Stefan Wermuth / Reuters

As a child, Lindsey Muller began grooming herself in odd and sometimes disturbing ways. She’d spend hours smoothing out barely visible “bumps” in her slicked-back ponytail. If she discovered a mosquito bite interrupting her skin, she would pick at the area until it bled or throbbed with pain and puss. Compulsive nail biting followed.

And then, something even more damaging: When Muller was in seventh grade, she was on a car trip with a friend and the friend’s mother. Spotting a gray hair, the friend reached up to the front seat and plucked it from her mother’s head. The mother laughed and said, “Emily has become really good at helping me search for the bad, gray hairs!”

Somehow, that one event planted the idea in Muller’s brain that hairs can be pulled out, and that this can be a good thing. It launched Muller’s decade-long battle with an impulse disorder called trichotillomania. Throughout her adolescence and young adulthood, Muller compulsively pulled out her own hair, one strand at a time, until she was almost entirely bald.

After years of trying various drugs and therapy regimens, she finally stopped all of her so-called body-focused repetitive behaviors when she was 24 years old. She now lives in Los Angeles and works as a mental-health therapist specializing in the treatment of these types of behaviors. She recently wrote a memoir about her experience, Life is Trichy, a play on the name of her disorder. A lightly edited transcript of my recent conversation with Muller follows.


Olga Khazan: Tell me about when you started skin picking and when you stopped. Did that overlap with the hair pulling at all?

Lindsey Muller: The skin picking started when I was in kindergarten. The nail biting, I would say, started around the same time. I don’t remember that as well because it was a much more minor behavior, meaning that it didn’t result in a lot of attention given to me by my parents with them telling me to stop. The skin picking was something they were much more concerned with. Then I stopped picking—again, I don’t remember an exact date, but I would say it was probably around sixth or seventh grade, which was right before I picked up the hair pulling. The nail biting definitely overlapped and persisted all the way through high school and into college while I was also pulling my hair.

Khazan: What were some of the emotions underpinning these behaviors for you? You talked about perfectionism and boredom, but what was going on in your brain at the time?

Muller:  Growing up, I was definitely a perfectionist. As a result, I put a lot of pressure on myself, even more than my family or friends put on me. I definitely had high expectations for myself, and I think that played a role in me just always feeling so tense. And that drove the urges, which I acted upon with the hair pulling.

But I also think that the sensory component was really big and really key. I was so used to being so busy and constantly doing, doing, doing, because I was a perfectionist and a Type-A personality, and I still am today. But I think that because of that, I was always used to and so focused on craving that sensory stimulation, so whether it’s mental challenge or physical activity, or doing, seeing a lot of things on my to-do list or my agenda.

So whenever I had down time, or what I like to call free time or unstructured time, that’s really when the behavior picks up. Because it was like, “Okay, now what do I do? I don’t really have anything going on right now, and I feel like I should be doing something.” I had a hard time just sitting idly.

Khazan: Working on the computer was especially a trigger for you—especially with the hair pulling, you talk about the area around the computer chair being covered in your hair. Why is it that the computer work in particular, at times when you were alone, would lead to that?

Muller: It’s interesting, I never associated it with any type of loneliness or isolation. It was more like, “I’m alone right now, no one is going to see me, I’m not going to feel embarrassed, I’m not going to get caught.” I almost felt there was more of an excuse to do it at the time when I was by myself.

But as far as the computer, even when I was reading, it was the type of thing that if I was doing something that I wasn’t really tuned into or interested in, and it was more of a passive activity, which the computer and reading typically are, I needed something else to supplement that to increase my level of stimulation. It was during middle school and high school and that was back when AOL was really big, and I remember a lot of time spent sitting at the computer and waiting for someone to respond back to me. I would type a response, and then I was sitting and waiting, that’s when I would pull. And then I would type again and respond to them. So there was a lot of that that. I recall that pattern.

Khazan: When you were nail biting, did you try the bad-tasting nail stuff?

Muller: Oh yeah. It was interesting because I tried many different brands. I remember years ago, my mom purchased it for me. It was the type of thing where, it was almost like I was on an unconscious mission to do what I was going to do. Even something that tasted bad was not foul-tasting enough to keep me from biting my nails. I would bite off the polish coat and then I would just keep biting.

Khazan: It’s interesting, because I started biting my nails after I watched The Parent Trap—the first one, the one with Hayley Mills—when I was seven or eight years old. The “good” twin has to start biting her nails to match the “bad” twin. That’s the first time I ever saw anyone bite their nails.

You mentioned that the initial trigger for pulling your hair was also really banal—a friend of yours pulled out one of her mom’s gray hairs on a car ride. Do you have an explanation for why it is that some small thing can set off these habits?

Muller: You witnessed a situation that’s external to yourself and it somehow affected you greatly and set off this behavior, and that also happened in my case. What we both witnessed, what I witnessed when I was in the car, it was a new behavior that I had never come across. I had never seen anyone model it for me until that day in the car. It’s not that I saw it and was like, “Oh wow that looks great! I want to try it.” It was more the concept of removing the particular hair colors that are mismatched.

From there, the feeling that I got when I pulled out the first few hairs was reinforcing enough that I continued to engage in the behavior. So witnessing something, it was like, “what a behavior, what a concept, what a thought,” and it kind of planted that seed. And then you acted upon it, and as a result something somewhere along the line felt good, or positively reinforced something in your mind, and it keep the behavior going and maintained it. It definitely has to do with neurological wiring. That’s why people continue to do things, even when they don’t want to do them, they continue to do it anyway.

Another example is people overeat and afterward they don’t feel well at all, but they still continue to engage in the behavior of overeating because at the time, in the moment, something is reinforcing their behavior of overeating. It’s the fact that food tastes good and there’s some level of satisfaction there. And the consequence that comes afterward is felt separately.

