As a psychotherapist who specializes in working with adults and teens with trichotillomania, and who has seen many clients get discouraged and hopeless, as well as blame themselves for what they consider “failure,” I’ve surmised that the trait that causes the most difficulty for those with trich is unrealistic expections which arise from perfectionism.  Add to that self-blame and an ongoing internal commentary about how “weak” or “pathetic” or “out of control” they are, and we have a recipe for disaster.  There is no quick fix, and that is the primary reason I’ve seen people give up. 

Here’s a typical scenario: A client comes in for her session after we’ve been working together a couple months:  “After two weeks of not pulling, I totally screwed up!  I “undid” my progress in just two hours.  What’s the point of even trying?  I might as well just pull…” 

I knew “Jennie*” (*not her real name) thought she was doing great, as this is the first time in two years she went two whole weeks without pulling.  Not only that, but she used mindfulness and therapy and exercise and all her tools. She was hopeful.  This time she could “do it.”

Although I was supportive of her one-day-at-a-time approach, and her two pull-free weeks, I knew this moment would come.  I knew because I’ve worked with many, many pullers over the years, and know how devastating such an experience can be. I knew because, as a former daily puller myself, mostly pull-free since 1989 (but not perfect), exactly what such a moment feels like.  And how easy it is to say to one’s self, since I’ll “never” be able to stop completely, I may as well just keep pulling because it just doesn’t matter.  

This is the same logic we use when, after having a piece of cake we meant to avoid, we say to ourselves, since I’ve already “ruined” my “diet” I may as well just keep eating. What’s the difference?  (Well, the difference between an extra 450 calories of sugar and fat and 4,000 is substantial.  What we really saying is, I blew it, I can’t do this, so I may as well give up. 

For pullers, Jennie’s experience is the primary reason pullers give up:  They convince themselves that, even if they are able to stop pulling for some period of time, if they  can “undo” their progress in a matter of hours, or even minutes, what is the point of even trying?  They’ll never be able to stop forever, after all.  (It’s amazing how many of my clients are psychics, since they are convinced they know the future!)

The good news is this:  No matter how frustrating or maddening having a slip can be, you CANNOT undo your progress if you have managed to live without pulling for any period of time that wasn’t possible in the past.  Specifically,  two hours, or 10 minutes, or two days of a slip or relapse cannot undo the work Jennie, or any of my clients, have done. Yes, I know that you desperately want back your hair, your lashes, your brows,  I also know this can and does happen for many.  But the only way for that to happen is to accept that for a period of time, maybe 18 months, maybe two years, depending on other factors, your recovery will not be visible on your head, face or body.  Rather, your recovery, at first, will be building up your ability to have more and more “good” days or perhaps minutes or houses—in which you IMPROVE. 

“Dan” (not his real name) pulled his hair out daily for three hours or so.  After three months, Dan had reduced that to one hour daily, with about four days a month of little or no pulling. In 18 months, he was able to see he was now pulling three days a week for less than an hour.  His hair had not grown back, but he was far closer than he had been.  He learned to feel good about the progress by marking a heart on his calendar for  each day he’d made improvement in amount of time pulling, and a star for any pull-free or practically pull-free days.  This gave him motivation to continue.

Back to top

Two years later, Dan was pulling no more than 10 minutes at a time, for a total of less than one hour a week.  His hair was beginning to come in.  He had learned that experiencing a pulling setback was not a “failure” but an integral part of recovery.   He stopped expecting perfection, taking a cue from friends in AA who spoke of “progress not perfection.”  Tolerating setbacks, not seeing them as “evidence” he would never stop pulling, was the most important single thing he learned.   Three years later, Dan has a head of hair for the first time since he was 12.  He still pulls an occasional hair, but catches himself in the moment.  He is his own best ally, not critic, something that took the most work, but made all the difference.

Recovery is not about the hair (though you may well get some or all of it back, and wanting that for yourself is very real in a culture such as ours).  And that can happen, and I’ve seen it repeatedly.  But here’s the bottom line:  b) In my view, recovery is about learning to support yourself through inevitable setbacks, and to stop beating yourself up.  It’s far harder to offer yourself compassion on the heels of setback than it is to have a remission in pulling which you may not even understand the origin of., If you ever have an experience like Jennie has and are able to tell yourself, hey, pull-free for 14 days.  That is amazing. And in an entire two weeks, I ONLY pulled for two hours.  Yeah, it’s painful, yeah, it’s frustrating, yeah I feel sad about my hair loss, but those feeling deserve compassion, not self judgment and nastyness.

Yes, you tell me, but in two hours the hair is gone. That does NOT take away the fact that Jennie has learned to live, for two weeks, being mindful, being aware, being self-accepting, living in the moment.  It does not take away the hard work and commitment she has brought to the work.   That does not move her further away from recovery, but closer.

The hardest thing you’ll face is the fact that, while you are doing the work, for much of that time, we’ll have to measure recovery on the “inside” (or an a calendar that shows more and more “good” days. Things worthwhile take time, no matter how smart how are, and no matter how much you think you “should” be able to just stop.  If it were that easy, we’d all “just stop”.  Perfectionism is the enemy of recovery, since it’s an impossible goal.  Human beings aren’t perfect.  That includes you!

Consider this: The first month you begin this work, which starts with a state of readiness, you  may find that you pull nearly every day, and that you have two pull-free days out of thirty.  The second maybe you have five pull-free days.  The third, ten.  Perhaps, by the time you get to month 11 or 12, you have 15 pull free days out of 30.  Now, that is progress.  Not only is it progress, it is, in my opinion, the most likely scenario you’ll see in recovery!  

It makes sense, doesn’t it.  If you were training for a marathon, you wouldn’t expect to be able to run 26 miles the first day, would you?  The problem is that people with TTM tend to be self-described “perfectionists.” (They’ll even say it proudly, I’ve noticed.)  “If it’s not perfect, the absolute best, 100 out of 100, it’s not good enough.” Well, that’s a problem then if you are interested in recovery.  In fact, it’s a problem if you’re interested in being human, but let’s start with TTM. 

In a few isolated cases, TTM suddenly stops—Almost out of the blue it goes into remission, often for quite a long time.  For most people with trich, however,, this SIMPLY is not the case.  It’s a step by step process.  If you allow yourself to believe you are “failing” because you have pulled for two hours, after getting through an amazing TWO WEEKS without pulling, you aren’t looking at the big picture.  Most importantly, you are standing in the way of real, lifelong recovery. 

In one of my favorite books,, “Radical Acceptance” by Tara Brach, the author makes numerous excellent points about perfectionism, and speaks of it as a true nemesis to recovery from any behavior or substance.  Perfectionism, according to Brach, makes it impossible for us to love and accept ourselves (necessary components to recovery), since it “measures our worth by our accomplishments.”  Brach isn’t trying to dissuade people from achieving or accomplishing (she did, after all, publish a book), but point out that measuring our worth in that way makes self love conditional—it means, if we aren’t perfect, or at least better than everyone else, we are unlovable, unworthy and failures.  Can you imagine the effect, then, on those with trich?

As everyone who’s even tried to address their pulling knows, it is hard, and it is frustrating.  But if what you’re trying to do is STOP PULLING RIGHT THIS SECOND FOREVER, you will reinforce a feeling of hopelessness that makes recovery 100 times harder.  If are looking to reduce your pulling by, say, 10 percent, and have three pull-free days in a month (or hours in day), and are able to feel good about taking those first steps, you are truly and meaningfully on your way. 

Back to top

You may write Claudia Miles at claudiamilesmft@gmail.com or call 415-460-9737.