Trichotillomania: the untold agonizing story of an obsessive hairplucking habit

The stress-related obsessive habit of hair plucking is a struggle that few talk about, despite its consequences - Ahram online talks with sufferers and experts

You could meet Israa , a college student, and never have a clue that behind her quiet voice and nice smile lies an inner conflict that takes its toll on her appearance. She never discusses her problem and because of the fact that she wears a head scarf nothing was noticed for a very long time.
“I never had a clue; I was usually too busy to notice changes,” says Israa's mother, a middle-class teacher and sole supporter of the family. “I would occasionally notice heavy patches of hair around Israa's bedroom, but I never really gave it a thought until she was the one who came along and told me she wants to seek help when she saw how her appearance was severely impaired.”
Salma, another patient treated at the same clinic, talked to Ahram online about her experience, saying she started a similar habit while experiencing anxiety during her final exams two years ago. The pulling developed into a habit that gave her, in her words, a "very soothing and relaxing feeling". She talked about experiencing some sort of trance in which she would curl into a chair in her bedroom and start first by feeling the hair between her finger tips, then plucking it, feeling no pain but rather comfort.
Dr Eman El Sawwaf, a psychologist treating both girls, stresses that the mounting pressures and uncertainties experienced by young people contributes to the increasing number of patients suffering from trichotillomania. Although the reasons are mostly psychological, related to stress and depression, recent research suggests genetic factors and biological reasons could also play a role.
El Sawwaf says severe emotional and psychological trauma can result from the secrecy by which a person maintains this habit; her patients come with a sense of shame and low self-esteem, in addition to severe depression, each requiring its own treatment.
Dr Heba Essawy, professor of psychiatry at Ain Shams University, claims this disorder could start at an early age – potentially as early as when a child can touch his hair – but the majority of cases she encounters start from the ages of 11 to 13. Most cases of Egyptian teenagers result from a form of anxiety or simple boredom, before it develops into a comfort habit.
Dr Essawy works with her patients using Cognitive Behaviour Therapy (CBT) to help them contain the urge of pulling the hair, starting with these tips:
The patient is asked to stare at themselves in the mirror while plucking their hair, thus transforming the act from an involuntary to a voluntary one.
Keeping a bandage on the finger tips restrains the patient from plucking.
Applying cream or oil on the hand abundantly also makes the task of plucking difficult.
Covering the hair, especially in time intervals, is known to trigger the bout.
Certain medications, particularly anti-depressants, have been seen to be helpful.
Dr El Sawwaf says that the three main keys to putting an end to this habit are medications, attempting relaxing methods, and performing the following exercise:
The patient sits in a comfortable position, and then imagines that they are overwhelmed by an urge to pluck their hair, even reaching out with their hand to do it before refraining at the last second.
This exercise should be repeated until the patient feels exhausted, and should be used several times a day.
Dr El Sawwaf adds that it is beneficial to change the habits or surroundings associated with the hair plucking; that is, if a condition starts with the person sitting in a certain position, he should change it, or join a group if he feels the urge to start plucking alone.
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