I am 27, have a job I enjoy and recently got married. Life is good. However, since I was seven, I have pulled out my hair. I mostly do it when I'm feeling anxious, but also if I'm sad, bored or lost in thought. I tend to have bad phases and then be OK for a while, but the good periods don't last long. Sometimes I don't even notice I'm doing it. It's become a habit, which leaves me feeling low and bad about myself.

I have had psychotherapy in the past, when I was having problems with my husband, who was then my boyfriend. It helped a little, but I still pulled my hair. I recently plucked up the courage to ask a GP about it and he looked blank. My parents and other family members knew I did this in childhood, but I don't remember them taking me to see a professional for help.

I know I am the only person who can take control of this, but I feel so alone. Is there anybody out there who has had this habit and managed to kick it? Neither my husband or friends know anything about it and I could never tell them. I've told my hairdresser that my hair falls out with stress, because I can't tell him the truth. I don't think it is noticeable, but it scares me that someone may spot a bald patch soon. Perhaps they already have, but simply haven't said anything.

Don't keep it a secret

I'm 30 and have had trichotillomania since I was 13: I mainly pull out my eyelashes and hair. It is much worse when I am stressed (overstimulated) and when I am bored (understimulated). I have stopped a number of times but have always relapsed.

Ask your doctor to refer you for CBT or habit reversal therapy. The therapist will train you to identify your impulse to pull and teach you to redirect it. Part of the treatment involves keeping a record of your hair-pulling episodes (eg, the date, location, number of hairs pulled and how you were feeling at the time). I found this process led to an increased awareness of the causes, which in turn made me feel more in control of it.

There are people who manage to quit permanently, but not everyone who seeks help may be able to do this. What is particularly damaging about this compulsion is the secrecy surrounding it, which is born out of fear that people will notice its physical results. I told my partner and family four years ago about my compulsive behaviour, which released a lot of pent-up anxiety and made me more relaxed about the condition.

It helps to educate yourself - there is a great book called The Hair-Pulling Problem: a Complete Guide to Trichotillomania by Fred Penzel.
K, Leeds

Seek help - and tell your husband

Trichotillomania can be treated, and if not eliminated, it can certainly be managed. I have lived with my own compulsive hair-pulling since I was a teenager (I am now in my late 20s).

It is caused by anxiety, so anything you can do to reduce your fretfulness will help. Lower your consumption of alcohol, as this can also be a trigger. Most importantly, go back to your GP armed with information about the condition and insist he or she refers you to a specialist who can help. This may be a dermatologist or a psychiatrist - ideally both. You may be prescribed a topical steroid to help the hair grow back where you have a bald patch. You will also be shown techniques that help you manage the behaviour.

I still go through good and bad phases. When I am having problems at work, or with my personal life, the pulling is worse. Talking about it with someone who cares about you may help you to understand your unconscious motivations. If you can confide in your husband and tell him how you feel when you're doing it, he will realise that you need his support in tackling this behaviour.

Although you may never be able to stop the pulling entirely, you will certainly be able to control it so that it does not affect your appearance. Thank you for asking for help - more people need to know and hear about our condition, so we need not be embarrassed when we have a flare-up.
H, London

What the expert thinks

You describe an almost textbook case of trichotillomania. Psychiatrists classify this as an "impulse control disorder". What that means is that you become tense just before you pull your hair or when you try to stop yourself from doing so (that's the impulse). You then feel relief or even pleasure when you "give in" to the impulse. The act of pulling therefore "rewards" the impulse - and that's why it's so difficult to overcome the problem.

It is estimated that only 1% to 2% of the population suffer from this disorder, so it's not surprising that you feel isolated and alone. To get in touch with other sufferers and find out how they have dealt with the problem, Google "trichotillomania". The websites that appear most helpful are: anxietyuk.org.uk/condition_tricho.php and trichotillomania.co.uk.

It is understandable to feel discouraged at this point, because your problem is so long-standing. However, don't blame yourself - you have tried to obtain help, but you have not been offered appropriate treatment. Start by assessing your mood generally, not just in relation to the hair-pulling. Do you think you might be depressed? Do you feel sad, tearful or empty most days? Does the future seem very bleak? If you suspect you are depressed, see your GP. It is important to address this problem first, otherwise your depression will sabotage your efforts to break the hair-pulling habit. Probably the most appropriate treatment for you will be a combination of cognitive behavioural therapy and anti-depressant medication. There is a particular medication that is most suitable when an impulse control disorder is part of the problem - ask your GP about this.

Once you start to feel better generally, it will be time to treat the hair-pulling. The best way to do this is to use a three-step approach of delay, displacement and distraction.

First, you need a way to recognise when you are about to pull your hair, so that you have time to stop yourself. Therefore, it will be necessary to make it more difficult to get at the areas where you pull. This will be relatively easy when you are alone - you could wear a hat, for example. When you are with others and don't want to attract attention, wear your hair in a style that cannot easily be disturbed, and make a conscious effort to keep your hands occupied, or at least away from your head.

You then need to displace the urge to pull - by doing something that is mildly stimulating instead. If you are alone, clap your hands together hard, or do some physical exercise.

In company, press your fingertips together or inhale, hold your breath for a count of 10, and exhale. These activities won't attract notice, but they will dispel your tension.

Finally, distract yourself. Count backwards from 200 by threes, or name as many shades of a primary colour as you can. Turn on the radio or television, or ring a friend for a chat. After three to five minutes, the urge will recede.

Expect a gradual recovery rather than instant success. Refuse to give up, and you will overcome this problem.
Linda Blair

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