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.

Twitter Digg Delicious Stumbleupon Technorati Facebook Email

36 Responses to “Pluck my life: Hair pulling in eating disorders”

  1. Thank you for posting about this Carrie. This post could be about me. I use tweezers to pull body hair too and I find it really embarrassing and almost never talk about it.

  2. Do you think this is at all similar to compulsive skin picking? As much as I hate to admit it, mild skin picking is something I have struggled with over the years and still catch myself doing during times of high anxiety. Thanks for breaking the silence.

    • Very similar, I think. I’ve had the nail and skin picking as long as I can remember, and they’re definitely similar in motive, triggers, etc.

    • +1 @Kelsi….I have, admittedly struggled with skin picking for as long as I can remember…and as with Carrie…it seems to affect me more when I am actually trying to work hard at recovery (outlet needed?!)….

      Worse…I notice my daughter does this as well…and her face is often a mirage of red spots and scabs…I so blame myself. I tell her to be careful and not touch her beautiful face…but I set such a horrid example, behavior-wise…Is this a weird search for “purity”/perfection in some realm of our existences?..I feel this “utter” need to locate and “empty” any errant clogged pore.

  3. So brave of you for posting this. I had no idea it was even a strange thing to do. I have spent hours tweeting out pubic hairs while sitting on the toilet till my ass was numb. Mostly in the middle of the night when everyone else is sleeping. It is trancelike, and I would have never thought to disclose it b/c… Well, b/c in the daytime I forget I even do it! Odd. I have never thought it mattered, but on rare occasion I have caused follicle infection. This is not at all the same state of mind for me as self harm. Self harm is usually associated w/ feeling rage, panic, terror.

    • Haha- tweezing, not tweeting. Damn autocorrect.

      • LOL. But I hear you on the trance like state, especially late at night. All of a sudden, I’ll look up and 2 or 3 hours have passed and I’m all WTF?

        • Oh, totally. Hours and hours.

          And that’s where it feels a little different from both self-harm and other OCD compulsions that I have. There’s shame, but it doesn’t come til later–while I’m actually finding those hairs and eating them, I’m tranced out and kind of blissful. Whereas when I used to cut, it felt neutral-to-unpleasant, and compulsions are always unpleasant except as they make me feel better. The hair thing feels intrinsically nice.

          Not sure I explained that well but I’d be curious to hear if it “feels” different to anyone else who has all of these problems.

  4. I guess this goes under “good to know I’m not alone”. I developed severe trich as my AN progressed. And by severe I mean – I’m basically bald on the top and sides of my head. I have to wear a head covering but you can tell there’s something wrong because I’ve just got little wispy tendrils that stick out along the nape of my neck and my temples. As I’ve been trying to recover from AN (with limited success and plateaued for a long time now) the trich hasn’t gotten any better. I pull constantly. It’s definitely tied to anxiety for me because when I can’t – if I’m around other people or in public or whatever – I feel…antsy, uncomfortable, etc. I have tried everything they say for anxiety and stress and such but…nothing doing.

    My main worry is that my hair will never grow back properly, that I may have caused permanent damage to the follicles, which I’ve heard can happen. I don’t really mind wearing my little turbans and such (I assume that plus my thinness makes strangers think I have cancer, which…as far as other people’s opinions go, I’d rather they thought that than an ED) but it is annoying and upsetting to have to be so careful to never let anyone see my head, to have something so abnormal to learn to cope with.

    Anyway, sorry, blah blah. I’m not surprised at all at the connection, since I already knew it from my own life. Just feels so…unfair. Adding insult to injury and all that. Siiiiggh.

    • I’m sorry to hear you’re struggling so bad on both fronts. It sucks when mental illnesses bring their friends…

  5. I confessed this same exact thing on my old blog a couple of years ago. I had TTM long before I had anorexia actually and the whole impulse control thing never rang true to me. Once I read that 2011 study it seemed to click that this was an OCD behavior. I too find that when my anorexia recovery is better that my TTM tends to flair up and vice-versa. The anxiety needs some release. I also have always been embarrassed to admit the TTM, even to therapists. I mostly pull the hairs on my head, but only the ones that feel “wrong”. And then I eat them. Yeah, gross I guess. I’ve always been prone to skin and nail picking/biting as well.

