I suffer from hair-pulling disorder

I compulsively pluck my eyebrows and have to draw them on -- I'm terrified I will be found out.

Published January 6, 2009 11:13AM (EST)

Dear Reader,

All I can say is, I'm glad it's 2009 and I'm happy to be back in the saddle! Our San Francisco writing workshops start up again this week, and I'm looking forward to our creative getaway later this month up on Tomales Bay.

Hope you had a good holiday. I think I'm going to like this year a whole lot more than last year!

Dear Cary,

I am a 26-year-old female grad student, and I have an unusual medical condition: I subconsciously pull out my own hair. It's called trichotillomania, and can vary from extreme (almost completely bald) to mild (occasional lapses of pulling out individual hairs). My particular variety causes me to pull out my eyelashes and eyebrows. I've read quite a bit of literature on "trich" as it is called, and it seems that there is still quite a bit of mystery and stigma surrounding the disease. Apparently it is less related to psychological conditions like OCD than it is to Tourette's syndrome (which I do not have), and dermatillomania, or compulsive skin picking (which I have had since age 8). There are countless ways in which trich affects people. Some eat the hair after plucking, and some pull only from the scalp in certain areas. It seems like the disease is unique to each individual, and no one seems to be able to stop or understand why they do it. I do not eat or do anything with my hair after pulling it, and the only hair I pull is from my eyelashes and eyebrows. I'm not sure why you would need to know this, except that I feel like I am telling you who I am.

It seems counterintuitive: If I am pulling out my hair, and it is distressing me, why would I not just stop? I'm a very intelligent young woman. I have what seems limitless potential, and this strange disease has me wrapped up in a conflict with myself. I know I cannot blame myself for this condition, and it is clear that trich is not something that anyone participates in intentionally. Yet I also cannot escape the disappointment I have in myself after I have pulled out my eyelashes. Clearly this causes much distress in the self-esteem department. I am a fairly attractive young lady, and growing up in American society has caused me to form an unshakable association of my appearance with my societal self-worth. So you see the unfortunate outcome of this is how my confidence suffers when I have physically altered my appearance for the worse.

I have found little encouragement as far as ever being free of trich. It seems that the "successful" cases are the ones who "manage" the condition, and that it's a condition I will just have to learn to accept. Throughout the years, I have been on countless anti-anxiety medications for this, to no avail. I have also talked to psychologists and psychiatrists who either have a limited understanding of trich, or who offer therapy solutions that have no effect. But I am not writing you for advice on this, per se.

I am writing you because of the way in which I have learned to cope with trich. When my anxiety increased during college, I started to pull out my eyebrows more. It got to the point where they were essentially nonexistent. Having dark hair and a fair complexion, my lack of eyebrows is quite noticeable. So I do what most women with my condition do. I turn to the cosmetic industry. I basically draw my eyebrows on with creams and shadows specially created for enhancing sparse eyebrows. I do my best to make them look as natural as possible, but really there is no way to hide the fact that most of my eyebrow hair is gone. The same goes for my eyelashes. I have tried false lashes and eyeliner, which both fall short of ever looking natural.

Lately, I have felt more and more like I have really caked on the makeup, and that the result is that I have inadvertently drawn more attention to my altered appearance. I would love nothing more than to feel at ease without gobs of makeup (to hide the evidence of dermatillomania) and fake eyebrows. But to go out in public (or even around my family) without first putting on a mask, feels as though I am advertising my mental illness to the world. I cannot really explain how vulnerable I would feel if I knew that everyone who looked my way would know instantly that for whatever reason, some of my eyebrow hair and eyelashes are missing. However, I get the impression that even with my makeup, people can tell that something is not right with the way I look. I suffer overwhelming insecurity when I am interacting with people. Certainly if people are not picking up on my drawn-on eyebrows, then they can sense the insecurity that shadows everything I do. Some of my family knows about my condition, and when I try to address the issue, they say that they cannot really tell that my eyebrow hairs are gone (when I am wearing makeup). But I feel that maybe they are trying to protect me, because they do not want to exacerbate my insecurities.

So my question to you is this: When I earn my degree and become a professional in my field, how should I handle the unnerving anxiety that accompanies how I imagine people view me? Some days I feel like I look like a clown, and that my excessive makeup mask is showing everyone just how insecure I am. This is the opposite effect of what I am trying to do, which is appear natural and comfortable. The obvious solution would be to stop wearing this makeup, but really I feel like my sans-makeup appearance is quite arresting and would certainly cause more problems.

What can I do?

Mona Lisa

Dear Mona Lisa,

What if we lived in a theocracy and you were suffering secretly from a lack of faith in God?

