Sandy Rosenblatt stood in front of the mirror in her playroom. Her parents were getting a divorce, and she felt all the tension closing in. Staring at that mirror, the 7-year-old started plucking out her eyelashes one by one. She often watched her mother groom her eyebrows with tweezers, and she swelled with pride at the thought of emulating her.
Satisfied, she ran upstairs and burst into her mother's bedroom, shouting, "Mom! Look what I did!"
Turning to see what surprise her daughter had in store, her eyes fell on Sandy's eyelash-less face. Horrified, she cried out, "Don't ever do that again!"
But it was too late.
Rosenblatt, now 39, is one of millions of people suffering from Trichotillomania (pronounced trick-o-til-o-MAY-nee-ah), a disorder in which people have an irresistible desire to pull out their hair from the scalp, eyebrows, legs, pubic area or any place where hair grows on the body. Experts say about 1 in 50 people – or 2 to 4 percent of the population – have the disorder, though numbers may be larger due to the fact people are too embarrassed to admit to medical professionals they pull their hair and go to great lengths to hide their behavior from family and friends.
"Often a person has a life of subterfuge and secrecy even from the people they're married to," says Charles Mansueto, director of the Behavior Therapy Center of Greater Washington in Silver Spring, Md., who has studied Trichotillomania, commonly referred to as Trich, for 20 years.
As a 7-year-old, Rosenblatt couldn't hide her hair pulling so easily. One day, her father came home and found his daughter with bald patches the size of baseballs on the sides of her head. Not knowing what to do, her parents took her to a therapist. In the comfort of his office, they played Connect Four, colored and talked about school – a gentle attempt to pinpoint a source of anxiety. But at home, the course of action was more traumatic, as the therapist instructed her parents to tape her eyes shut before bed with a pink cloth so she couldn't pick her eyebrows and eyelashes while falling asleep.
About an equal number of boys and girls under age 10 are prone to develop Trichotillomania, but hair pulling becomes more common for girls around the age of puberty. While those who seek treatment are women nine times out of 10, experts believe not as many men get help because they can disguise their appearance easier by shaving off patchy bald spots on their heads or beards.
Yet people who do want help may not be able to find it, as Mansueto says there aren't enough professionals who can properly treat the disorder or even diagnose it. "It's not uncommon for us to hear that people have gone to doctors, and doctors look at them oddly and [say,] 'You do that?'"
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Many physicians confuse the condition with obsessive-compulsive disorder and often prescribe antidepressants meant to treat OCD, which do not successfully treat Trichotillomania. Mansueto – a member of the Trichotillomania Learning Center's Scientific Advisory Board – says no medications stop hair pulling or make a significant impact in preventing the behavior. The best treatments fall under cognitive behavior therapy, which Mansueto describes as teaching people to "channel some of their motivations in other directions so to leave the body intact."
Hair pulling is classified as a body-focused repetitive behavior, which includes actions such as nail biting, skin picking and tongue chewing. Though the condition was introduced in the Diagnostic and Statistical Manual of Mental Disorders in 1987, it wasn't until the early 2000s when health agencies recognized Trichotillomania as a widespread disorder that causes suffering. "[People] drop out of college because they're pulling while they're studying," Mansueto says. "They don't get involved in relationships and avoid intimacy. They can't do ordinary things like dive in a pool or be out in the wind for fear of being detected."