Like most, Laurie Piotrowski started in her early teens. Rather than pull her hair out from the roots, she would twist it into tiny balls and then break them off.
“I had really long hair and I thought if I cut it I wouldn’t pull it out,” she said. “It didn’t work.”
After finding hair balls scattered around the house, her mother took Piotrowski to the pediatrician — the first of a succession of doctors she would see over the next 20 years who would offer various medications, psychological counseling and behavioral suggestions.
None did the trick.
Now 40, Piotrowski, an administrator at Fort Dix, N.J., said she still has to fight the urge to pull her hair.
With help from psychologists at the Center for Emotional Health of Greater Philadelphia and a monthly support group, she said, she has managed to let her hair grow for as long as two months before relapsing.
No easy cure
“These habits tend to wax and wane over time,” said Marla Diebler, founder and director of the center, which specializes in treating anxiety-related disorders. So far, Diebler said, no medication has been found effective, although some studies have shown that in adults, the over-the-counter supplement n-acetylcysteine may help.
Behavioral treatments seem to offer the most promise.
One technique, habit-reversal training, attempts to substitute a new, more benign habit for the old. People are given objects to hold or play with — rocks, rubber bands, clay or Koosh balls.
A second method, stimulus control, makes the environment less conducive. Diebler offers the example of a patient who pulled her hair while watching TV, always sitting with her elbow resting on the arm of the couch so she could reach her scalp. By merely shifting her position to the middle of the couch, Diebler said, the woman would at least be more aware of her behavior and perhaps less likely to do it.
And, finally, people who pick and pull without thinking are trained to be aware of their behavior. Those patients, Diebler said, may benefit from sensory cues, such as wearing bracelets that jingle when a hand begins to move toward the face.
It may be comforting to the afflicted to know most creatures are prone to hypergroom themselves bare.
“Nobody really knows what causes it,” Woods said. “But every species with some kind of hair or soft covering seems to do a version of this. Dogs lick themselves in a particular area and open a bald spot. Cats and chimpanzees take the fur off themselves and others. Mice do barbering. Birds pull out their feathers.”
Animal behaviorists have found all these animals, like humans, start the habit around puberty.
“It might be a predilection that you inherit,” said Martin Franklin, director of the Child and Adolescent OCD, Tic, Trich & Anxiety Group at the University of Pennsylvania. “Once you start the process, you are vulnerable to it.”
Franklin and his colleagues are organizing a study of children and adolescents to evaluate the efficacy of the three primary treatment techniques. Therapists have also found people benefit from learning to recognize and better manage their emotions.
Piotrowski still holds out hope.