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Trichotillomania: The Calm and Chaos of the Hair-Pulling Disorder

A photo of the back of a person's head with two white hands on top of it. The head has very short, potentially-shaved short dark hair.
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Some people with trichotillomania decide to shave their heads to prevent the urge to pull their hair.

Although references to hair-pulling can be found as far back as ancient Egypt, the hair-pulling disorder known as trichotillomania is still riddled with shame, misconceptions and lack of awareness.

“I could pull my hair out!” is commonly used as an expression of anxiety or exasperation. But for folks who live with the hair-pulling disorder trichotillomania, the urge to pull out hair can also arise while thinking, out of boredom or from a desire to induce a brief moment of calm.

Host Anita Rao speaks with three people about their work to unpack the shame and stigma around trichotillomania. Haruka Aoki, a poet and illustrator who recently published a comic about their trich journey in the Washington Post, describes what it was like to learn the name for the disorder later in life, as well as how her response to hair-pulling urges has evolved since childhood. Dr. Suzanne Mouton-Odum, a licensed psychologist, director of Psychology Houston and board member for the TLC Foundation for Body-Focused Repetitive Behaviors, provides necessary context for our understanding of the disorder and describes her counseling work with folks who experience it.

Rao is then joined by Dorin Azérad, a hairstylist who works with clients experiencing all forms of hair loss, including from trichotillomania. A self-described “trichster” of over 20 years, Azérad describes the impact of her own experience with trich on her relationship with her hair and offers tips to others with hair loss about how to have a positive experience at the salon.

Thank you to Chapel Hill-based listener Tova for pitching this episode topic, as well as to Sarah, Naomi, Erin, Tova and Jillian for contributing to this episode.

Three myths about hair-pulling … BUSTED!

Myth #1: Hair-pulling is a form of self-harm.

Fact: Trichotillomania can certainly have some harmful side-effects, such as trouble with bald spots or the high cost of wigs and toppers. But according to those who experience trich, the act of hair-pulling isn’t harmful in and of itself. Instead, it’s about zoning out or calming the body down.

Myth #2: The urge to pull out hair is always a response to anxiety.

Fact: It’s true that many people pull their hair in moments of heightened stress or anxiety, but this is certainly not the only trigger for trichotillomania. It’s very common for folks with trich to pull their hair in response to a variety of other environmental or emotional cues — including when they’re bored, frustrated, fatigued or thinking.

Myth #3: The only goal of trich treatment is to stop pulling entirely.

Fact: While becoming completely pull-free may be an attainable goal for some folks with trich, many people who have the urge to pull will experience it in some form for the rest of their lives. As a result, treatment for trich is often about recognizing and responding to the urge to pull rather than suppressing the urge entirely.

Please note: This episode originally aired November 11, 2022.

Update: Dr. Suzanne Mouton-Odum recently co-authored a book for clinicians on how to treat body-focused repetitive behaviors.

Audrey Smith is a writer, educator, and temporary producer of "Embodied" based in Greensboro, NC. She holds a Master's degree in Secondary English Language Arts Education from the University of North Carolina at Greensboro (2018) and a Master of Fine Arts degree in Nonfiction Writing from Oregon State University (2021).
Anita Rao is an award-winning journalist, host, creator, and executive editor of "Embodied," a weekly radio show and podcast about sex, relationships & health.