Trich, revisited

I wanted to go a little more in depth about our experience with Annabelle's hair-pulling, and my thoughts on it, since people have asked some questions about it.

My understanding is that trichotillomania, while still in large part a mystery, is generally believed to be associated with anxiety and/or OCD (although I just read on some website that it's not considered a compulsive disorder, but rather an impulsive disorder). Annabelle has never been formally diagnosed with trich, but I assume that's what it is since it's gone on far too long to be considered "a phase," as our pediatrician believed it to be when I first discussed it with him.

Here's how it evolved in Annabelle's case: I first noticed her pulling her eyelashes out as I was nursing her when she was about ten months old. I can still picture it. It alarmed me, because it just seemed so strange. At that time, I had never heard of a condition or disorder involving hair-pulling. Shortly after that incident, Michael and I just happened to land on a documentary on TV about this condition where people pull their hair out called trichotillomania, or trich for short. I was horrified. Could my baby daughter have this? But her eyelash pulling was short-lived. She stopped doing it as suddenly as she had started, and I breathed a big sigh of relief and then pretty much forgot about it.

She's been a finger-sucker since she was an infant. She discovered the middle and ring fingers on her left hand as a little baby and began sucking those two fingers as a self-soothing mechanism. Over time, she began twirling her hair in the back as she simultaneously sucked her fingers. The two activities went hand in hand. No big deal. Except she began twirling wicked knots into her hair which I then had to cut out.

I don't know exactly when she started pulling her hair out instead of just twirling it. I discovered it right around the time she turned four, I think. I saw her doing it, wrapping strands of hair around her index (or twirling) finger, as she sucked the two fingers on the other hand, and ripping the strands of hair right out of her scalp. Just the sound was enough to turn my stomach and break my heart. And I began finding her pulled-out curls randomly on the floor.

I tried to reason with her to get her to stop. And as I've documented, I taped her fingers (the sucking fingers and the pulling finger) pretty much every day for over a year. And her hair did grow out while her fingers were taped, but whenever the tape wasn't on, she'd go right back to sucking and pulling. Then I tried just washing my hands of the whole thing and telling her if she wanted to pull, fine, but she could only do it in a specific chair in a specific room of the house. Well, that didn't work either. So I tried tape again, and very shortly thereafter discovered that even the tape wasn't stopping her from pulling anymore. So now we're trying the stuffed animals as a redirection tool. I can't really say how it's going; she's carrying the stuffed lambs with her almost everywhere, and sleeping with them, but I suspect she's also still pulling (I know she's still at least twirling because I've seen the telltale corkscrews sticking out from her hair).

So.

I don't know what drives her penchant to pull. I suspect that it started out as a sensory thing - at least the twirling part. And that it, for some reason, evolved into pulling. I wouldn't say that she's an overly anxious child. She certainly wasn't an overly-anxious baby or toddler. She and Daisy were both colicky, crabby infants, but by the time Annabelle started messing with her hair, she had outgrown that. In fact, she's always been mischievous, happy-go-lucky, just lookin' for a good time. Our little party girl. Daisy is the one who's had all the anxiety and phobia issues, but man, oh man, has that girl come a long way. She's overcome so much of that. However, some of the phobias seem to have transferred to Annabelle recently. Those twins, I tell ya - a science experiment in action. Anyway, although Annabelle has developed some phobias of things she didn't use to be bothered by (like animals), I still wouldn't classify her as overly-anxious.

Now, the compulsive vs. impulsive. There might be something to that. I would not say that Annabelle has any compulsive leanings, but she definitely has impulse-control issues. She does very well in structured situations (like at school), but when she's got free time on her hands, like at home, she's willy-nilly. So, yes, I can see the hair-pulling being some sort of impulse thing with her.

But I've been thinking a lot about this whole disorder thing. Without having done much research, I'm only speaking here as a lay person and a parent. I wonder, though, why exactly trich is considered a disorder or condition. A friend once asked me if it's the same type of thing as self-mutiliation. No, it's not. Self-mutilation, I believe, usually comes on the heels of some severe trauma. Hair pulling, it seems to me, is more along the lines of nail-biting. So why is it such a bigger deal? I mean, lots and lots and lots of people bite their nails - often down to the bloody nubs. And although it's an unattractive habit, it's pretty accepted. Does trich have such a stigma simply because we are an appearance-focused society and the appearance of someone's hair (or missing eyelashes or eyebrows) is harder to overlook than bitten-down nails? I don't know the answer to that, but it's something I've been thinking about.

The truth is, trichotillomania is more prevalent than most people realize. Since I started blogging about our trials with Annabelle's penchant for hair-pulling, other people with trich have come out of the woodwork. A couple of my friends in real life have confided in me that it's something they deal with. And I never would have known. Look around you - chances are, if you're in even a small gathering, there is at least one person there who pulls their hair (or eyelashes or eyebrows or other body hair) out. And here's the thing: you wouldn't know it unless they told you. They function. They deal with it. It's troublesome, but it doesn't consume their lives (although I'm sure there are people with severe cases of trich whose lives it does consume, but I have to think that those people have other, compounding issues).

Ultimately, I have to hold onto this for Annabelle. I can read all the books and try all the tricks to try to get her to stop, but one day she's going to be a grownup and I'm not going to be able to hold her hand through these kinds of things. She will have to find a way to deal with it, by herself. Whether I can find it in myself to let go of it now or not, the truth is that some day I will have no choice but to let go. She will have to own it. And I have to trust that she'll find a way to deal with it, and that she'll be okay.