    • It’s amazing how often I find people literally saying the exact same things as I’ve commented/thought in the comment forms of ED Bites posts. When I’m actively working towards recovery I often manage that anxiety with skinpicking/hairpulling. Well, I’m always picking/pulling but it certainly increases during low symptom periods of my ED and decreases if I’m using a lot of ED behaviours.

  6. I have a giant ME TOO to this post. For me it’s eyelashes, eyebrows, stomach hair, and nipple hair. Eyelashes and eyebrows were basically non existent at the worst of my ED and people pointed it out all the time… THey’d literally ask me if I knew I had no eyelashes. Yes, I know. And I’m totally ashamed. Thanks. In recovery, the pulling of the eye-related hair has gotten better but it’s not completely stopped. The other ones – stomach / nipple – are basically the same… but they are very conscious and deliberate decisions where as the eye hair seemed not as deliberate – seemed like it just happened. Through treatment, my pulling just naturally got less (maybe b/c anxiety management got better? or anxiety levels in general seemed to get less intense?). But I still look forward to taking tweezers into the shower with me and pulling out stomach hair. I am careful to put the tweezers back where they belong so no one ever wonders why the tweezers were in the shower. It’s a little escape that I look forward to.

    What’s interesting as I reflect on this is that my experience pulling out eyelashes and eyebrows felt noticeabley different than other body hairs. Eyelashes and eyebrows always happened before I knew it, I used my own fingers, etc. The other body hair – I plan it and I use tweezers.

    Overall – it feels very OCD is and not self-harm ish – for me.

    What I notice about the level of shame that comes with this topic is that I thought about posting under “anonymous” instead…

    • I used to obsessively pluck my eyebrows too. I pretended to myself I was just ‘shaping’ them but would spend hours at it and take it too far. I stopped cold turkey when people started to comment , by sitting on my hands when I got the urge. I still get the urge sometimes.
      I also pick my skin and um, eat it!! Gross I know but maybe I need the calories. Lol!
      Oh and goes without saying I suffer from intense anxiety and an ED.

  7. I’ve never commented before, but since I also pull out my hair (before, after and during 7+ years of anorexia). I’ve never brought this up with treatment providers, but my family is aware of my strange habit.

    My hair pulling is less obvious that most. I pull out the little baby hairs on my face (and, as embarrassing as this is for me to admit, I’ll pull out my nose hairs as well). I don’t really plan on doing it, but if I have an opportunity to start (while watching TV, studying, doing homework, reading, driving, talking, even listening to a prof. in class) I will, without even realizing it. For me, it’s immensely satisfying and soothing. I use my fingernails, so this habit is accessible to me at any time.

    I do have OCD as well as anorexia, so this behaviour seems to fit in with the rest. Everything described here in this post pretty much describes me to a T.

    I just wanted to speak up so that others know that they aren’t alone! I highly doubt it’s uncommon,

    • Lol to the nose hair, I do that and go at my beard all the time. I tend to get round to shaving it off when the bald patches are starting to get really obvious. I find myself doing this while reading the paper in the morning, all zoned out..

  8. Thank you so much for posting this. I’ve done enough reading to know that it’s relatively common in people with eating disorders, but it’s just not talked about, presumably because of the sense of shame. Still trying to figure out if, and if so how, to bring this up with my therapist.

    One interesting thing — the only fiction I’ve ever seem trich show up in was one of Jessica Warman’s books (Where the Truth Lies, maybe?), and the character with trich also has a restrictive eating disorder, though I’m not sure it’s ever labeled.

  9. Wow, I thought I was alone in this behavior. I honestly did not even realize it was classified as TTM. I had known about that but just associated it with pulling out hair on your head..
    I have so much shame associated with this behavior because my family and boyfriend will either catch me doing it or they will find tweezers in places like the bedroom or living room and know. I let it get so bad once that I could barely sit without the back of my thighs hurting so bad from tweezing the hair there. I agree with the trance state because it starts and stops without me even noticing it at times. I’ve wasted so much time doing it but it’s almost always associated with anxiety.
    Anyway, I’m sorry other people are going through this but I am glad to know I’m not alone..

