I’m still wondering at the wisdom of posting my last post about Annabelle’s trich. The last thing I want is for anyone to pity her or see this as freakish behavior (though, I admit that seeing a bald spot on my own child’s head, caused by her own hand, is horrifying).
I’ve researched trich quite a bit over the last few years, and while I don’t hold myself out to be an expert, I have learned some things:
First and foremost – and this responds to probably the most prevalent misconception about trich – it is NOT an OCD behavior. OCD is characterized by repetitive, ritualistic behavior (for example, washing one’s hands over and over, or feeling compelled to turn a light switch on and off a certain number of times), the driving force being a belief that if such behavior isn’t followed, something bad will happen, or the general order of things will be upset. Trichotillomania is classified, rather, as an impulse (as opposed to compulsive) control disorder – in other words, an inability to control one’s impulse to do certain things, in this case, twirl or pull one’s hair. It is considered to be the same type of “habit” as nail-biting and skin picking (know anyone who habitually picks at their cuticles? I bet you do.). The sad and frustrating thing about trich, and what makes it stand apart from nail-biting, is that it impacts a person’s physical appearance so much more drastically, and therefore it has a much stronger social stigma attached to it. If you see someone biting their nails, even down to the bloody quick, you hardly give it a second thought, because so many people do it. If you see someone pulling their hair out, on the other hand, well, that just sort of screams “crazy,” doesn’t it? But in reality, the two behaviors are extremely similar.
As for Annabelle – and I suspect for many people with trich who began the behavior very, very young – I believe it started out as a sensory thing. I think as a baby, she just liked the feel of hair between her fingers (much like some babies like rubbing tags or the silk edge of a blanket between their fingers). I think over time, it became a self-soothing behavior – very much linked, in her case, to her finger-sucking, which she also continues to do to this day – and gradually the rubbing/twirling just grew more vigorous until she was breaking the hair off, and over more time, yes, it became a response to boredom and stress. To this day, she only does it when she’s idle – sitting in the car, for instance, or watching TV, and in bed as she falls asleep at night. It tends to go in cycles with her – she’ll go for months when it will seem very much under control, and her hair will grow out beautifully, and then for whatever reason, she’ll go on a pulling cycle that might last weeks or months. Right now it’s the worst it’s ever been – I say that because never before now has she ever actually pulled hair out at the root, creating bald patches – and I’m sure it’s tied to the upheaval of having a new baby and the boredom and lack of structure that comes with summer break.
As far as behavioral therapy, yes, it’s something to consider. But the truth is that our insurance won’t pay for it, it’s very difficult to find a therapist with specific knowledge about trich, and I’m not sure it would help anyway. I have a friend whose daughter also has trich, and they took her to THE expert/renowned trich therapist (in a different state), and the tools she offered, from my understanding, weren’t all that different from what we already offer at home which I’ve learned about just through my own research.
It is very difficult, without a doubt.