Sep
05
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