What your Hair Stylist Needs to Know about Trichotillomania (Hair Pulling Disorder)

All too frequently people who struggle with body focused repetitive behaviors,  such as Trich and CSP, avoid getting hair cuts due to fear and shame. Seeing a hair stylist who is informed and compassionate can help. In my community outreach efforts I train hair stylists on how to support clients with body focused repetitive behaviors. If you do not have a salon in your area that is sensitive to these topics, you can give them this outline.

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/ Chronic skin picking (CSP) 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 or scarring. In more serious cases, severe tissue damage and visible disfigurement can result. (http://www.trich.org) Variations may include chewing and nail biting.
What Can a Stylist Do?

  • Be gentle with shame. Many will deny it even when it’s obvious, or lie about the how the damage occurred. Confrontation may be too overwhelming. Stay with compassion. Shame and self-esteem are the most toxic aspects of these problems.
  • Create a safe space.  Provide as much privacy as possible, including a station in a corner, room dividers,  or away from other chairs. 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. Ponytails, pinning across the area, layers, hair pieces, and waves. Good Concealer for skin.
  • Refer to a dermatologist if you see signs of infection or irritation.  Evan’s Dermatology Partners in Austin is great. This will not manage the behavior, but treat the wounds and diagnose underlying medical conditions.
  • Normalize. Everyone picks/pulls at least a little. It is estimated that 1 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. Find therapists at trich.org, skinpick.com, and courage-counseling.com

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 the picked or pulled area.

Priscilla Elliott is a Licensed Professional Counselor and Somatic Experiencing Practitioner in south Austin. She owns and provides psychotherapy at Courage Counseling, PLLC. While specializing in helping clients who are struggling with trauma, trichotillomania, and/or skin picking disorder; she also supports many in life transitions, anxiety, and depression. Call now for help: 512-673-3987

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