Once upon a time, hats, scarves, headbands and caps were my best friends. Even dupattas and ghoonghats (veils) started to look appealing to my 24-year-old self. Because no one knew my shameful secret, no one knew what I was hiding.
I was hiding the bald patches on my head — those grotesque soft hairless spots on my scalp that I had created, by pulling out one hair strand at a time, till my fingers hurt, head itched and cheeks flushed from guilt and pleasure all at once.
My tryst with trich, a body-focused repetitive behaviour (BFRB) disorder, began in my early 20s when I finished college and started working for an American MNC. As a recent marketing graduate who had led a very sheltered life, I started suffering from anxiety and ended up compulsively pulling out my hair — to the extent that I started developing bald patches behind my ears. I spoke to no one, went to work with a smiling face, and changed my hairstyle every so often.
Because that’s what trich does to you, it instils a sense of shame so deep that it becomes extremely difficult to discuss your problems with anyone — especially your “normal” or neurotypical friends.
But that should not be the case.
A study suggests that trichotillomania affects almost 4 percent of the global population. This means that there are more than 300 million sufferers globally, who pull hair anywhere from their scalp, eyebrows and eyelashes to their body or pubic area. Precise numbers are not available, however, because there has been no large-scale global study of BFRBs. BFRB sufferers often speak of a trance they go into when they pick or pull or bite, only realising after some time that they have been doing so. BFRBs are often mistakenly associated with obsessive-compulsive disorder (OCD), but it's common for people to experience their compulsion without obsessive thoughts. BFRBs have been on the radar of the collective human consciousness for around 2,500 years. In Epidemics Book 1, the ancient Greek physician Hippocrates tells young doctors, “We must note whether he plucks his hair, picks at his skin, or weeps.”
In my experience, one of the most common complications the damage that hair-pulling can do is to self-image — in the form of embarrassment, shame, guilt and depression. For years, I used to avoid activities like going out in the sun, swimming without a cap, or even going for actual haircuts, lest one of the “parlour aunties” looked at me like a freak.
I’ve been to a few therapists and psychiatrists who’ve prescribed me antidepressants like Zoloft or Prozac, and the disorder has taken a back-seat for months, even years at times. I locked my shameful secret in a dark box deep inside my funny little brain, never to be unpacked. All I ever wanted to do was forget about it, not talk about it, and pretend like it never existed.
Nonetheless, I had learned to look for and avoid specific triggers like arguments between close friends, disappointment displayed by parents, or even dandruff season in winter, which made me want to scratch my head.
But that changed once again in November last year.
At the time, I was living in one of the friendliest cities in India — Bengaluru. As I waited for a tardy friend to finally show up, I ran my hands through my hair and yanked a solitary, coarse hair out. The tingling sensation, and the burst of release I felt at that moment warned me that I was falling back into my old habits. And I was right. In just a month, I developed bald patches on my head, and my hair started to look stringy and limp.
I found a therapist near my home and started going regularly. A cheerful but slightly bossy creature, the therapist suggested various exercises as a part of my habit reversal therapy. I must’ve been a difficult patient for her — I often lied, dismissed her concerns and finished her exercises half-heartedly, without ever trying to “dwell deep”, as she suggested.
She must have picked up the signs, obviously, because even though I showed up regularly, my notebook remained crisp and new, with only a few pages filled with disjointed lines written with my left hand (I am right-handed).
My therapist finally suggested an exercise that, to this day, I tremble to write about. She said, “I want you to go about your day and pay attention to your pulling. Each time this ‘episode’ happens, I want you to collect the discarded hair in an envelope. I want you to write the date, time and the things you were thinking about when you started pulling.”
I went home with a sinking feeling in my stomach. Was I ready to look at such hard “evidence”? To face what I have done — what I have been doing for years?
I don’t think I managed to fill even one envelope. All I remember is me sitting on a floor with a dusty hairball in my hands and tears in my eyes.
Twenty minutes later, I messaged a hairstylist on Instagram and told him I wanted to shave my head, make a “clean start”. He showed up at my door with his gear and chatted happily as if he was giving me a regular haircut. He ran his fingers through my hair one last time, and asked me if I was sure. “Yes,” I said, my voice steady, but my fingers fidgeting.
Half an hour later, I ran my hands over my bald scalp and looked at myself in the mirror. It was only my hair, but a part of me felt like a close friend had died.
“Tomorrow, your friends and colleagues are going to ask you if you are going through chemotherapy,” he said awkwardly.
I cancelled my therapist appointment and laughed for a while at that insensitive joke.
As I am learning over time, shaving one’s head is not a “cure” for trichotillomania. As with most body-focused repetitive behaviour disorders, what works for one does not necessarily work for others. I can only stay vigilant and try not to fall prey to the same behavioural patterns.