Hair Pulling Patterns: Trichotillomania

Understanding your Hair Pulling Patterns: A hair pulling self-help monitoring tool: Treatment for Trichotillomania

Have you ever caught yourself mindlessly pulling at your hair? Maybe you’re scrolling through your phone or watching Netflix, and suddenly you realize that you’ve been twirling and tugging on your hair for the past few minutes. It’s a common habit that many of us have, but for some people, it can evolve into a more serious condition called trichotillomania (trik-o-til-o-MAY-nee-uh). While you have some awareness of your habits, a hair pulling self-help monitoring tool can make all the difference in helping you break through your ingrained patterns and change your behavior.

Trichotillomania is a clinical term for hair-pulling disorder, a condition where an individual feels an intense urge to pull out their own hair. The diagnosis is part of the umbrella of “Body Focused Repetitive Behaviors” (BFRBs). While the behavior might be conscious at times, it is also likely to happen automatically outside of a person’s awareness. This can happen anywhere on the body, including the scalp, eyebrows, eyelashes, and even the pubic area. The hair pulling behavior may also extend beyond the self, extending to pets or dolls.

While it may sound severe or obscure, trichotillomania is a common ailment that affects up to 4% of the population (over 320 million people!). The condition affects people of all ages, genders, and backgrounds; however, it often develops during adolescence. It is important to note that not everyone who pulls out their hair has trichotillomania.

Five questions you can ask yourself to determine if you might qualify for a trichotillomania diagnosis and might benefit from using a hair pulling self-help monitoring tool:

Does my hair pulling happen frequently, often resulting in hair loss?
Does my hair pulling happen outside of my awareness?
Does my hair pulling occur despite my best efforts to stop?
Does my hair pulling interfere with my daily life, cause emotional distress, and/or impact my daily functioning?
Does my hair pulling have no other medical or mental health explanation?

If you answered yes to any of the above questions designed to help you understand if you can benefit from a hair pulling self-help monitoring tool, it is likely that your hair pulling is not just a nervous habit, and is in fact trichotillomania. Coming to that realization can feel really overwhelming. Ultimately, the most important thing is to be kind to yourself. Trichotillomania is not your fault nor is it a sign of weakness. It’s just a condition that you’re dealing with and it is something that you can learn to manage.

If I suspect I might have trichotillomania, what steps can I take to help myself get better?

The gold standard of treatment for trichotillomania (and all BFRBs) is the ComB method (“comprehensive behavioral model”). The first phase of the ComB method is a comprehensive assessment. The SCAMP model provides a framework for understanding and studying different aspects of hair pulling. The 5 SCAMP domains are: Sensory, Cognitive, Affective, Motor, and Place.

These domains are not mutually exclusive, and they often interact and influence each other in various ways. By developing an awareness of how you are impacted across each domain, you can start to build awareness of your triggers and behavioral patterns. Gaining an understanding of what is going on across all these domains using a hair pulling self-help monitoring tool can help both an individual and a therapist gain a better understanding of what causes the hair pulling and can be the first step towards learning to manage.

What are the SCAMP domains?

The SCAMP model offers a variety of different factors to consider when it comes to hair pulling.

Sensory: This domain refers to how the five senses (sight, hearing, taste, touch, and smell) impact and exacerbate the situation.

For trichotillomania, Sight and Touch are two of the senses that leave people most vulnerable to hair pulling. Perhaps you notice a lack of symmetry that you want to correct or a coarse hair you want to pull. Perhaps you find that caressing the hair is soothing or even feel that the sensation of having the hair pulled out is enjoyable. Perhaps you are moved to pull based on something that feels itchy or uncomfortable.

Having a sense of what your sensory triggers are can help you become more mindful of your behaviors.

WARNING: If you are someone who routinely eats your hair, it is important to seek medical attention as ingestion of hair can cause gastrointestinal injury.

Cognitive: This domain refers to your unhelpful thoughts as it relates to hair pulling.

It is likely that you have inaccurate thoughts or “wishful thinking” that drives your habit. Perhaps you have difficulty tolerating physical flaws and convince yourself that you can create symmetry with your eyebrows, yet you end up overplucking. Perhaps you have convinced yourself that this is a smaller issue that you can manage, even if you find it uncontrollable and distressing. Perhaps you think others will judge you for the behavior, which prevents you from sharing and getting help.

Having a sense of what your cognitive distortions and limitations are around hair pulling can help you start to challenge them based on your reality.

Affective: This domain encompasses all your emotions that coincide with your hair pulling.

It is about noticing the different emotional states that are triggered throughout the process. How are you feeling before you pull your hair? What about during? What about after? Generally, you might find that different emotions are triggered during different situations. Perhaps you feel sad, hurt, and disappointed, which might lead you to pull your hair because you have difficulty expressing yourself. Perhaps you might be bored and restless, and resort to hair pulling when you actually need something to fidget with. Perhaps you might feel angry and frustrated and pull your hair as a reflex. Perhaps you are anxious and ashamed and the hair pulling further exacerbates those feelings. Unconsciously, people who struggle with trichotillomania are also known to pull during uncomfortable situations they want to escape.

Having a sense of what your feelings are throughout the cycle of hair pulling can alert you to your underlying needs.

Motor: This domain is about your voluntary and involuntary movements with regard to hair pulling.

More specifically, what are you doing with your body that impacts your hair pulling. What is your posture? Where are your hands positioned? Perhaps sitting with your hands propped near your face makes you more vulnerable to pulling. Perhaps you are someone who has difficulty standing still who needs to fidget. Perhaps you smooth your hair or eyebrows before pulling. These are the unconscious or subconscious movements that precede your behavior.

Having a sense of how your positioning and movements correlate with your hair pulling can empower you to create barriers that make the behavior less automatic.

Place: This domain is about the environments that are more likely to activate hair pulling.

You may find that certain places and situations exacerbate your hair pulling. Are there specific locations you are more likely to pull? Different times of day? Are there certain people who are around you or are you normally alone? Perhaps you are stressed out at work or school. Perhaps you are more prone to pull in the bathroom, where you are more likely to examine your appearance and identify targets for pulling. Perhaps you are more prone to pull in the car while sitting in traffic or at your desk as your hand is propped on your forehead while you peruse emails or in laying in bed while you scroll through social media.

Having a sense of the settings that activate your hair pulling can help you build an awareness of when you are most vulnerable.

A 10-Minute Daily Exercise: a hair pulling self-help monitoring tool

The first step to treatment for trichotillomania is to develop an awareness of your unique hair pulling behaviors.

This is a journal exercise. You will want to grab a pen and print out the handout below. Set aside some time for yourself throughout the week to complete the task.

The tracker can help you begin to notice your patterns of hair pulling behaviors by recording observations using the framework of the 5 SCAMP domains.

Start with the goal of completing the tracker daily for one week. It is important to monitor each day, because the events and circumstances in our lives can be so variable. For example, what life looks like on a weekday vs. a weekend.

There is also an example below of the hair pulling self-help monitoring tool you can reference.

Start by printing out 7 copies of the blank daily tracker handout below. If you don’t have a printer, you can create your own chart with a similar layout on a piece of paper.
Familiarize yourself with the SCAMP model detailed above. Take some time to review the SCAMP model and understand how the different domains relate to hair pulling behaviors. This understanding will help you know what to pay attention to. It will also help you categorize and analyze your observations accurately.
Reflect at the end of each day. Set aside approximately 10 minutes at the end of each day to reflect on your hair pulling. Find a quiet and comfortable space where you can focus and be present.
Record your observations. Using the tracker, document your hair pulling experiences at the end of each day. Even if you do not find yourself pulling, it is important to record situations where you touch the affected areas on your body, as it is a behavior that can precede the hair pulling. Systematically go through each SCAMP domain and record your observations. Take note of your observations before, during, and after.
Be Honest and Specific. When completing the tracker, be honest with yourself and provide specific details. The more accurate and detailed your observations, the better insights you can gain into your hair pulling habits and triggers.
Reflect on the Patterns. At the end of the week, review your completed trackers collectively. Look for any patterns, recurring triggers, or commonalities across the different domains. These patterns will provide valuable information for developing strategies to manage hair pulling.
Share your findings with someone you trust. After you have completed the exercise for the week, share your results with a loved one or friend to get support.

Understanding your Hair Pulling Patterns: A hair pulling self-help monitoring tool

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Hair Pulling Patterns: Trichotillomania

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