I managed to undo three months of progress in just a few days.

By Kimi Vesel
May 14, 2020
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While working from home recently, I remembered a Zoom conference call at the last minute. I knew I'd have to turn my camera on, so I grabbed a wig—the first one I could reach from my bed: a natural-looking one, short and dark-brown. I lazily pulled on a stocking cap, then the hair, not bothering to arrange it because I was sure no one would be paying much attention.

Not long after the call began, one of my coworkers remarked: “Kimi, did you cut your hair?”

Shit. I forgot the wig I usually wore to the office was a completely different color and went down to my waist. “Uh, I actually got it cut a few weeks ago," I said.

“Fair enough; I haven’t seen you in person for an entire month, after all," the coworker responded.

I hadn’t yet mustered up the courage to tell my coworkers I have trichotillomania, a psychological disorder similar to OCD that causes me to compulsively pull out my own hair. Trichotillomania─sometimes abbreviated to ‘trich’ by people who have it─is defined by the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) as recurrent hair-pulling despite repeated attempts to stop, resulting in noticeable hair loss, as well as subjective distress or impairment in daily life.

I’ve had trich since I was a preteen, have tried both therapy and medication for it, and have come to accept it as part of my identity over the years. But boy, am I having a tough time in quarantine.

Before the pandemic—and after fourteen years of pulling my hair—I had finally come up with a game plan to get my trichotillomania under control, and it was working.

At the beginning of the year, I committed to growing my hair out. At that point, my hair was the shortest it had ever been, but I could still style it to hide most of my bald spots. I started wearing a wig every day to work or any other excursion out of the house, in order to keep my hair covered so it could grow without interference, and my hair-pulling plummeted to almost zero.

I was doing so well, but sheltering in place brought an entirely new set of circumstances than I’d originally planned for. Since I didn’t have to dress up for work anymore, I stopped wearing the wigs—something that kept me from pulling at my hair. That, combined with the stress of working from home and worrying about my family’s safety or my friends who’d lost their jobs, turned into undoing three months of progress in a matter of days.

See, with trich, hair-pulling turns into a mindless behavior. While social distancing and working from home, I'd spend hours every day on conference calls, my fingers mindlessly trying to get rid of split ends or anything that felt "off" (think: a hair that's thicker or coarser than the rest). At, the end of the day, I'd find myself cleaning tumbleweeds of hair off of my bedroom floor. There was not a fifteen-minute interval in a day when I wasn’t pulling.

I looked in the mirror one morning a few days into quarantine and noticed one of the bald spots I’ve had for years now stretched across the entire crown of my head. I was gutted and deeply disappointed in myself.

I'm not alone right now—the pandemic may be worsening hair-pulling and skin-picking disorders for many others.

In a recent webinar hosted by the International OCD Foundation, Fred Penzel, PhD, a psychologist who serves on the scientific advisory board for the IOCDF and the TLC Foundation for Body-Focused Repetitive Behaviors, attributed upswings in hair-pulling and skin-picking during the pandemic mainly to extreme fluctuations in sensory or emotional stimulation.

"I’ve always believed that this is a form of self-regulation; it’s a way of dealing with being either overstimulated or under-stimulated, and in the current situation, you have a mix of both,” said Penzel. Although it's too early to definitively say with data that body-focused repetitive behaviors (BFRBs) are on the rise chiefly because of self-isolating, the TLC Foundation noticed an increased need for services early on, and expeditiously rolled out additional programming for support groups and webinars featuring several experts in BFRB research.

Anecdotally-speaking, two of my friends who also have trich—Rebecca and Jude (who requested not to use their last names for privacy)—have found the self-isolation that comes with social distancing particularly difficult when it comes to resisting hair-pulling. "My stress levels had increased, and it was getting hard to deal with the pulling," says Rebecca. Jude was in the same situation: "At the start of lockdown, my scalp-pulling was off the charts."