  10. My trich is almost entirely located to my left shin, that combined with dermatillomania (compulsive skin picking) means that I have a rather impressive collection of scars. I fins strangely that if if my AN symptoms are “under control” my skinpicking and hair pulling skyrocket and vice versa.
    The amount of stigma which surrounds these two similar disorders is remarkable so thanks for posting about this on your blog!

    • Another on the “same here” list! Thanks for posting this. I never thought to connect the two before. Since I started attempting ana recovery my legs have sure taken a beating.

  11. My daughter is recovering from AN and she does this too. I wonder if there is a medication that would help break the compulsion. It is so obviously biological, given how common it is.

    • I’ve tried a variety of medications (SSRIs, even an atypical antipsychotic) and I’ve found that the single most effective thing is CBT with a psychiatrist familiar with Trichotillomania and Dermatillomania.

    • There are therapies out there for TTM, including habit reversal training (which is sort of an offshoot of CBT).

      Medications are also an option, including SSRIs and N-acetyl-cysteine, which is an OTC supplement that has been trialed with success in TTM patients in a formal trial. NAC has sulfur in it, so I don’t know how it might smell/taste. The liquid form I had to take to protect my liver was utterly vile, but they were probably giving me mega doses, so who knows. But I thought I should warn you.

  12. I had the same behavior with eyebrows. For the first time , because of your pot, I am relating that behavior (compulsive) with ED (anorexia)

  13. WOW,I thought I was completely alone with this behaviour. I was aware of TTM and pulling hair from the head or eyelashes/eyebrows, but never realized that it could also be used in relation to tweezing. As with you Carrie, I use tweezers to pull out leg hair. And the trance-like state discussed is exactly how I experience it. I find that in the moment it calms my anxiety but afterwards I am left with awful looking legs. I also have anorexia and pre-existing OCD and depression. Thanks for the post!!

  14. I had the same behavior with my eyebrows. For the first time, because of your post, I am relating that behavior (compulsive) with my ED (anorexia), some decades ago… (yes, decades, I had a ED without knowing that ED existed).

  15. Also, I’d like to say that the title of this post is AWESOME.

  16. I just recently found your blog by searching for new research for EDs. I have noticed that I do the same thing that you have discussed! I thought I was the only one and I’m glad I didn’t. Like you, now I don’t spend as much time but during super stressful or anxiety ridden days it comes back.

    Thank you very much for posting about this!

  17. I’m not sure if this is related: I don’t pull my hair OUT, but I do tug on and fidget with my hair almost constantly when I’m anxious, unless I’m really conscious of it and have something else to do with my hands.

  18. My older sister had TTM and was a binge eater. My older brother had AN.
    My daughter was dx with AN at a young age. (and after aggressive treatment is in firm remission)

    Clearly lots of genetic predispositions and overlaps

    Just to say this is not surprising to me. And a big xoxox

  19. I pull my hair
    I was bulimic for 8 years
    I scratch and pick my scalp
    I tweeze my nethers
    I have recently slipped into anorexia

    i wish I could meet you, so I could give you a hug. you understand me. I wish we didn’t have this in common with me because you seem so wonderful

  20. I am so glad I am not alone with this hair pulling problem. As someone else mentioned I also scratch and pick at my scalp. I want to stop both habits but it so soothing and relaxing. I have done both to the point of bleeding. HELP

  21. Omg thank you for writing this! I have always picked at my face, though never bad enough to be obvious, and scratched at my scalp until i get scabs and than pick them off…definitely a trance state and also a method of dissociation for me. I have been ashamed enough to keep it secret even from my therapist until i read your post:):)

  22. I have been with trochotillomania for a long time and this is terrible. I’ve been feeling very lonely at this because as people around me think just a stupid habit, as if I didn’t want to stop that. without the I had to do every day, I didn’t know myself, I improved a lot in recent years, spend days without remembering that problem, but when anxiety is like an atomic bomb has come to devastate everything. Sorry for my English, I try to speak but even that has been difficult.

  23. I have TTM and have had it for many years. Attempts to treat it have been unsuccessful. For me it’s eyebrows, generally nothing else. It’s a feeling of “they just need to be gone. I buy good tweezers. I can’t get to my tweezers tonight and feel anxious. I also have a binge eating disorder that feels very similar “those oreos must be eaten”

  24. What’s up to all, the contents present at this web page are truly awesome for people experience, well,
    keep up the nice work fellows.