medicines, and the creation of a medical advisory group and support networks, Trichotillomania persists in mystifying science in its causes, classification, and treatment. Frankly, we don’t know much more about compulsive hair-pulling than François Hallopeau did in the late 1800’s. I believe this is because we are not asking the right questions.]
Living with trichotillomania is a torturous existence. It makes a mockery of life by stealing your functionality. It doesn’t kill you, but it makes you wish you were dead. So for a weekend, in 1997, 122 of us bore our burdens together at a private camp in Massachusetts.
Mostly women attended the trichotillomania retreat. Some felt liberated to expose their sparsely covered heads; others still held on desperately to their scarves, wigs and hats, even in the presence of forgiving company. I had been flaunting my shaved head around town for years, but it was pleasant to see understanding in the eyes of perfect strangers; to share the company of people who made no presumptions.
I saw varying degrees of hair-pulling. There were some whose pulling was a mild, completely unnoticeable nuisance; there were others with small rat bites (as my grandmother calls them) here and there; there were those who pulled out 50% of their hair; and then there were some who had ravaged 90% of their scalp.
Seeing so many heads au naturel I noticed a trend: the most commonly bald spot was the very top of the head (areas 2, 3, 4 & 5 in the picture), and especially where the hair swirls around – the giri giri (as the Japanese call it), or the cowlick. Also commonly bald was the area directly around the ears (areas 7 & 8, and area 10 near the ears).
Of course, no statistics or measurements or surveys of any kind have ever been taken, but by my observation the area going down the back center of the head (area 10) was less prone to baldness. The very back of the head was not targeted by itself; that is, pulling at the very back of the head was generally a pattern that extended down from the top of the head. If a person experienced minor pulling, it was generally restricted to the crown and ear areas.
Even more interesting, the nape of the neck (area 9) was often left untouched, even by the most ravenous of pullers. I saw several women with severe trichotillomania – who had literally pulled every hair from their scalp – and yet allowed the hair at the nape of their neck to grow sumptuously.
In the years subsequent to the retreat I noticed other patterns. Those who pull from their bodies, also tend to favor the same areas. For example, those who pull from their legs tend to pull along the bony areas – the shin and the knee – and almost never binge-pull from the fleshy area behind the legs or even the thighs. And those who pull from their beards tend to favor the areas to the left and right of the chin cleft.
What bothers me about pulling patterns is that there is level of consistency between individuals when there is no reason there should be. It’s not like pullers go around comparing where they pull and all decide to pull (or not pull) their hair out in the same places. I would like to see hair-pulling patterns and trends documented. The more details we know about hair-pulling, the more likely we will come to an understanding about it.
These patterns remind me of acne patterns. Clusters of acne tend to crowd together within specific zones – the T-Zone (forehead, nose & chin) or the cheeks. There is a wide variety of skin on a single person’s body. What characteristics do these different areas of skin have that can dictate where the pimples will be focused?