To help with their hair-pulling urges during quarantine, both Rebecca and Jude took a pretty drastic step: They shaved their hair—and wound up pleasantly surprised. "It was a very hard decision to shave my head even though I had done it before," says Rebecca, who wasn't able to get her normal shorter haircut due to barbers being closed. "At first, I wasn't happy about it at all, but it's starting to grow on me again. It’s important to remember to be gentle with yourself during this time because it’s hard to live in a time with so many unknowns, and it’s important to take control of the things you can." Jude is also embracing her new look, which is more of an undercut than Rebecca's full-shave: "I decided to take ownership of my hair," she says. "The moment I did it, I had no regrets and I wondered what had taken me so long."

Since my previous strategy to reduce hair-pulling wasn't working in quarantine, I knew I had to come up with a new plan.

It’s important to note that people pull their hair for many reasons, and no two people are alike in what triggers or works best for them—that means, while shaving their heads worked for both Rebecca and Jude, I knew it wasn't the best route for me. To that end, Nancy Keuthen, PhD, a psychologist at Massachusetts General Hospital and scientific advisory board member of the TLC Foundation, encourages people to understand their hair-pulling behaviors before diving into specific strategies.

The first thing I noticed about my own behaviors and urges was that if I physically couldn’t pull, I wouldn’t even think about it (this concept is technically known as "stimulus control" in habit reversal training—meaning, physically preventing access to hair-pulling essentially reduces hair-pulling). This meant I had to start wearing my wigs regularly again, even if I had no intention of leaving the house. The next-best thing for me turned out to be a satin bonnet tied tightly around my head (which, in addition to helping me not pull, also just feels good), Basically, the most effortless way I’ve found to curb my hair-pulling is to cut off access to my hair as much as possible.

Another component of habit reversal training (HRT) that I've been implementing is called "competing response training," which amounts to doing activities that keep the hands busy to distract from hair-pulling. To keep myself entertained (which, to be honest, helps with trich urges and my overall sanity), I’ve been doing daily jump rope workouts, 1000-piece jigsaw puzzles, and putting on makeup for Zoom dates as self-care that engages my hands; friends of mine also play music, garden, or even sew masks.

Finally, I’ve been trying to take steps to minimize both sensory deprivation and stress, so I can reach a happy medium of stimulation. Engaging all five senses and routinely bringing in new sensations—the sound of stovetop popcorn, the scent of a candle or essential oil, the taste of a new recipe, or the look of the living room with all the furniture rearranged—keeps me from getting bored inside my little apartment during quarantine. For stress reduction, I’ve turned off notifications on most of my social media apps, try to identify something I’m grateful for every day, and try to meditate semi-regularly.

These strategies have helped, but the most important part of dealing with trichotillomania in quarantine is forgiving myself when I experience a setback.

Total abstinence from hair-pulling would be ideal, but because that's usually easier said than done. In that case, Keuthen says practicing "dialectical abstinence" is especially important. This approach, she says, focuses on trying to refrain from hair-pulling as much as possible, but practicing self-compassion when slip-ups happen.

“The idea is that we want to try to cease the dysfunctional behavior totally, but that we will have setbacks, and that we need to be forgiving ourselves when we have these setbacks, and to just get back on the horse and try again," says Keuthen.

Personally, my quarantine game plan for hair-pulling is still very much a work in progress. I mess up often, and I still pull my hair nearly every day (though less than when quarantine first started). In spite of that, it's a great comfort to acknowledge that I am doing my best. It gives me the confidence to do things like finally confide in a group of my most trusted coworkers over Zoom about my trich (and confess that, before we were mandated to work from home, I used to alternate between three different wigs to see if anyone would notice). Their reactions were nothing but earnest and kind.

“What a relief!” I said, after finally telling them about my trich. “Now I can start wearing all my fun wigs on our calls.”

The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDCWHO, and their local public health department as resources.

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