Carla Bernado’s battle with trichotillomania, also known as hair-pulling disorder, started when she was 11.
She would pluck out her eyebrow hairs, focusing on the thicker, darker strands. This lasted for a year until she moved on to the hair on her head.
Her mother noticed the hair-pulling and decided to research possible causes and therapy.
When Carla reached Grade 9, the hair-pulling had worsened. By this time, she was sort of aware of why she was doing it – to cope with any negative or uncomfortable feelings. She then started seeing a psychologist.
Bradley Drake, a clinical psychologist at the Centre for Cognitive Behaviour Therapy, says trichotillomania falls within a category of disorders referred to as obsessive compulsive and related disorders. The causes for trichotillomania are partly biological and partly learned, he says. Hair pulling is typically triggered by an urge to pull or the general experience of tension.
“Those diagnosed with the condition often struggle to resist the urges and can also pull at times without realising it, referred to as automatic pulling. The neurological loop that those with TTM are stuck in involves the triggering of an urge to pull, often followed by attempts to find ‘the right hair’ to pull and then a sense of gratification or relief following the pulling. The problem is that the more one acts on that urge, the greater the likelihood of the urge returning and so the cycle continues.”
Carla, 29, a former journalist who now works for UCT’s communications department, says the condition cast a shadow over her life. It affected her relationships, and visits to the hairdresser were a no-no.
“In every single past relationship, I would not allow my partners to touch my hair, and if they came close to doing so, I’d freak out,” says Carla, who lives in Observatory with her fiancé. With my fiancé, I am finally in a place where I feel safe and comfortable and where I don’t need to hide the effects of my pulling. I also have not been to a hairdresser in forever because only one stylist I have met in my almost two decades of pulling knew what trichotillomania was about. Others would call it a bad habit, tell me I was destroying my hair, suggesting I take up smoking instead, shaming me in front of other customers – just really not very professional or thoughtful.”
Carla researched ways to cover up bald patches on her head, including wearing hats and caps and tailoring outfits accordingly, and spent a fortune on hair extensions.
“For two separate years, I also wore what is known as a hair system. It covered my own hair and allowed it to grow and lessened any pulling.”
But that required particular hair care and monthly visits to the hair clinic where the system was fitted.
“I loved my visits there because it was the closest I could get to a normal visit to the hairdresser, but often the appointments would be during a workday and it was so difficult explaining why I needed to leave the office or take time off.”
Carla has now been one month hair-pulling free and continues therapy.
She says the worst part of the condition was the shame she felt when she couldn’t control the urge to pull her hair out.
“I also felt that I was wasting my mother and father’s money and time when I didn’t succeed in stopping. But what I’ve come to realise is that all of the ‘worst moments’ happened when I thought I needed to hide this or keep it a secret.
“The moment I started talking about my journey with trichotillomania earlier this year, that weight and that shame were almost instantly lifted. Not only did I feel so much better, but I had so many friends reach out to say they were also suffering in silence and because of speaking out about it, a friend could respond with a recommendation for help, and now I am receiving the best help and treatment from Bradley Drake and Dr FP Joubert.”
Carla’s advice to others is to never hide the condition and never be ashamed.
“We are all struggling in some way or another. If you have a toothache, you go to the dentist and seek help. Mental health is no different. If you’re struggling, reach out, speak out. And if you have a similar condition to me, I’d be happy to share my resources with you.”
According to Mr Drake, the prescribed treatment for trichotillomania is cognitive-behavioural therapy with or without medication. This type of therapy makes use of habit reversal, which provides the patient with alternative options that can be used to manage the urge until the urge passes, without pulling.
“Patients are introduced to specific techniques referred to as competing responses which essentially provide alternative behaviours which are incompatible with pulling. This is done in addition to a set of strategies aimed at targeting one’s interaction with the environment, referred to as stimulus control. Stimulus control is aimed at reducing the likelihood of urges being triggered or reducing the likelihood of pulling in response to those urges. Mindfulness and other cognitive strategies aimed at how people think about their ability to accept and withstand the urge are also utilised.”
The aim is to reduce the association between the presence of the urge and the tendency to act on it, he says.
“This, if successful, can eventually also result in a reduction in the frequency of urges, thus further assisting the patient to reduce their pulling and often have their hair grow back, thereby improving their quality of life. Treatment may also simultaneously target mood or anxiety symptoms as these can increase the frequency of urges, if left untreated.”