The Hair-Pulling Problem

Excerpts from the book, The Hair-Pulling Problem; A Complete Guide to Trichotillomania

"The reason a hair puller would experience pleasure from something that would cause the average person pain, is because the intensity of the sensation is also able to provide an intense level of relief when the sufferer is understimulated. On the other hand, if an individual is overstimulated, the act of pulling and the intensity of the sensation that it provides can be so absorbing and distracting that it enables them to focus upon it very tightly, shutting everything else out, and bringing on the almost trancelike and self-absorbed state associated with automatic pulling."


"Many of those with TTM need intensive help in retraining themselves, both in terms of behavior and their outlook on life. No one with TTM prefers to do what he or she is doing, no matter how pleasurable it may seem to feel as they do it. Obviously, if they could stop, they would. Those do not have TTM or some other body-focused disorder cannot fully understand the anxiety and desperation that follows the powerful urges and repetitive self-destructive behaviors that are at times so compelling. Some sufferers have described it as feeling like being possessed, or as if their hands were not their own.
 
I believe that one major mistake non-sufferers make is that they somehow look upon disorders such as TTM as merely being some annoying problem habits, similar to smoking or overeating (actually also very difficult habits to break). People with TTM are seen as having poor self-control and lacking a will to resist--people who simply give in to themselves. Hair-pulling is not just a bad habit or temptation to be kicked. It is a biological and behavioral override of a person's ability to control his or her own physical actions. You cannot throw a hair pulling problem away the way you would your pack of cigarettes, and go cold turkey. It is a result of the way your nervous system operates, and may well be genetic. It has become part of your mental and physical life. When people ask me how you can differentiate TTM symptoms from other types of grooming habits, I tell them, "If you feel as if the problem has a mind of its own, it's TTM."

This is not to say that sufferers are not responsible for themselves. They are at all times. Even though the problem most likely has a biological/genetic basis, you can fight back and be responsible for finding effective therapy and following through with it. A person in the midst of hair pulling problems simply cannot just stop, and to expect them to do so is unrealistic. Stopping is the final product of a persistent effort over time, the result of changing behavior, environment, biochemistry, and thinking. It is not a place to start, but a goal, a destination."


"[Cognitive] therapy, briefly, is based upon the theory that emotional disturbance is caused by extreme and illogical beliefs and ways of distorted reasoning, which make up an individual's own outlook and philosophy of how life ought to be for themselves and others. It further suggests that we human beings have a tendency to think illogically. These beliefs can often be deeply held for most of a person's life, and come to mind almost automatically. They can be acquired during one's early years, from one's family, one's later experiences, or may be shaped and influenced by an illness itself. Cognitive therapy essentially teaches us that people and things don't upset us, we upset and disturb ourselves as a result of the erroneous views we take of them. Much disturbance comes from beliefs that we ought to be able to control people and situations in order to control ourselves, when in fact the only thing ultimately under our control is our own thinking and our own behavior.

Cognitive therapy can't teach you how to get everything you want from life, but it can help you take the chances necessary to maximize what you are able to get, while helping you to accept what you cannot. It can also be quite helpful in other ways as well. Along with learning to take responsibility for your own emotions, learning to think and reason logically are the keys coping with everyday life in a world that often seems anxiety-provoking, frustrating and disappointing. As unwanted as anxiety, frustration and disappointment may be, they can be tolerated and lived with."