Pluck my life: Hair pulling in eating disorders
I’ve used this blog to confess to all sorts of bizarre behaviors related to my eating disorder, from laxatives to suicide attempts. Lest anyone reading this blog still be under the illusion that an ED is glamorous, let me remind you that it’s not. At all.
But I haven’t really discussed one of the things that has sort of come along with the ED for me. I found it more than a little shameful (this from a girl who found bowel movements to be a stimulating source of discussion during treatment) and frankly kind of weird. I was aware, on some level, that it was part of the cluster of symptoms that came along with having anorexia: a little obsessive, a lot compulsive, and mainly related to anxiety. Yet I still didn’t want to discuss it, neither on my blog or with my therapist, because it was just really bizarre, yo.
I pull out my own hair.
There. It’s the truth.
I generally don’t pull out head hair or eyebrows/lashes (I used to tug at my eyelashes but I stopped when I started freaking out that I might give myself pinkeye again*). Mostly, I use tweezers on my legs. It’s fairly easily concealed, as least when the situation really requires. I can wear long pants or tights for more formal occasions, and for less formal occasions, well, I’m a known outdoorsy person and they look a lot like nasty bug bites rather than Carrie is, you know, tweezing her freaking legs.
It started during my last bout of long-term treatment. I had an ingrown hair, and I had to use tweezers to pick it out. It hurt, though not unduly. But I started to obsessively check over my legs for any signs of a recurrence of this. It’s a behavior I know very well. In high school, when I was convinced I had AIDS or some other deadly virus I was going to give to people, I would check my body for hours each day for signs of cuts, sores, etc that would spread all of my nasty germs all over other people and I would be killing them if I weren’t careful.
Only now, I was looking for errant leg hairs. If I saw one that even might be funky looking (and really, what leg hair isn’t?), I pulled it out. Soon, I was spending hours each day doing this. I knew it was weird and becoming a disturbing time suck, but I didn’t think it was an actual disorder that could be identified and treated. Actually, it’s known as trichotillomania.
When I first looked up information on trich and anorexia, I found three studies. It was…disheartening…to say the least. Yet I would hear other sufferers and parents talk about it, and I started to realize that even if my behaviors weren’t totally textbook, they weren’t all that strange. I still didn’t like talking about it, though, and went to great lengths to try and conceal/disguise/explain away the strange-looking marks on my legs. It wasn’t completely debilitating, but it did make me very self-conscious and it took up at least an hour a day, often much more. I just kept pulling until I either got all the hairs that felt funky, it felt “right” to stop (I had completed the compulsion, as it were), or I got a cramp in my neck or hand.
Which is why I was really pleased to read a study two years ago that looked at repetitive hair-pulling behaviors in people with EDs (Zucker et al., 2011). They found that 1 in 20 people with EDs had diagnosable TTM, and that the more anxiety your reported, the more like you were to show signs of TTM.
…in this sample, individuals with eating disorders who also endorse hair-pulling are more likely to endorse ritualistic compulsions associated with the obsessive compulsive spectrum, rather than impulsive features.
While TTM is currently regarded as an impulse control disorder, the presence of the defining clinical feature of TTM in this eating disorders sample had no association with scores on continuous measures of impulsivity. By contrast, compulsive behavior was predictive of hair-pulling, in accord with the notion that hair-pulling may share underlying features in common with the ritualistic compulsions in those with eating disorders.
Some researchers have speculated that trichotillomania (or TTM, as it’s abbreviated) was more like self-harm and classified it as related to problems with impulse control. As someone who has engaged in regular self-harm, I do see the potential similarities and overlap. However, I think there are some differences (for me, anyway) in terms of what motivated the behaviors. TTM for me was always more associated with anxiety than self-harm. I would obsess about hair pulling whether I wanted to or not, even if I wasn’t especially distressed. With self-harm, it was much more impulsive. The emotions would just boil over and bam. Not that I wouldn’t obsess if I felt the urge to self-harm and I couldn’t, but it was only under specific circumstances.
As well, the point of self-harm was, well, hurting myself. The goal was to turn down strong emotions I couldn’t handle (which did include anxiety at times), and to do that, I felt I needed to actually inflict damage to myself. It was the only way that I could figure out how to feel better. With TTM and related behaviors I’ve struggled with my entire life (skin, finger- and toenail picking), I would often cause bleeding or other harm, but that was never the goal. If I could do the behavior without hurting myself, I would. It was often, in fact, the more severe damage that would jolt me out of the trance I was in and startle me enough to try and stop.
In their review of childhood TTM (much of what they write could apply to adults, so don’t be put off by their use of the word “child”), researchers wrote:
Many children with TTM are natural “fiddlers” and tend to have a need for tactile stimulation via the fingertips (eg, blades of grass or blanket fuzz), which may serve as a self-quieting, calming function, especially in infants and younger children…TTM is often not a focused, conscious act, but rather the hands seem to “have a mind of their own,” and pulling often occurs in a disengaged or “trance-like” state…The bedroom (while talking on the phone or before falling asleep), bathroom (while looking at oneself in the mirror), or family room (while watching television or reading) are “high-risk” situations for pulling. Last, children with TTM tend to have perfectionistic personality qualities. Body dysmorphic disorder and general feelings of inadequacy are especially prevalent among such patients. (Tay, Levy & Metry, 2004).
Um, hi. Have you been watching me my entire freaking life?!?
Later research has supported the placement of TTM on the obsessive-compulsive spectrum. It’s not OCD per se, just that there’s a lot of overlap between the two disorders. This is supported by the most recent study by Zucker et al., who didn’t notice any relationship between TTM and self-harm, but there was a strong relationship between obsessive-compulsive behaviors.
In the end, it appears that there is a significant subset of people with EDs that struggle with repetitive hair-pulling. Given the size of this population, it’s curious that no one ever asks you about these things. While some forms of hair pulling are visually obvious, others aren’t. There’s also a tremendous shame involved in these behaviors, and it’s not something I generally willingly disclose. It finally came out when my legs looked so bad, my mom called me out on it. It was at its absolute worst when I would do better with the ED because the anxiety needed some way out. If it wasn’t the starving, it had to be something else.
Do I still pull? Yes. I don’t spend nearly the amount of time on it that I used to, and my legs don’t look horrific anymore. I haven’t been able to stop completely but it’s not a huge time suck anymore. Compared to how awful it was just a year ago, that’s been some huge progress.
*Yes, pinkeye is unpleasant, but when I got it in high school, the symptoms appeared overnight and my eyes crusted shut while I was sleeping. When I woke up, I couldn’t open my eyes and I just about lost it. I did, of course, manage to get my eyes open with the help of a warm washcloth, but the thought of another case of pinkeye leaves me pretty freaked out.