Trichotillomania is classified in the Diagnostic and Statistical Manual of Mental Disorders, or DSM IV, as a mental disorder not so much because pulling out one's hair is intrinsically harmful but because the behavior "causes clinically significant distress or impairment in social, occupational, or other important areas of functioning."

Your lack of faith in God, in our hypothetical theocracy, might also cause "clinically significant distress or impairment in social, occupational, or other important areas of functioning." In such a society, the equivalent to the DSM IV would probably be that big book everyone calls "the Bible." For your lack of faith, you might be deemed "spiritually ill" and burned at the stake.

So it is important to question the nature of the authority that brands you as a person with a mental disorder.

I picture you sitting across from someone who questions you about this phenomenon; you say to her, "It is simply a vivid symbol of our lack of control."

She appears puzzled, or impatient.

So you ask her, "How much control do you have over what your hands do?" She looks at her hands, makes a fist, wiggles her fingers, looks at the engagement ring on her ring finger, examines her fingernails. She puts her hands back in her lap. You ask, "What are your hands doing right now?"

She is sitting with her hands folded in her lap. You, also, are sitting with your hands folded in your lap. You are not plucking out your eyebrows. You only do that when you are alone.

"So, what do you do with your hands when you are alone?" you ask her. "Do your hands ever do anything that you consider not quite conscious? Do they flutter to your face, brush your hair back, scratch at each other? Do you ever bite your fingernails or play with a piece of lint or rub your fingers together to no apparent purpose?"

She admits that, of course, in an idle moment, her hands might pick up a piece of paper and crumple it, or play with a pencil, or tap a fork on a table, or rub her chin, or pick at a scab, or play with her hair, or roam about in a pocket, or rub the fabric of a skirt.

"So," you ask her, "what is so terrible about what my hands do?"

We are not in control of our hands. Our hands rub against things of their own free will; they pick up objects; they scratch our ears; they go into our hair and mess around; they even seek to pleasure us against our will; they are intolerably rude and sometimes criminal; they molest us; they rob us. Our hands terrify us and defy us. They remind us that the "I" we so cherish is not so much a despot as a tiny, impotent observer of the animal in which it lives.

What is so terrible is how it makes you feel. What bothers you is your fear about how you are perceived. We are not the tolerant, open society we profess to be. We are primitive worshipers of the body image. Our institutions are Puritan villages run by high school prom queens. You, a brilliant young woman with a bright future, fear being cast out because of a peculiar habit that affects your appearance but has no bearing on your intellectual capacity.

Your fear is based in reality. You have looked around you and have seen how women are categorized. It's not a sign that you are defective, but that the world around you is organized to systematically exclude instances of difference, particularly among women who do not conform to a bodily ideal. Why, as a woman, should you be in mortal fear of what effect your appearance is likely to have on others? Is this not the problem of the male gaze that feminists have struggled so long to deconstruct? Is this not the objectification and interjection of the dominant view that has so paralyzed women over the centuries and so effectively held them down for purposes of pleasuring, child-rearing and labor exploitation?

Since you have a powerful intellect, why not attack this problem intellectually, rather than accept uncritically the view of the mental health establishment? Why not band together with others who also do this and summon some collective power and support? Why not look deeply into what this really means, and use it as a springboard for insight and discovery?

It does not escape my notice that you call yourself Mona Lisa. What is the Mona Lisa doing up there on the wall in the Louvre but waiting, patiently, to be recognized? She smiles at us submissively until we breathe life into her by gazing at her admiringly. Has she no job? What is she doing the rest of the time?

Or am I missing the boat? Am I being unreasonable? If so, I can only say that while I accept what you say about how you feel, I sense that your anxiety arises from social conditions that you do not explicitly acknowledge -- that women in the workplace have scant protection against exclusion on the grounds of difference.

Surely you do have a problem; you cannot stop plucking your hair out. But the deeper problem, in my view, is that you are seeing yourself through the eyes of others. This is a philosophical issue: What people "see" is their creation. Certainly you can change your appearance, and it is often useful to do so. You can wear your mask. But when others regard us, they create something; what they create is not us.

Of the thousands of ways in which our essential lack of control might manifest itself, this habit of yours is among the least harmful and offensive; it is not a compulsion to harm or dominate others, or to deceive them; it is not a complicated, hidden kind of delusion or deception or will to power; it is not a blind identification with a higher being or any of the other myriad defenses we construct against our essential lack of control over the universe.

Your hands simply pluck hairs out of your face. They may do so for reasons you are not conscious of, and it will be useful for you to consider what those reasons might be, or what those anxious, tense moments that precede this action might be. But the plain truth is radically transformative: We are not in control! The notion of a sovereign self ruling over the body is a fiction. Each of us is more like a hive or colony in which a tiny, questing intelligence we call "I" ventures about with hollow bravado, falsely claiming dominion over terrain it scarcely recognizes.

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By Cary Tennis

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