Grappling With Trichotillomania As the World Reopens

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“Hair-pulling can be on the spectrum of anxiety disorder and worsen during periods of anxiety,” Dr. Weschler notes. Since the start of COVID, “there’s been an uptick in every anxiety disorder,” trich included. (Honestly, the pandemic has already taken so much—lives, jobs, the quiet peace of never knowing the word “Cuomosexual.” Must it take our eyebrows, too?)

If you’re new to the Anxiety Eyebrows club, let me be the first to welcome you. I developed trich in high school, meaning I’ve dealt with pulled-bare brows for over half my life, and I have some thoughts to share.

First, more people pick than you think. “Most people that do this to themselves think they’re the only ones that do it and they feel alone and isolated, but it’s really common,” Dr. Wechsler says. “It affects up to 2 to 5 percent of the population in some studies.” That number may very well be higher. “Many trichotillomania cases are misdiagnosed and underreported due to the secretive and embarrassing nature that is associated with compulsive behavior disorders,” says Bridgette Hill, a certified trichologist and founder of Root Cause Scalp Analysis.

Because BFRBs are underreported, they’re also understudied. Experts haven’t identified one clear cause for trichotillomania. It’s likely a mix of “genetic, biological, and behavioral factors,” per a recent report from The New York Times, which can be triggered by a single traumatic event; or general stress, anxiety, or depression; or sometimes nothing at all. Some say the condition is related to Obsessive Compulsive Disorder (OCD), although that’s up for debate. Either way, I’ve found the comparison to OCD—a more talked-about mental illness—can help contextualize the all-but-uncontrollable nature of trich: This is not a bad habit or a personality quirk. It’s a psychological disorder.

That said, a picking episode isn’t always the frantic, panicked experience you might imagine. Many go into what could be called a “trich trance,” completely oblivious to what they’re doing and how long they’ve been doing it. But while picking may be mindless, it’s never meaningless.

“It’s no accident that when people are anxious and do these repetitive behaviors, they’re done to the skin, hair, or nails,” Dr. Wechsler says. “The brain and the skin are made from the same embryological layer of cells—they’re kind of hardwired together—so there’s something about feeling a physical symptom that can sometimes decrease a mental symptom of anxiety.” This hardwiring is more formally known as the Skin-Brain Axis, the network responsible for splashing our deepest feelings across our faces. Embarrassment manifests as blushing, fear manifests as blanching, stress manifests as stress skin. And for some, mental anguish manifests as the pore-deep pain that precipitates Anxiety Eyebrows.

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