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I follow the receptionist through the turquoise and white blowout bar past the counter where women perch sipping Bellinis while their hair is dying and their nails are drying. She seats me at a makeshift station set up in a private back room. This is where they serve women whose religion doesn’t allow men to see their hair. My stylist, Kat, does not look alarmed when I remove my wig and shove it into my handbag.

I pull out bobby pins and shake my long hair down my back as Kat says, “We’ll do your color first. What were you thinking?”

“I would like to cover my gray and match my natural dark brown color.”

“I think some red and caramel highlights would look good. Is that all right?”

“You’re the professional. I trust you.”

She leaves the room to mix the color and I breathe in deeply for six counts and out completely for eight counts like I had learned in therapy to calm myself. Kat and I haven’t discussed how she would cut my hair and I worry it still isn’t long enough do anything fashionable enough to allow me to lose the wig.

I have trichotillomania, TTM for short, the uncontrollable urge to pull out hair strand by strand, causing baldness in extreme cases. My first therapist gave my mom a photocopied magazine article to explain my diagnosis. It was 1988, and I was 11 years old.

On the rare occasions I’ve revealed my disorder, the first thing people say is ‘Doesn’t it hurt?’ I tell them that pulling out individual strands of hair by the root does not hurt the way it feels when a clump of hair is pulled out.

But how does it feel? Well, physically there is a release when the follicle lets go of the hair’s root. Psychologically, there may be some small relief of mental or emotional pressure. I believe this is where the idiom “so upset I could tear my hair out” originated. Hair-pulling, sometimes done unconsciously, can be soothing to someone having anxious or upsetting thoughts. Think about a child sucking her thumb.

I probably had signs of the disorder years before my diagnosis. I remember I was three years old on my grandmother’s lap and as one of my cousins hugged her good-bye a strand of my hair was cleanly plucked from my scalp. I remember my fascination at the thick black, wet root. As a young child I liked to rub my eyelashes between my fingers. TTM is often about sensory experience; the fingertips caress and select a single hair and tug, sometimes rubbing the hair across the lips, then another and another. It is a body-focused repetitive behavior, like its cousin, skin-picking. Sometimes tension builds up in my chest and stomach; I feel really anxious and my fingers fly to my hair.

To keep my hands busy, my first therapist gave me a foam stress ball to squeeze. She encouraged me to snap a rubber band on my wrist when I caught myself pulling. I learned many years later the technique is called a competing response. At her office, she asked me why I pulled. I was 11; I didn’t know. Twenty-eight years later I still can’t explain the relief or release or reward I got when I pulled. I also don’t know why my mom stopped taking me to that therapist. I hadn’t been effectively treated.

Kat returns to the room and commences painting color onto sections of my natural hair she then wraps in foil. If she is curious about my condition, she doesn’t ask.

Until now, I had dreaded the stylist’s chair and would go years between haircuts. Explaining the bald patches on my scalp to a stylist – or worse, removing a hairpiece or scarf in front of other customers – was too embarrassing to face. While realizing I wasn’t bringing much to the chair for her to work with, I still desired to keep the relationship with the stylist “Don’t ask; don’t tell.” I hated answering questions but the standard answer was “Stress makes my hair come out,” which was close to the truth. I hid the bald patches with headbands, hair clips, scarves and hats. At my lowest points, I wore wigs.

My mom bought my first wig at a store in the mall – a hot scratchy hairpiece in an unfashionable style. It was wavy and looked like it belonged on a middle-aged woman. I wore it in 8th and 9th grades with a wide headband because I was afraid the wig would slip or blow off, which made me look like Annette Funicello in a 1960s beach party movie.

In the best of times, I would stop pulling and my hair would grow back. TTM can relapse and remit. In the worst of times, I covered the problem with scarves, hats and wigs. The year after I turned 21 should have been the best time of my life. I was newly married to my high school sweetheart. I was a newspaper intern and a journalism student. But the pressure was great; I pulled out handfuls of hair. When I could no longer cover the bald spots, my mother ordered from a catalog a new wig in a brown bob.

Over the years I occasionally sought treatment. I tried the antidepressants Prozac and Luvox because I had read that selective serotonin reuptake inhibitors were effective in treating obsessive compulsive disorder, which is what researchers used to classify TTM as. Now they see it as an impulse-control problem.

At another time I saw a psychiatrist, who took notes while I rambled about my stressors, mainly a toxic boss, for an hour. She left me to figure things out for myself. She never told me how I was progressing and she certainly never mentioned when my treatment might end. I pulled more. I stopped seeing the shrink in 2007 when I quit my job because of the stress. The crown of my head was nearly bald. I covered it with scarves for the next three years, until 2010, when at a dress rehearsal for a concert, I realized the scarves were no longer giving enough coverage.

The Community Chorus was dreaming of a white Christmas and I was praying the singers standing on the risers above and behind me were not looking down at the top of my head and seeing what isn’t there. My face felt as red as the Christmas flowers.

I drove home and went straight to my bedroom. I stood on tiptoes and felt around on the shelf in my closet for the brown bob of synthetic fibers my mom mail-ordered more than 10 years before. I accepted the fact that I was sick enough again to go back to wearing it.

Almost daily for the next two years, I braided my long hair or spun it into a French twist, bobby-pinned it to the back of my head and pulled the wig over it, tucking wisps of my real hair under the elastic band of the cap to which the fake strands were attached. And I convinced myself I blended in with normal people because my hair didn’t look any different from theirs. I kept pulling, years kept passing and the wig kept aging.

Then on July 16, 2013, I was wearing my ratty wig and sitting on the edge of a sofa in new therapist’s office when she suggested a definitive treatment plan: We would start cognitive behavioral therapy at the next session. Dawn first taught me focused breathing, in which I slowly inhaled deeply and exhaled completely for 5 minutes. Grounding techniques such as breathing are an early step in CBT.

 

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