Trichotillomania Triggers

Trigger warning: This post is dedicated information and experiences with Trichotillomania so if this is a difficult subject for you, please don’t read on. I would hate for you to be triggered. Having said that, immediately following this post will be one on a list of ideas and tips to help with hair pulling.

It’s been a while since I talked about Trichotillomania, whether about my experience or about the disorder in general. I’ve been learning more and more about what triggers me so I thought I’d do some research into triggers more generally and after doing all that reading, I thought I’d collate some of it in case it could be helpful to any of you guys.


CAUSES

Scientists still don’t know what causes Trichotillomania – and other BFRBs (Body-Focused Repetitive Behaviours) – but there are various theories, including:

  • A way of dealing with stress or anxiety
  • A genetic factor, like a chemical imbalance in the brain, similar to obsessive compulsive disorder (OCD)
  • A change in hormone levels during puberty
  • A type of self-harm to seek relief from emotional distress
  • A trauma in childhood

Pulling can then become a type of addiction. The more a person pulls their hair out, the more they feel the need to keep doing it.

TRIGGERS

While there isn’t much definitive research into the causes of Trich, we are learning more and more about what drives people to pull once they’ve started pulling, the internal and external triggers that occur right before someone pulls. External triggers include certain people, or places, or situations while internal triggers include certain thought processes, emotional states, or physiological sensations. When the particular trigger (or one of multiple triggers) is experienced, a person who struggles with compulsive hair pulling may be ‘triggered’ to pull. The pulling satisfies something, like creating a feeling of relief or calm for example. 

These triggers can be sorted into a multitude of categories, these being some of the most common…

  • Emotional – The emotions behind hair pulling can be very complicated and multi-layered. For many individuals with Trichotillomania, pulling is a way of dealing with negative or uncomfortable feelings, such as stress, anxiety, boredom, or frustration, to name just a few. Several studies have shown that stress was reported to be the most common trigger for increased hair pulling. This may be because pulling out hair relieves stress; when someone is anxious, the tension in their body increases and the sensation (and sometimes pain) of pulling can help to release some of that energy. I can definitely relate to all of this. When the pulling is focussed (as opposed to automatic – something I’ll come to later in the post), it can almost be a mindful activity, centering in on what your hands are doing and allowing some of the anxiety in your system to dissipate. Pulling can feel satisfying and create a sense of relief, which can reinforce the urge to pull, especially when trying to cope with negative feelings; we all want something to make us feel better when we’re struggling.
  • Sensory – Many people will pull out particular hairs that have a certain feel to them, such as being thicker or longer than the rest of their hair. Texture can also be a huge trigger, if certain hairs feel crinkly or just stand out when touching one’s hair, for example; this is huge one for me. My hair is mostly straight (if vaguely wavy) but the individual hairs are very smooth so when I find a crinkly hair, it really stands out and it’s all I can think about until the tension is so high that I can’t concentrate unless I pull it out. Sometimes that’s it but sometimes that causes a period of pulling that can last for days, or until my pulling arm gets so painful that I physically can’t lift it to reach my hair. The location (like the parting or hairline – another relatable experience) and the physical sensations that hair can create against the skin can also trigger someone to pull in order to relieve a person of those sensations.
  • Environmental – A person may have particular locations and situations where they are more likely to pull. The privacy of rooms like a bedroom or a bathroom may make pulling more tempting; these rooms are also ones where you’d mostly likely find mirrors and tweezers, items that could also serve as triggers. There are also certain activities that create opportunities for pulling, such as using a computer, reading, watching TV, and so on, all of which have certain things in common: these activities are generally stationary and your posture during these situations gives your hands more access to your hair, if you pull from your scalp or eyebrows for example.
  • Cognitive – Cognitive triggers are often connected to thoughts about imperfection. I can definitely relate to this as a lot of the triggers for my hair pulling are related to perfectionist thoughts and feelings. And these thoughts can manifest as hair pulling in multiple ways. The imperfection could be with the hair itself: that it feels too thick, too curly, that it’s the wrong colour, or that it doesn’t match the rest of your hair. And when the hair starts growing back, a person may feel compelled to pull out more hair to balance out the length of the regrowth. Sometimes the imperfection comes in the forms of attempting to stop pulling. For example, if a person challenges themselves not to pull for a day and then they pull just one hair, then they may think that they have failed. ‘Failing’ to meet those goals can results in even more pulling, out of frustration and a low sense of self worth. Pulling can also be triggered by perfectionist thoughts in other areas of their lives, like school or work or relationships, etc. When one (or many) of these areas start to break down and a perfectionist can’t fix it, the loss of control can be overwhelming, leading to the developments of problems like Trichotillomania where they feel that they do have some sense of control. At least to begin with anyway: when they feel out of control, they can pull out their hair and think, “Look, I can control what I look like; I am still in control.” However, when hair pulling spirals into the disorder that is Trichotillomania and stopping feels impossible, the perfectionist thoughts only get worse because now you’ve lost control in another aspect of your life.

