Joanna was sitting at the kitchen table of her father’s house frantically trying to study chemistry, but focusing was impossible. Joanna was too overwrought from her inability to understand her least favorite subject, a class she was not passing. Grinding her teeth and rubbing the bones in her face aggressively with the heels of her hands, Joanna thought about her lack of discipline and academic failure. She was so wound up with nervous energy that she could rip my hair out. So, she did.
Joanna patchy scalp was not punk; it was the result of adolescent stressors like academic pressure, family issues, and a rapidly changing body mingling with severe anxiety and depression. Joanna was bald because she pulled almost all of her hair out strand by individual strand, because she had an impulse control disorder that affects an estimated 2 to 4% of the country, though most Americans have never heard of it.
The first hair pull was the most relieving sensation. Instead of balancing equations or dwelling on daily stressors, her fingers made their way to her scalp Joanna didn’t know what she was doing, or how bad it would get. Her index finger and thumb would zero in on a singular hair, twirl it, stretch it taught, then pluck it right out. Joanna would examine the root and feel momentarily satisfied, even relaxed, but as immediately as the rush of calm came over her, the overwhelming tension returned, peppered liberally with shame.
This cycle of tension pulling, then relief, then pulling again would repeat over and over until Joanna was unrecognizable. For a while, she had more than enough hair to cover the signs, but eventually, single hairs add up, parts widen, and bald patches connect. No one seemed to notice until the unappealing effects escalated enough to be an undeniable problem. Comb overs don’t fool anybody.
Though it is technically self-inflicted and somewhat painful, trichotillomania is not consciously self-harm. It’s more like nail biting than cutting, meaning Joanna did not want or choose to pull her hair out, it was a compulsion. It was horrible and she wished it were something she had consciously chosen to do, as that might have made it easier to stop.
Joanna was acutely aware of what she was doing, but she was powerless to stop it, as if a wicked puppeteer was controlling her body. Joanna hand would go to her favorite spot in search of the perfect hair. If she could only find the right one, maybe just maybe it would be the last. No matter how coarse or perfectly painful, Joanna would always go for one more hair, then another. One strand would turn into 10, then hundreds into fistfuls, until I was mostly bald. Every time Joanna had a particularly rough bout of pulling, she would see the dislodged hairs, casualties scattered around her and Joanna would ask herself, “What has she done?”
During the peak of her disorder, trichotillomania attacked every facet of her life. No one wanted to leave her alone, but she could not stand to be social. Joanna resented those who cared about her for trying to help, for reminding her that she was a mess. Joanna wanted everyone to just ignore her, so maybe she could have some reprieve from thinking about her hair all the time. It’s exhausting to fixate on one very negative aspect of yourself ad nauseam, to wonder if people were concerned with the inside or the outside of her head. She had to stop obsessing if she ever wanted to get better, but everywhere she went her hands went too, until they didn’t.
Joanna found that being a teenage girl without the security of what was once an impressive mane of hair to be profoundly distressing. Like most high school sophomores, Joanna paid a hell of a lot of attention to how people looked at her, to what people thought. She was lucky that she had a big attitude or she would not have been able to handle the kind of attention you get if you look a little freakish. People stared, so she stared right back.
Burdened with a visible sickness, Joanna saw a wide spectrum of human responses too different. Some people were bewildered, some tried to ignore what was obvious, and others thought she was dying. Her friends who knew of her torment tried to be helpful. They would hold hands or paint her fingernails to keep her from pulling, if only for a moment.
Of course, a great number of people were disgusted by Joanna and unsympathetic about it, like the kid who tried to snatch her hat or the girl at school who outright stated that she looked like “a freaking zombie.” The worst reaction of all, more devastating than all of the mean kids, came from her loving parents who were so heartbroken and wanted nothing more than to fix her.
Seeing how hard it was on her parents that she was hurting herself, weird looking and mentally ill gave her tremendous guilt. It was like every pang on her own scalp was pain felt by her entire family. Joanna thought they wanted her to be a prettier, less embarrassing teenage girl, but she later realized that they really just wanted her to stop suffering.
Trichotillomania was only one symptom of her teenage angst, but unfortunately it was the most evident. A holistic approach to treating her mental anguish was infinitely more successful than any purposeful attempt to cure trichotillomania as a specific disorder. Had any of the methods intended to control her hands or cover her bald patches truly worked, Joanna would have still been a very troubled kid with poor coping mechanisms, just one with the appearance of normalcy.
Joanna cannot pinpoint exactly what pushed her to eventually recover; it was a combination of meditation, medication, therapy, time, and not having any hair left to yank out by the root––mostly therapy and time. Thanks to recovery, Joanna entered her junior year of high school a healthier teen with a cute little pixie cut.
A decade later and she is still recovered. Sometimes, she wishes she had the experience of being a perky teenage dream with a full head of hair, but Joanna also knows that being a little strange helped her hone her style and sharpen her tongue. If it had not been trichotillomania, neuroses would have manifested in some other destructive way, she’s sure.
These days, her head is protected by long healthy hair that she grew herself. She still touches and twirls it somewhat compulsively. However, now instead of pulling her hair out, Joanna channel her urges into grooming. Joanna takes pride in her hair, but she hypothetically could cut it all off in an instant. It is lovely, but she’s not deeply attached to it or any other physical characteristic. Bad haircuts grow out, bad hair day’s end; Joanna is more than the dead tubes of protein dangling from her scalp.
The Good housekeeping 2015, 14 May 2018, https://www.goodhousekeeping.com/health/a33314/trichotillomania-hair-pulling