Trichotillomania is a private but widespread condition, affecting up to 1 in 50 people at some point in their lives.
She really cared how she looked, and she was undeniably glamorous. A flawless complexion, beautiful teeth, and full, luscious hair. Only it wasn’t.
Laura removed the wig shamefacedly to reveal shredded follicles and patches of bare raw scalp like a ravaged crop field. Her eyes welled up.
“Can you believe,” she said despairingly, “I’ve done this to myself! How self-destructive can you get?”
She felt ashamed and stupid.
I asked her why she felt she pulled out her own hair. “What do you feel trichotillomania gives or seems to promise you?”
Pausing pensively, she at last replied: “Well, it sounds mad, but it’s hard, I guess, for people to understand how good it can feel sometimes. Almost like a relief. But it’s also terrible to see in the mirror what you’ve done to yourself. I’m an intelligent person… how can I stop doing this to myself?”
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Actually, Laura wasn’t alone. Trichotillomania is a private but widespread condition affecting up to 1 in 50 people at some point in their lives.1 But how to help the hair-pulling client?
Here are five scalp-easing ideas you might find useful when treating this particular type of self-harm.
Tip one: Explore the pulling pattern
Laura knew everything about hair pulling. She knew that trichotillomania is variously described as a habit, an addiction, even a facet of obsessive-compulsive disorder. She knew that it commonly starts in the teenage years (as it had for her) and that it’s much more common than most people know. We discussed:
- When it had begun (20 years earlier)
- What had been going on at the time (messy relationship breakup, academic exam stress)
- When it happens (when stressed or bored)
- When it doesn’t happen (when out with friends or relaxed with boyfriend)
- How an episode of hair pulling naturally stops (when it hurts really badly or she has to do something involving other people).
Once I understood the ‘danger times’ or triggers and other particulars of the pattern, we looked at how we might start to break that pattern.
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Tip two: Have them do something else
I asked Laura about times when she’d thought she might pull, but then hadn’t.
“Well, usually it’s when I’ve suddenly become distracted by something else, then it’s like the moment has passed and the urge is gone.”
As simple as it sounds, we explored what Laura might do instead of hair pulling when she got the urge. She felt she could go for a walk, or type on her phone what she was feeling and everything that hair pulling had taken from her over the years. She actually later reported finding this form of expression really useful. This, for her, was a powerful way of ‘urge surfing‘ – in other words, riding out the urge until it passed without giving in to it.
One hair puller I worked with was lucky enough to own a swimming pool and would get changed and swim every time she got the urge. Using distraction sounds so obvious, but what you are doing here is retraining the brain to the point where it starts to feel more natural not to pull in response to these trigger times.
But we can go deeper than this (if you’ll pardon the pool-related pun!).
Tip three: Deal with the unconscious impulse
Of course, people often find themselves pulling at their hair without having been aware of any trigger at all (although there always is one).
Here’s something that’s going to sound crazy but (along with the hypnotic reinforcement work we did) really helped Laura. I asked her to purchase some of those athletic leg weights and put them around her hair-pulling arm. During ‘danger times’ – basically, whenever she was alone – she’d wear this weight on her arm.
So she could still pull, but only with the weight on. Now the focus became redirected into the effort of lifting her arm. She actually expressed concern that if she did carry on pulling, she’d develop a “horribly over-muscled right arm”!
Again, this dilutes the old impulse by adding another element that wasn’t there before. After a few days of doing this, Laura felt the urge to pull had diminished by around 85%, even when not wearing the weight.
Actually, this is a facet of ‘scrambling’ the pattern so it no longer runs on smooth tracks.
Tip four: Scramble the trichotillomania to rain on its parade
As Laura said, it seemed as if a part of her was working against her own best interests, and we all know how powerful the mind is. I used hypnosis with Laura to help her stop feeling like pulling. Consciously, she already knew all the good reasons not to pull. She needed to feel, not just think, differently about pulling her hair out.
Scrambling is a hypnotic technique in which lots of successive mini-trances are used to break or ‘scramble’ an old pattern so that, ideally, the client can’t (or finds it very difficult to) fall back into the same problematic behaviour.
We first get the steps of the pattern in order by asking the client to close their eyes and envisage the initial step of a hair-pulling episode, then open their eyes. Now we have them close them again and access the second step of the episode, and so on until the point at which the episode naturally comes to an end.
Once we have the pattern in order and the client affirms they can hypnotically access the state, we start to scramble it. We encourage the client to inwardly experience the pattern in the wrong order, or going straight from the initial urge to the feeling after the episode has concluded. We might also intersperse the pattern with a totally unrelated state, such as being out with friends – the opposite to the hair-pulling ‘trance’.
Eventually, Laura found she no longer felt the urge to pull hair at all, but just went straight to the feeling of pain and regret whenever she even thought about pulling. We had ‘rained on the parade’ of the problem pattern.
Lastly, we can use hypnosis to help the client preview a longer pull-free future.
Tip five: Look to the future
After scrambling, when Laura was well and truly ready for deep hypnosis, I had her practise drifting out of herself if she even thought about hair pulling, and feeling separate from it.
I suggested to her:
“When you stop tormenting your own scalp and let it breathe and live, it will begin to heal. Take time to really think about how you’re going to feel and look in the future once your hair has been ‘liberated’ and had a chance to flourish.”
I had her hypnotically time travel, seeing her hair recovering and growing stronger, fuller, and thicker.
Two years later, Laura came to see me for a completely different issue.
“Wig?” I asked tentatively.
“No,” she said proudly, “this is the real deal.”
Learn How to Deal with Clients’ Unconscious Urges Quickly
Compulsive or habitual behaviours are, of course, unconsciously driven. Otherwise they’d be easy to stop! To deal with compulsions quickly and comfortably, clinical hypnosis is unmatched. You can learn how to integrate modern, conversational hypnosis into your practice in Mark’s online course, Uncommon Hypnotherapy.
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About Mark Tyrrell
Psychology is my passion. I've been a psychotherapist trainer since 1998, specializing in brief, solution focused approaches. I now teach practitioners all over the world via our online courses.
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