There are two ‘types’ of pulling: focused pulling and automatic pulling.

  • Focused pulling is when a person pulls their hair out intentionally. This may be due to feeling a hair that’s too thick or too coarse or out of place somehow, to relieve stress or anxiety in their lives, or to get some relief from the overwhelmingly strong urge to pull. Or it could be a combination of things.
  • Automatic pulling is when a person pulls out their hair without realising it, or without fully realising it. Automatic pulling may occur while working on a computer, watching TV, reading a book, or really anything that can be done one-handed. Similar to this, some people are completely aware that they’re pulling but feel absolutely unable to stop themselves, like their hands have a mind of their own. This can be due to how long a person has been struggling with Trich or the strength of the urge to pull, for example.

Some people do one or the other but many people do both.


This is obviously not a medical or scientific guide. I completely encourage you to research the subject further if any of this resonates with you. The NHS, for example, has a great page about Trichotillomania but I wanted to share what I’ve learned while researching and my experience with some of the areas that came up. And as I said at the beginning of this post, I will be sharing a collection of suggestions for managing and potentially reducing your pulling directly after this post.

EXTRA NOTE: Here are some of the articles I read while researching that I found to be really interesting and potentially helpful: (1) (2) (3) (4) (5) (6) (7)

The First Semester of my Masters Degree

Now that I’ve finished my assessments, I thought it might be an interesting idea to sit down and write about my experience of the first semester of my Masters Degree. Because I’m doing it part time (mainly to protect my mental health), I’m only doing one module rather than two, which is what the full-timers do. The module I did was called ‘Creative Process’ and it was four hours of uni time, a two hour seminar where we talked about different areas of the creative process and then a two hour workshop where we played the songs we’d written based on the ideas and concepts we’d talked about the week before. It was a really interesting module and I wish my mental health had been better so that I could’ve focussed and enjoyed it more.

I feel really lucky when it came to my group and my tutor.

My group was only about nine people (when the other groups were much larger as far as I know) and they were all absolutely lovely. We were all really different, both musically and life experience wise (but I guess that’s what happens when you get to Masters level), which was really interesting when it came to writing and socialising and… just everything. It was a completely new experience and one that I’m really grateful for. Up until now, I’ve mostly been surrounded by people my own age with similar experiences.

Everyone was so, so good, all in their own way. They all had their own style (some had particularly beautiful musical signatures, some wrote from interesting perspectives with thoughtful lyrics, and so on) and it was so interesting and exciting to see how they developed over the semester. We were and I know will continue to be so supportive of each other’s music and development as songwriters. It always felt safe to bring in something I felt unsure or insecure about and the feedback was always constructive and because the person wanted you to get better; I never once felt like someone was being mean or looking down on me. It was such a supportive atmosphere and I’m so grateful because I think that was a huge part of what helped me to grow so much as a writer.

I made two really good friends in particular, both of whom I’m still in the same group with to my absolute delight. They’re truly beautiful souls. One of them, Luce Barka, wrote this amazing song during the semester and has said she’s happy for me to share it with you guys. I really, really recommend it…

I also had a fantastic tutor, Isobel. She’s a really cool, independent singersongwriter, which I think made her an especially good teacher because she’s very immersed in the industry we’re all trying to get into, in her own, distinctive way. She’s also dealt with serious health problems (which she has talked about publicly so I’m not breaking her confidence or anything) so I felt like she was a really good tutor, especially for me. She understood, or had a kind of understanding, of what I deal with. She was a really, really great tutor, in discussions and when giving and guiding feedback. But for me personally – and this is my blog after all – she was incredible when it came to helping me manage the course against all of my issues. When my anxiety was overwhelming, she helped me adjust the tasks to make them easier while still allowing me to do the task and learn the skills. I am massively appreciative of how accommodating and generous and kind she was, even before  she received the Student Support Agreement (the document with all my information and recommendations).

Anyway, she was amazing. I learned so much, obviously from the course but also from the way she delivered it and the feedback she gave me. I feel like I’ve grown so much as a writer and I feel like she’s a really big part of that. Plus, I’ve never had a teacher who was so understanding, who helped without hesitation, with just my word to guide her. I can’t properly express how much I appreciate that. It’s never happened to me before and it felt so wonderful to be treated as if it was something you just do, rather than being made to feel like a burden or an obstacle to be manoeuvred. So, as much as I learned (and I learned a lot), that is what I’m most grateful for and one of the things that I will always remember about this semester.

