Weeding the Body: Trichotillomania and the Unconscious Desire to Pull

God spare you the judgment of a fifteen-year-old girl. Recently, one whom I like a lot showed me some pictures of her classmates, slowly swiping left, submitting them to my sentencing and her own. She paused at one photo and used her fingers to zoom in. "She pulls out her hair," she confided, her voice low with disgust. "It's so gross." I couldn't see anything out of the ordinary, and I told her so. "Her eyelashes," she said. Indeed, eyelashless, the girl's face looked slightly bare and denuded, unnerving but not exactly unattractive. I told my friend to go easy. "I just don't understand why she can't just stop," she said, dismissing in an instant both her classmate's physical appearance and her personal fortitude. Without her eyelashes, this girl was functionally nothing.

As fate would have it, I knew exactly why she couldn't just stop. For one thing, I'd spent the last four years researching her condition, known as trichotillomania—the chronic and compulsive pulling out of one's own hair. For those with trichotillomania, simply stopping is not an easy option, or even an option at all. The act of pulling is compulsive and unconscious, like jiggling one's leg or biting one's nails. For another thing, I'm one of those who can't quite stop.

As with most medical terminology, the name trichotillomania is Greek in origin, from trikhos and tillein, meaning "hair" and "to pluck," respectively, and the suffix mania, meaning "madness." Few people have heard the name of the syndrome, but many I spoke to while researching—most, even—knew someone who has it: "A girl I went to middle school with has that. She had to go to rehab." "A cousin of mine pulls out her eyebrows." "My brother used to pluck his hair." "A woman at work wears a turban to hide her hair loss." People shared these stories with me eagerly, relieved to put a name to a face, so to speak. But there's often a shade of pity and befuddlement: Who would do such a thing?

Anywhere from 0.5 to 4 percent of adolescents

and young adults may have some form of trichotillomania, which means the disorder may be as prevalent as anorexia. But the numbers are slippery, and potentially low; the data, as with all medical research, rely on people's willingness and likelihood to report their symptoms. There have been no large-scale studies of the disorder to date. Those who pull their hair out don't often report it. They are unlikely to consult with doctors or seek specialized counseling. They aren't often sent to hospitals. They rarely even suffer pain. In fact, most people who have trichotillomania have probably never heard the term at all.

Nevertheless, there's a certain startling uniformity to the narratives of those with trichotillomania, or trich, as it's called casually within the community (pronounced "trick"). They all incorporate the same tropes, the same moments, the same sensory fixations, revelations and relapses, ebbs and flows and cycles of defiance and shame. For example, most people who do it describe their need to pull as an unconscious desire, like an itch, like a feather to the back of the brain. Once the desire is resisted, it becomes manifest—unbearable, even. They describe the resistance as a constriction in the chest, a heat in the cheek, an ache in the soul. Only satisfying the urge can ease the discomfort. Just as itching calls for scratching, trich calls for pulling.

Most pullers describe their compulsion as a sort of task or game, which centers on the rooting out and removing of "bad" or "wrong" hairs—coarse or wiggly ones that undermine the purity of the whole. One woman described pulling to me as "gardening the hair" and "weeding." The process is tactile, meditative, intuitive—an exploration of what makes each hair different. Some 10 to 20...