Pulling Hairs from My Legs: OCD or Trichotillomania?

Reader’s Question

I will spend hours daily going over my legs with tweezers searching for any hairs I can pluck (including ingrowns). I examine the hairs I pull and feel disappointment when there is no “root” or bulb at the end. It may sound sick, but I stick the hairs to a piece of paper organised by “good hairs” that have bulbs or red tips and all others or “boring” hairs. When I am finished, I throw the paper and hairs out. I seem to be unable to tweeze these hairs if I do not stick them to paper after each one.

I do have time periods where I will go weeks without plucking, and then I relapse or whatnot and find myself doing the tweezing every day. I do not pull out my head hair and I am not even that interested in plucking my eyebrows (although I do groom them).

Is this a form of OCD or Trichotillomania?

I have always been too embarrassed to mention this to anyone. I have never been diagnosed with either the above illnesses. And I’m female.

Psychologist’s Reply

Obsessive-Compulsive Disorder (OCD) and Trichotillomania (TTM) are closely related. TTM is the recurrent pulling out of one’s hair and can involve hair from any part of the body although the eyebrows, scalp, and eyelashes are the most common. A close examination of TTM finds two types of behavior — purposeful and automatic. Purposeful TTM involves a type of ritual (as you describe) and is felt to be related to OCD. However, some behaviors are automatic, like the automatic habits of cigarette smoking when driving, after a meal, when on the phone, etc. The automatic behaviors in TTM are suspected to be related to Tourette’s Disorder. We do know that TTM has both excitement and calming as part of the emotions connected to the behavior. TTM is most commonly found in females.

The most frequent treatment for both OCD and TTM includes a combination of antidepressants and Behavior Therapy. The use of antidepressants is very interesting in my opinion. Most antidepressant medications work by increasing the availability of the neurotransmitter Serotonin. In studies, low levels of Serotonin are thought to be associated with depression, eating disorders, OCD, TTM, body dysmorphic disorder (your nose never looks right!), and other conditions. A certain percentage of depressed individuals with no history of OCD will suddenly develop OCD and TTM behaviors such as counting, hand washing, germ phobia, hair pulling, etc. While TTM is a chronic condition (without treatment), the compulsive behavior (hair plucking) will increase and decrease with your level of stress. This is true of all behaviors related to OCD, TTM, and many depressive behaviors.

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The Serotonin connection between OCD, TTM, and Depression tells us that you will have many symptoms of depression as well. You are likely to have problems with low self-esteem, chronic fatigue, sleep/appetite problems, poor concentration, social withdrawal, loss of humor, etc.

For treatment, I would strongly recommend consulting with a psychiatrist as they are best trained in treating OCD and TTM from a biological perspective. The psychiatrist may also refer you to a Behavioral Therapist for additional treatment. It’s important to begin treatment. Without treatment, any positive effort (new job, new relationships, college enrollment, etc) will actually increase your TTM to the point of disabling you and ruining your efforts. Keep in mind that while you are very secretive, TTM is actually fairly common. It’s estimated that 1% of the population has TTM, so you are not alone. While your symptoms and behaviors are unusual to you, they are commonly found in treatment of TTM and will not be a surprise to any mental health professional.

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