[Editor’s Note: I’m a skin picker. I pick and scratch at my skin, especially around my fingernails. I’ve always thought of it as a manifestation of my OCD. When I start getting nervous, I’ll start picking at my cuticles or scratching my shoulder. I don’t do it much, but when my anxiety picks up I do. So when I saw Adrienne Jones, who blogs at No Points for Style, talking about trichotillomania on Facebook, I jumped at the chance to invite her to write about it, and dermatillomania, here in case any of our moms are dealing hair pulling and skin picking as symptoms of depression or anxiety. -Katherine

On Hair Pulling and Skin Picking -postpartumprogress.com

For more than twelve years after I started pulling out my eyebrows and eyelashes, I thought I was the only person in the world who did this strange and frightening thing. I don’t remember how it started, or what I was thinking, or how I felt about it. My first memory about pulling is a memory of exposure—a classroom, an open book, a tiny heap of lashes on the page.

“Ewww, gross! Mrs. Polson, Adrienne is pulling out her eyelashes! Oh God, that is so disgusting! Why would you do that? You’ll have a bald face!”

I swept my hand across the page, sending the lashes into the air, and spoke low. “It’s no big deal. You don’t have to tell everyone. It’s no big deal!”

That was in 1980 when I was nine years old, and for the next dozen plus years I made excuses for the hair that was missing from my face. I faked vision problems in hopes that glasses would offer some camouflage, and turned my face away or down, hoping that people wouldn’t notice. Eventually, I learned to use makeup to make the missing hair less noticeable, though no one who looked carefully could fail to see. I wanted very badly to be invisible.

I tried everything I could think of to stop, and since I pulled mostly when I was reading (and I read a great deal), my efforts usually centered on somehow keeping both of my hands busy (one holding the book, the other occupied with something else) or incapacitated. I wore gloves; held a lump of silly putty; put substances on my fingers that would sting my eyes; wore wrist weights; kept my fingernails trimmed brutally short; and punished myself relentlessly.

I’ve always been possessed of this irrational belief that self-flagellation could somehow cure all that ailed me.

Nothing worked, least of all the perpetual shame and guilt. I would pull a little less for awhile, or even manage not to pull at all for a brief time, but eventually I would succumb to compulsion. Shame over my situation morphed, at some point, into a belief that I was ugly and, worse, that I deserved to be ugly. I thought I could live with ugliness as long as I could camouflage my bald face enough so that people would not stare.

I was 21 when my mom handed me a magazine folded open to an article. I don’t remember what it was called or the name of the magazine, but I remember how I felt when I read it. Not only was I not the only person in the world who pulled her hair, but there was a name for it: Trichotillomania.

I was overwhelmed by relief.

tricho – hair

till(ein) – to pluck or pull out

mania – madness

Trichotillomania (TTM) is one of several body-focused repetitive disorders, the two most common of which are TTM and dermatillomania (compulsive skin picking). Little is known about the mechanisms and causes of trichotillomania, and even less was known 20 years ago when that first article I read was written. I have watched for two decades as the research has generated more and more understanding about TTM, but we still don’t know what causes it. Genetic, hormonal, emotional, and environmental causes likely all play a role.

Recently, researchers have linked some cases of TTM to a mutation on gene SLITRK1, the same gene that seems to be associated with Tourette syndrome. TTM was for many years considered a form of obsessive-compulsive disorder or self-injurious behavior, but it was re-classified in the DSM-IV under the umbrella of impulse control disorders.

What we do know is that both hair pulling and skin picking are attempts to self-soothe. The pulling itself is not painful, and is in fact experienced as satisfying or even pleasurable. My own experience is that pulling from my usual sites (brows and lashes) is not painful, while pulling from elsewhere on my body is. People with TTM may pull from any part of the body, but the most common pulling sites are scalp, brows, lashes, beard, and pubic area. Average age of onset is eleven, but TTM has been documented in children as young as one year.

When I “came out” about my experience with trichotillomania on my blog, I was inundated with messages from people who have the disorder, and 100% of them spoke of the shame they felt. They hated themselves for not being able to control a behavior that most people never experience and can’t understand. They wrote about how hair pulling and skin picking made them feel weird, crazy, and weak.

Here is what I know: TTM is not my fault. It is a quirk of biology and wiring and circuit mis-fires. I don’t know if we’ll ever find a cure or a universally successful treatment for hair pulling and skin picking, but I do know that those of us who pull and pluck and pick have nothing to be ashamed of.

My story doesn’t have a happy ending in the sense that I have not so far been able to stop pulling. I have taken every pill, done every treatment, and tried every self-help cure I’ve ever heard of. While I remain open to new possible solutions, I have given up on the frantic search for a way to stop pulling.

But the story continues happily in any case. My parents gave me permanent makeup for my birthday: tattooed eyebrows to replace the ones I pulled out. As recently as a year ago, I wouldn’t have gone to the appointment, believing that my bare face was a punishment I deserved. But yesterday, I went. Finally, I know that it’s okay for me to do what I need to do to feel good about myself and I don’t have to apologize or try to disappear or punish myself.

Trichotillomania is just a crappy thing that happened to me. If hair pulling and skin picking have happened (or are happening) to you, too, know this: Your worth is immeasurable, whether you pull or not. You have nothing to be ashamed of.

Sources and resources for hair pulling and skin picking: