Recently, while working from home, I unexpectedly recalled a Zoom meeting. A wig, the first one I could reach from my bed, seemed the most natural, so I put it on before turning on my camera. It was short and dark brown. I sloppily threw on a stocking hat and combed my hair into place, figuring no one would notice anyhow.
One of my employees asked me, “Kimi, did you cut your hair?” shortly after the call started.
Shit. My typical workplace wig was a different color than I remembered and reached just halfway down my waist. “Uh, I actually got it cut a few weeks ago,” I explained.
“Fair enough; I haven’t seen you in person for an entire month, after all,” the coworker said.
I hadn’t yet worked up the nerve to inform my coworkers that I suffer from trichotillomania, a disorder that causes me to pull out my hair excessively and is conceptually similar to obsessive-compulsive disorder (OCD). The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) defines trichotillomania, also known as ‘trich’ by those who suffer from it, as an impulse control disorder characterized by compulsive, repetitive hair-pulling despite conscious efforts to stop, resulting in both objectively noticeable hair loss and perceived distress or impairment in daily functioning.
Since I was a young adolescent, trich has been a part of my life. I have attempted counseling and medicine to treat it, but ultimately have learned to embrace it as part of who I am. But wow, this confinement is making me crazy.
Before the pandemic—and after fourteen years of pulling my hair—I had finally come up with a game plan to get my trichotillomania under control, and it was working.
I decided at the beginning of the year to make a concerted effort to lengthen my hair. My hair was at its shortest then, but I was able to use creative styling to cover most of my thinning areas. Eventually, I was able to reduce my hair-pulling practically to nil by covering my hair with a wig whenever I left the house (for work or otherwise).
I had made excellent progress, but staying put brought up a totally different set of conditions than I had anticipated. No longer was I required to wear wigs for work, so I stopped using them to avoid damaging my hair. Three months of development were undone in a matter of days due to the stress of working from home and worried about my family’s safety or my friends’ who had lost their employment.
You have to understand that trich causes hair-pulling to become an automatic habit. I used to spend hours on daily conference calls while socially isolating and working from home, aimlessly trying to shave off split ends and other “off” patches of hair (such as those that are thicker or coarser than the rest) with my fingers. After a long day, my hair would accumulate on the floor of my bedroom like tumbleweeds, and I’d have to sweep it up. I never went more than fifteen minutes without yanking.
A few days into my confinement, I looked in the mirror and saw that one of the bald patches I’ve had for years had spread across my entire scalp. I felt like a failure and was devastated by my own failure.
I’m not alone right now—the pandemic may be worsening hair-pulling and skin-picking disorders for many others.
An increase in hair-pulling and skin-picking during the pandemic was primarily attributed to extreme fluctuations in sensory or emotional stimulation, according to Fred Penzel, PhD, a psychologist who serves on the scientific advisory board for the International OCD Foundation and the TLC Foundation for Body-Focused Repetitive Behaviors.
“I’ve always believed that this is a form of self-regulation; it’s a way of dealing with being overstimulated or under-stimulated,” Penzel said. Although it is too soon to say with data that body-focused repetitive behaviors (BFRBs) are on the rise primarily due to self-isolating, the TLC Foundation recognized an early need for services and quickly rolled out additional programming for support groups and webinars featuring several experts in BFRB research to address the growing number of people affected by this condition.
Two of my friends, Rebecca and Jude (who asked that their last names not be used for privacy reasons), also suffer from trich, and they told me that they had an especially hard time avoiding hair-pulling when they were socially isolated. For Rebecca, “the pulling” became increasingly stressful. And Jude could relate: “At the beginning of lockdown, my scalp-pulling was off the charts.”
During their time in quarantine, Rebecca and Jude shaved their heads in an extreme measure to combat their impulse to tear out their hair. “Even though I had done it before, the decision to shave my head was very difficult,” recalls Rebecca, who was unable to receive her usual shorter haircut since barber shops were closed. I wasn’t thrilled with it at first, but I’m beginning to like it again. It’s tough to live at a time with so many unknowns, so be kind to yourself, and do what you can to take charge of the things you can. While Rebecca has gone for a complete shave, Jude has opted for something closer to an undercut: “I made the decision to claim my hair,” she explains. “As soon as I did it, I felt completely at peace and wondered why I had waited so long.”
Since my previous strategy to reduce hair-pulling wasn’t working in quarantine, I knew I had to come up with a new plan.
It’s crucial to remember that there are various causes of hair pulling and that no two people will respond to the same treatments in the same way; therefore, while I knew that shaving my head would help me, I also knew that it would help Rebecca and Jude as well. Psychologist at MGH and TLC Foundation scientific advisory board member Nancy Keuthen, PhD, recommends first learning about the roots of one’s hair-pulling tendencies before attempting to change them.
The first thing I realized about my own habits and impulses was that if I couldn’t pull my hair, I wouldn’t even think about doing so (this idea is referred to as “stimulus control” in habit reversal training; in other words, removing the ability to pull one’s hair out by physically removing one’s hair reduces the urge to pull one’s hair out). I was forced to resume routinely donning my wigs, even when I had no plans to leave the house. As a close second, I found that wearing a satin bonnet snugly around my head helped me not pull and also felt pleasant. Simply limiting my exposure to my hair has proven to be the simplest and most effective method I’ve found for reducing my compulsive hair-pulling.
I’ve also been doing “competing response training,” a subset of habit reversal training (HRT), which consists of keeping one’s hands occupied with other tasks in order to divert attention away from hair-pulling. Jump rope, 1000-piece jigsaw puzzles, and putting on makeup for Zoom dates are just a few examples of the self-care that employs the hands that I do to keep myself busy (and, to be honest, assist with trich cravings and my overall sanity); friends of mine also play music, garden, or even sew masks.
Finally, I’ve been making an effort to lessen the effects of sensory overload and stress in order to find a comfortable middle ground. I avoid going stir crazy in my tiny apartment during quarantine by stimulating all five senses and bringing in new sensations on a regular basis, such as the popping of popcorn on the stove, the aroma of a candle or essential oil, the flavor of a new dish, and the sight of the furniture rearranged in the living room. I’ve found that turning off social media app notifications, practicing gratitude daily, and meditating occasionally all help me deal with stress.
These strategies have helped, but the most important part of dealing with trichotillomania in quarantine is forgiving myself when I experience a setback.
Ideally, you wouldn’t take out any hair at all, but I know that’s easier said than done. Keuthen argues that “dialectical abstinence” is crucial under such circumstances. According to her, the key to success is in treating yourself with kindness even when you fail to live up to your own high standards (in this case, refraining from tearing your hair out).
When we fail, it’s important to forgive ourselves and try again, says Keuthen. “The idea is that we want to try to cease the dysfunctional behavior completely, but that we will have setbacks.”
The details of my hair-pulling strategy during quarantine are still being ironed out. The number of times per day that I pull out my hair has decreased since I initially entered quarantine, but I still do it rather often. Still, it’s reassuring to know that even if I’m not perfect, I’m doing my hardest. It has given me the courage to do things like tell a small group of my closest coworkers through Zoom about my trich (and admit that, before we were required to work from home, I used to switch between three different wigs to test if anybody would notice). They responded in a really sincere and kind manner.
“It’s about time!” I opened out about my trich for the first time and said. I can now put my wacky wig collection to use on our calls.