Hair pulling (trichotillomania) makes an unwanted, gripping demand that overrides your ‘will to stop’. It makes you feel as if one part of your mind takes partial ownership of the other part, rather than being a part of it. The outcome is visible damage to your body and many invisible wounds to the self.
Currently, the most common treatment for hair pulling is Cognitive Behavioral Therapy. CBT attempts to address the negative thought patterns, which affect how you feel and behave. The snag is that changing a conscious negative pattern is a partial remedy that leaves the original cause of hair pulling intact. All too frequently, when enough anxiety is aroused, the need to pull defies the best of intentions and good will.
Psychiatrists have tried numerous drugs to make hair pulling ‘go away’. But the overall results of trials continue to be inconclusive, with only a minority of patients responding to drug intervention. If a drug’s side effects begin to interfere with treatment compliance, then discouragement prevails. The intricate nature of trichotillomania complicates research so that, right now, no neurobiological model that details the brain-behavior relationship is available. Little relief is blamed for the high rate of recidivism and, consequently, the Food and Drug Administration has not approved a medication for trichotillomania.
Psychoanalysis can be an effective treatment for hair pulling. This treatment, where ‘only talking’ occurs, stands out as particularly helpful to complex anxiety conditions such as trichotillomania. I personally know of successful outcomes after analysis when emotional experiences─ like being heard and feeling deeply understood─ have transformed this stubborn symptom. The analyst, who becomes a mutually-trusted figure, is well-placed to reflect both current feelings and the early ones put away for lack of any other way to think about them. In this way, the analysis becomes a thoughtful exploration that can intercept the circular course of hair pulling which strives to persist unabated and unmediated. Trichotillomania rarely resolves alone.
In a culture, such as ours, which is overly preoccupied with physical appearance and a reverence for youth, hair or its absence is an important part of body-image ─ those thoughts, feelings, and behaviors related to appearance and self-identity. And, for a child, who is still in the process of maturation, the loss of hair raises fundamental questions about being wanted and attractive as a future adult in the world.
In our very time-conscious society, I realize that psychoanalytic treatment requires a sincere investment in the self. It requires time to lessen the grip humiliation exerts on the preferred state of aloneness. Time for trust to arise and comfort to develop that allows the deep explorations of psychoanalysis. Time for mental growth to occur as the outcome of repeated transforming emotional experiences. And time for learning to live life fully.