Trichotillomania (trick-o-til-o-MAY-nee-ah) is a disorder that causes people to pull out the hair from their scalp, eyelashes, eyebrows, pubic area, underarms, beard, chest, legs or other parts of the body, resulting in noticeable bald patches. (http://www.trich.org) Also referred to as TTM and trich.
Excoriation Disorder, also knows as Chronic skin picking (CSP) or Skin Picking Disorder, is a serious and poorly understood problem. People who suffer from CSP repetitively touch, rub, scratch, pick at, or dig into their skin, often in an attempt to remove small irregularities or perceived imperfections. This behavior may result in skin discoloration, infection, or scarring. In more serious cases, severe tissue damage and visible disfigurement can result. (http://www.trich.org) Variations may include skin/cheek/tongue chewing and nail biting.
What Can an Esthetician Do?
- Be gentle with shame. Many will deny it even when it’s obvious, or lie about the how the damage occurred. Confronting them on this may be too overwhelming. Stay with compassion.
- Create a safe space. Provide as much privacy as possible, including a station in a private room or corner or away from other people. Speak in a soft tone of voice to prevent others from over hearing. Respond to what you see and hear with acceptance and understanding.
- Be creative with ways to mask the damage. Good Concealer or non-irritating make up for skin.
- Refer to a dermatologist if you see signs of infection or medical attention. Evan’s Dermatology Partners is the best I’ve found. This will not manage the behavior, but treat the wounds and diagnose underlying conditions.
- Normalize. Everyone picks/pulls at least a little. It is estimated that 1-2 in 50 do enough damage for it to be considered problematic, likely more. Most think they are the only one.
- Refer for treatment. There is no quick fix, BUT there is help. A therapist who has specialized, advanced training on this topic can help clients understand these behaviors and reach a point where they no longer control their life. This can be as simple as quietly slipping them a business card or pamphlet.
What Not to Do?
- Don’t say “Stop it!” or “Just don’t pick/pull,” or “Quit it.” If it were that simple they would have already stopped.
- Don’t talk about it loudly where other people may hear about it.
- Don’t whisper to colleagues, even if it’s about something else.
- Don’t use products that may irritate or overly dry the picked/ pulled area.