Trichotillomania

Transcription of Lucinda talking about Trichotillomania

For those who are unable to view the video, prefer to read, or who have difficulties in hearing, this is a transcription of the talk

What is Trichotillomania?

It's a very very complex disorder. Many years ago it was considered to be an OCD, an Obsessive Compulsive Disorder, but in recent times it's now been classified as ICD, Impulse Control Disorder. It is a hair pulling disorder, in other words a person that may have it, has an irresistible urge to pull out their hair - sometimes without even knowing that this is the case.

It's considered to start at 10 or 11 on average but I've known it starting at a year, 18 months, younger. There's another level when it starts to kick off - 15, 16, 17, around the time when girls go to university and college; studying affects it. Recent figures from Professor John Grant who came to visit us here in England, indicate that 82% of those who suffer from TTM or manage it are female.

Tell-tale signs to look out for

There are tell-tale signs for parents that they could watch out for. I think there are several things that you need to be aware of, apart from the very obvious collection of hair under your daughter's bed or around a settee where she sits or the floor. You might find that your hoover is filling up massively with the amount of hair. Your child might be surprisingly intelligent - above average. She may also be deeply sensitive: this is very much the current feeling about how girls with TTM exhibit these qualities. Highly intelligent, above average. Deeply sensitive. Very difficult situation to deal with. So if you have a daughter that seems to be very intelligent, and also is very sensitive, and you're finding piles of hair around somewhere, it might be good to dig a little deeper - very, very carefully because it's a very unusual subject to deal with.

The typical pattern of hair pulling

It's kind of a sensible thing if you're looking to understand sites that girls might go towards, people might go towards. It's probably a good idea to understand how it kind of works. Very often a person might start with eyelashes, extracting eyelashes; they might migrate to eyebrows, and then eventually migrate to the hair; on the crown of the head or behind the ears. These are very very much the standard, if you like, features throughout. If you take photographs of the backs of girls with TTM you'll often see the hair at the back is untouched.

You can have critical TTM i.e. a full head of hair removed - I've known of a person that removed a full head of hair in five hours - and then you can have mild TTM, where you might just pick on your arms or legs. It really is as long as a piece of string, and it's about the same as someone who's about a stone overweight and 22 stone overweight - the variances are very great.

It's a very secretive condition

The majority of the girls will keep it secret, when they're very young a parent might be aware that they will usually object to having any reference made to it, and very often families will just calm down and quieten down about it because there's a kind of barrier, if you like, of talking about it. So it's a very big secret, and some I must say, keep this secret for forty and fifty years. And it is private - hair loss for women is a very private issue. Doubly so if you're in the situation where you have self-blame - my hair, my hands, my fault. Women express great feelings of shame, humiliation and embarrassment that they are actively pulling out their own hair.

Is it forever?

From the research that I have made over the years, the girls themselves, even when they've ceased the activity, always feel a bit anxious and nervous that it might come back very very quickly. So it's a bit like alcoholism, there's no known cure for alcoholism and there are millions of alcoholics who don't drink. So it's my belief that you may indeed have all the qualities of TTM, and miss out the pulling bit. I believe there are ways to avert that.

Tips to manage the hair pulling

Techniques like breathing - deep breathing - really really helps. There are lots and lots of ideas from various people that you can incorporate, but I have found that rubbing the thumbs here, around and around, the girls that use this and make it a habit; it is exactly the same feeling you get when you separate a single hair. So by learning to do this rubbing and rolling and thumb soothing - when you're listening to a lecture, sitting on a bus, riding on a train, plane or anything, and build it up as a habit to sort of sneak into the nervous system where all of this sits, it sort of makes you calm down, you can actually feel it if you practice it, brilliant.

Another technique to help reducing impulses and managing them, it getting yourself a really big darning needle - one that does not puncture the skin but creates a sensation - and by needle tapping in and around the area, it can send a shudder that very much emulates the same feeling as an extraction of the hair. So together with the feeling of searching and looking for a hair (the thumb technique) and the needle tapping, it very very closely resembles the same process of the seeking out a hair, extracting and fiddling with it. It feels very much the same.

What is permanent damage?

Knowing something about the structure of hair is very useful. Each follicle is designed to come back twenty-two times and last for six years, so repetitive pulling begins to age the hair and it starts to get crinkly and grey, which are very attractive hairs to actually feel and pull - so that doesn't help the situation. But literally as time goes by, with repetitive pulling, the hair comes back thinner and weaker and eventually fades altogether. But it does depend on the type of hair you have to start with, the quality, the amount, all sorts of things. The youngest girls I've come across with TTM scarring, i.e. permanent damage, could be in their mid-twenties - early to mid twenties - when they've had very, very chronic TTM.

What help is available?

Anything that you feel could help you - doesn't matter how crazy it sounds - you know if it helps and it gets you calm then go for it.

CBT - you'll need to register with your doctor, it is part of the NHS, it might take quite a while to actually get it, but do pursue it - you're entitled.

Hypnotherapy - works in conjunction with other things. There's no doubt that going towards Yoga, Pilates and Meditation really helps with the impulses, as does frantic exercise like Zumba and running. All of these things seem to expel energy, and they do help with managing your TTM.

My first steps to manage TTM

Definitely book into your doctor, register that you have this condition. Don't be too surprised if they don't have a huge amount of knowledge about it - it's still a secret and very private - but register and also register to go for your CBT; you are entitled. You're also welcome to come and visit us here at the Lucinda Ellery Consultancy where we've helped thousands of women over the years, and we will give you whatever advice we can.