Dr. Tarra Bates-Duford
Unresolved Stress & Trichotillomania
For many people stress is not only a common part of life but a manageable part as well. However, stress for some people can become unmanageable and even debilitating. Although, not readily discussed and understood, Trichotillomania can a dysfunctional coping mechanism is response to intense stress. Trichotillomania can be a long-term (chronic) disorder, leaving in its wake emotional and physical scarring. This disorder requires treatment in an effort to reduce and or mitigate the symptoms associated with the disorder. Without proper treatment, symptoms can vary in occurrence as well as severity over time. Symptoms can also come and return without warning, varying in time lapse and symptom re-emergence, i.e., symptoms can stop for days, weeks, months, and even years. According to the DSM V, Trichotillomania is a disorder that involves recurrent, irresistible urges to pull out hair from your scalp, eyebrows or other areas of your body, despite multiple efforts to stop. Those that engage in hair pulling in response to extreme stress experience patchy bald spots on the scalp and eyebrows, hence, whatever area of the body that involves chronic hair pulling. Hair pulling for those diagnosed with Trichotillomania can create instant feelings of satisfaction and relief from stress. However, there is a vicious cycle people with Trichotillomania must endure, intense stress, hair pulling, relief, embarrassment, intense stress, embarrassment, hair pulling, etc. In order to avoid the negative intense feelings associated with the disorder those that suffer feel compelled to engage in the cycle, thereby reinforcing it every time they engage. Suffers of Trichotillomania experience significant distress that can interfere with family, social, and work functioning.
Trichotillomania can be very confusing to individuals with no prior knowledge or experience with the disorder. It is confusing for a number of reasons, the first being by can’t those with the disorder just stop pulling out their hair, picking at their skin, chronic nail biting, etc. The second reason being, why would someone pull out their hair then attempt to cover the area with a weave, wig, hat, etc. The third reason being what gratification can someone possibly get from pulling out their own hair.
Taylor is a 26-year-old female who started a job with a large, reputable fashion design company. Taylor is excited and thrilled to have been offered such a career building opportunity. Although, Taylor recognizes what a great opportunity she has landed she often feels as if she is undeserving. Taylor is one of the youngest members of the company, she is also the most despised by other staff. More experienced staff felt Taylor was not qualified nor deserving of her role within the company. Most of the staff were subtle with their dislike of Taylor, by some were overtly and blatantly hostile. Not sure of when it began Taylor started ripping out the hair located at the nape of her head. The only thing Taylor remembers is feeling instant relief from her anxiety when she pulled out her hair for the first time. The more distress Taylor endured at work the more she pulled out her hair. However, she quickly noticed once she removed the hair she soon began rubbing the hair against her cheeks which provided additional relief. As her work related problems escalated so did her hair pulling. Taylor soon began wearing stylish hair scarves, hats, and weaves to cover the bald patches on her scalp. She wants to stop, but feels powerless to do so. Taylor is becoming increasingly embarrassed about her appearance, worrying someone at work will discover her secret, will know how weak and insecure she really is. Taylor wonders if her hair pulling is isolated to her job with the fashion design company or is it a general response to intense stress. Can she learn appropriate coping mechanisms to manage stress without receiving mental health treatment from a professional?