The first few weeks were really, really tough. After my massive meltdown in Victoria station, I was having meltdowns every day (as I wrote about here), which was having a big impact on my mental and emotional health, also leaving me physically exhausted. That significant meltdown was triggered by an email from the Disability Coordinator (who was also an Autism Specialist), suggesting a very last minute change of plan for our scheduled meeting which still leaves me bewildered. As an autistic person, sudden changes of plan are known to be highly problematic. That, plus my existing anxiety, caused a massive meltdown that took a very long time to recover from. And it left me feeling less than confident in her ability to support me even though we had had a positive first meeting and I had left feeling cautiously optimistic that this time it might be different. It then didn’t improve as actions promised at that meeting didn’t get done, leading to more meltdowns. So that was a real complication and painful part of the semester.

Having said all of that, I loved the classes. We learned about songcraft, collaborating, imposter syndrome, professional practice, perfectionism, and so much more. It was fascinating and fun and the briefs, while often stressful (with only a week to write the song), were interesting and challenging. I wrote some songs that I’m really proud of and I feel like my songwriting grew a lot because the briefs were challenging.

We watched this video in one of the classes and I thought it was really good so I thought I’d share it:

I loved it – loved getting better at songwriting – even the bits that pushed me and made me feel uncomfortable.

However, out of class was another matter. We were expected to do research that would later become the foundations of our assessment essay and presentation. Except whenever I asked, they wouldn’t tell me what the assessment entailed and just said it was ‘self directed learning’ so I didn’t know what I was actually researching, which caused me terrible anxiety. I created a reading list of books, articles, and interviews about creativity and songwriting but as hard as I tried to do the work, my OCD – my need to write everything down – battled against it. And usually won. So if I wasn’t writing, I was reading. I had no downtime. I was constantly anxious, like, end-of-the-world-anxious. And I felt like I was failing.

They explained the essay and presentation in the last couple of weeks but I still didn’t really understand. The language was complicated and vague and while I understood the general idea, the grading criteria was pretty ambiguous. I didn’t know what I had to do specifically to get good grades. I need clarity. It was incredibly stressful.

It took a couple of last minute meetings with my module leader to really understand what was expected of me but I was now facing a myriad of problems. The research I had been doing had little relevance to the subject I was writing about so I’d have to redo all of that, as well as actually write the essay and prepare the presentation. Plus we were in the final two weeks of the semester and the university would soon be closed for the Christmas holidays so I would have no way of contacting anyone for any support. I was wound so tight I felt like my spine might snap. I felt like I couldn’t breathe. I’m really grateful for those meetings but I just wish the assessment had been clearer earlier in the module so the research I was doing could’ve been more focussed. With all the problems associated with Autism, like chronic fatigue and chronic pain, time is something I have to be incredibly thoughtful about.

I worked every day of the entire holiday (apart from Christmas Day, which I spent with my family – something I don’t often get to do) but the assessments were always in my head so I felt like I couldn’t take a break or have any time to rest and recharge. I still didn’t feel sure that I was doing it right but still, I worked hard on it and gave it everything I had. I finished both the essay and the presentation with time to spare, allowing myself time to redraft and prepare, giving myself the best chance of doing well. I submitted the essay, despite big technical problems with the system, and I did my presentation to the best of my ability, despite finding presentations incredibly difficult. Now I just have to wait for the marks.

Now, having run through the whole semester (and having reflected a lot on the difficulties), I just wanted to share a couple of specific, positive experiences:

  • For one of the early seminars, we had a guest tutor, who works primarily as an expert in Personal Transformation, come and talk to us. Because we were such a small group, he was able to really talk to each of us about our lives and our creative struggles. Considering how little we knew each other at the time, it was amazing how open everyone was and I think it’s part of the reason we became so close and supportive as a group. It was a real bonding experience to hear all of these personal stories and I personally felt really honoured to be part of it, to have been trusted with those stories.
  • One week I brought in a song that I was really proud of. It had a repeated line in it – “it’ll get easier” – and everyone picked it up really quickly, singing along and harmonising. It was beautiful and emotional and it was one of the most special moments of the semester for me.
  • During my research, I found a quote by Paul Gardner that I’m endlessly inspired and intrigued and excited by: “A painting is never finished – it simply stops in interesting places.” There are so many things that could mean. What do you think it means? Or what does it mean to you about a particular thing in your life?

Overall, it was a very mixed bag. The good moments were great and made me feel amazing. I got a lot out of it. But I spent a lot – A LOT – of the semester in crippling anxiety and I had a lot of meltdowns. It was fucking hard. And the marks haven’t even come back yet. I’m terrified that I’ve done horribly. But I’m trying not to think about it. I’m just trying to get through this new semester. Which may be even more stressful than the last.