under more control as of the past few months – in a few more weeks, I probably won’t have to wear a hat everywhere – but I still pull from time to time. In my case, an SSRI and hypnosis seem to have helped, especially the hypnosis, but that may not be workable for him.

    I’ll second what the others have said about making it harder to pull, avoiding triggers if possible, and finding substitute sensations. One substitution that helped me was massaging my scalp, which let me keep my hands near my head and feel hair against my fingertips without doing any damage.

    I’ll also second the recommendation to trim or shave, if he’d be okay with that. (I use an electric razor on dry skin, and I find it doesn’t cut close enough to cause ingrown hairs.) I’ve shaved my head a couple times, and it worked great until the hair got longer and tempting. You can’t pull what’s not there.

    There’s also a trich group on LJ: http://trich.womanorium.com

    Oh, yes, and he doesn’t have to totally quit cold turkey, and shouldn’t beat himself up if he can’t. Compulsive behavior doesn’t just go away overnight. It takes time, and setbacks are normal. I doubt I’ll ever be *completely* pull free, but right now, I’m not pulling enough to leave bald patches, and that’s enough for me. He may want to be completely pull free, but make sure he gives himself time and is compassionate with himself. Pulling less is progress, even if he’s not at his goal yet.

    One final edit: I found this at the LJ trich community. It looks like it’s definitely worth a shot for him.

    http://www.uke.de/kliniken/psychiatrie/downloads/klinik-psychiatrie-psychotherapie/decoupling_for_TLC_19_2_10.pdf

  9. Hteall says:

    Compulsive behavior doesn’t just go away overnight.

    Yah. To stop biting my nails, I had to do it literally one nail at a time. And even now, I still bite one fingernail. (Because there are some activities where I don’t want long fingernails, y’know? And to keep from biting again, I basically have to grow my fingernails pretty long; there’s no middle ground.)

  10. HseNew says:

    This is what my fiance is working on doing. He’s down to one nail. But I honestly think he has damaged his nails (especially this one now) that they’re never going to grow back, or atleast grow back normal. But it has definitely helping going one at a time.

  11. Hteall says:

    Give ’em time. They may never be as strong as “normal,” but then again, they might surprise you. Mine are moooooostly normal-looking, though they tend to be a bit bendy and prone to having the top layer crack and peel instead of curving. *sigh*

  12. Sssne says:

    I heard gelatin tablets can help with that, but that’s just what I’ve heard from my nail health obsessed friends and from around the internet.

  13. RedNope says:

    Awesome advice and link, thank you so much!

  14. Rev007 says:

    Another trich-sufferer here. It is definitely a difficult thing to manage, because it can provide a lot of soothing or pleasurable feelings even as it causes physical pain or mental guilt from doing the behavior. I pull from my head and eyebrows mainly but occasionally find myself twirling pubic hair too.

    Trich is thought by most doctors currently to reside on the obsessive-compulsive disorder spectrum, as it shares many characteristics with that disorder. So for most of us, cold turkey is not really an option without a lot of outside support and coping techniques. But some management tips can definitely be tried on one’s own.

    Suggestions:

    – He can try wearing thin gloves at times when he tends to pull, which make it a lot harder to pull just one hair, and also remove the pleasurable tactility of hair in one’s fingers.

    – Focusing on the fact that the behavior is happening can help him modify it; a lot of trich tends to be subconscious and then – oh crap, where did all this hair come from? Removing the automaticity from it by paying more attention to his hands can help. You can help with this, too, if he pulls where you can see him — just a simple reminder of “Hey, you’re pulling, did you realize?”

    – As others have suggested, finding an alternative way to occupy his hands can be helpful. A squishy ball to roll in his hands, a stone to rub, a string to play with, a bit of cloth to feel, could all serve as a substitute sensation.

    Trich is not easy. I haven’t ever really been able to be in remission completely. My eyebrows go to hell when I’m stressed and my head hair is perpetually frizzy with new regrowth. So make sure he understands there may be setbacks, or that the course of the disorder may have ebbs and flows where sometimes he pulls more and other times less. I feel a little more zen about realizing I may never be 100% free of it and that I can live with that; it means I don’t have to live up to a perfect ideal, and can instead shoot for more reasonable goals of “have matching eyebrows” or “only pull a few hairs a day.”

    Good luck!

  15. RedNope says:

    Thanks so much, this is great advice.

  16. SseNope says:

    Personally, I used to (trigger warning) rip up the callouses and cuticles on my fingers and toes. The compulsive plucking I did of my eyebrows, nipple hair and ladystache was preferable to the damage I did to my feet. I don’t do it as often because the hairs that I was neurotically trying to keep at bay have since thinned out and even stopped growing back.

    My chin hairs get plucked as soon as they are long enough to grab, but basically plucking my chin is incredibly difficult because the tweezers can’t grab such fine or short hairs. I stopped plucking my nipples when I realized that doing so caused (painless) ingrown hairs.

    I still bite the hell out of my nails, and will use a thumbtack to tear the cuticles if given half the chance. But keeping my nails properly cared for–cuticles pushed back, nail edges smooth, etc–helps prevent my idle, anxious mouth from finding those rough edges and tearing away. It does become a sensation thing for me, all of these self-harm anxiety outlets are. It’s not quite the pain, but the discomfort that is appealing.

    What if he blocks or restricts his access to the pubes? Maybe he could wear underwear all the time? Or–and this seems less practical and probably completely unrealistic–perhaps he could go get waxed, thus preventing hair to be around to be plucked? Even swapping out his tweezers for something that’s less efficient might be just discouraging enough.

    If stress triggers the behavior, figuring out ways to deal with the stress is an obvious tack. As I said though, my plucking is probably one of my least destructive self-harm anxiety behaviors. If he does find it to be a productive outlet for his anxiety and stress, then he might want to simply look into how to avoid ingrown hairs and other negative effects. But if he wants to stop the behavior, it’s probably more productive in the long run that he deals with the root cause rather than just transferring the behavior to another body part like I did. 🙂

    Recently these two anxiety resources have been suggested on VP, and I think they look super useful. They’re based off of Cognitive Behavioral Therapy, which made all the difference in my brain:
    Living Life To the Full, a web-based self-propelled therapy system
    When Panic Attacks, a book

  17. RedNope says:

    Thanks so much for those resources, we will definitely take a look.

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