Khazan: How did it feel when you pulled your hair? How did it get progressively worse?

Muller: Initially, the goal of engaging in the behavior was not even focusing on what it felt like when the hair was pulled out of my scalp, it was on removing a certain color strand. That was the initial drive and the initial goal. I wasn’t even really keyed in to what it felt like when the hair was removed. It was literally just a visual thing where I was trying to remove the lightest color strands.

At some point it switched over to, “Wow, I like how this feels.” And then over time it went into the phase where it wasn’t even about how anything looked, I wasn’t using vision as a part of the behavior. It was like, “I’m doing this because it’s something I have on me at all times, it’s easy access, and I do it to compensate for when I’m bored, or when I’m wound tight. It’s on me at all times and it’s easy to do and I can cover it.”

And then eventually it became like habitual. I started to pair the computer with hair pulling. Talking on the phone with hair pulling. Sitting at the kitchen table working on homework with hair pulling.

I continued to do it without realizing how much I was pulling out on a daily basis. So the way it progressed to 80 percent, 90 percent bald at one point was the fact that every spare moment that I had when I was by myself, I was pulling.

Khazan: You said you got to 90 percent bald at one point. How did you cover it up?

Muller: Setting my alarm extra early in the morning, using a lot of gels, styling products. I would spent a lot of time working to use my existing hair to cover the bald spots, and then I would hold it in place with either gel or hairspray. And then in addition to that a lot of hair pieces, hair attachments. I would say the majority of the time that I was engaged in the behavior, I had a hairpiece that clipped into the front of the hairline and just kind of fell backwards over the whole crown area of my head. It clipped in about an inch behind my front hairline and fell back over the whole balding area. And then I would take the little bit of the hair that I had around the front hairline area and I would pull that back over the hairpiece so it would cover the clip, and it would look like my hair. I never was free to wear my hair how I wanted, it was always determined by what hairpiece I had and how much or how little balding I had and what way I needed to style it in order to cover the clips and the bald patches.

Khazan: Did people say anything?

Muller: In the book, I mention the one experience that I had where I had the piece of hair sticking up and my classmate sitting behind me pointed it out. And I definitely dismissed that as, “Oh, my brother cut my hair.”

Other than that, no one ever noticed. Maybe they noticed and just never said anything. When the book was released, I sent out an email to family and friends, ex-boyfriends, coworkers, professors, everyone I knew. It was an overwhelming response of people saying, “I had absolutely no idea.”

It leads me to believe that I just did a really really good job covering everything. Which I hope I did, because at the time that was my goal, and I spent a lot of time making sure that I appeared so-called “normal,” whatever normal is. Normal enough in appearance that people didn’t look at me funny or question me.

Khazan: Were there any parts of your scalp where you didn’t pull?

Muller: When I first started, I initially pulled from my front hairline to the point where the front hairline was literally set back a full inch. And then I cut bangs to cover the hairline when it was growing in. I realized I didn’t want to pull from there anymore because it’s very hard to cover. From there I pulled out the underpart of my hair, like the hairline that’s by your neck.

And eventually I realized that I didn’t want to pull from there because I couldn’t wear my hair in a ponytail for sports, and that part was going to be visible. So then I moved to the crown portion, and that’s where I spent the majority of my pulling years pulling from, the crown area. It was the most sensitive and the part that felt the best. The only areas I didn’t pull from, I never touched my eyebrows or eyelashes or the hair anywhere else on my body. As far as my scalp, I never pulled from the area around the ear region.

Khazan: It’s so interesting how people set little limits around what they will and won’t do.

Muller: I know. And again, it wasn’t a conscious effort to not pull from the side area. I don’t know if I had fewer nerves there. It just never felt as good as the crown portion. But you’re right. It’s interesting how that happens.

Khazan: Do these types of behaviors have to do with anxiety?

Muller: I don’t consider myself to be an anxious person. I do consider myself to be very tense at times. I have this intensity about me and I think that is due to the fact that I am very driven, very ambitious, very goal oriented, very Type A. But I don’t have anxiety where I worry about things.

Khazan: What meds did you try?

Muller: Wellbutrin, Zoloft, Paxil, Celexa. I think that’s it.

Khazan: And none of them worked?

Muller: I had side effects with all of them. I didn’t feel right and I was moody or irritable. I got acne, weight gain, an insatiable appetite. It was just—each one that I tried, either the side effects worsened or the side effects changed to other side effects. That definitely, if anything, made the hair-pulling worse because then I was very focused on my appearance and thinking about the pulling and how it affected how I looked, and then on top of it having bad skin, not feeling good about myself. Feeling moody and feeling very blah. Apathetic, I would say. So it was definitely counterproductive.

Khazan: Why do you think you ultimately stopped?

Muller: Number one, I recognized that the negative of pulling outweighed the positive. It got to the point that I was engaging in this behavior for so many years that it just did not become fun anymore. And I ultimately realized that the only way this is going to stop is if I choose not to engage in the behavior anymore.

I spent a lot of time focusing on the difference between having the urge and the behavior, which are two separate things. The urge is, you feel that craving, you have that drive, you feel that itch to do something. The behavior is making the choice to act on that urge. I did a lot of self-talk: “Okay, I have this urge, but I have the choice whether or not to act on it, and I’m going to choose not to because I don’t want to.” It was a lot of self-awareness and taking time to tell myself things that were going to get me through the struggle of having these urges and not acting upon them.

I’ve accomplished many other things in my life that have been very challenging. Trichotillomania, having to overcome this, is by far the hardest thing I’ve had to experience, and if I can do this, I can almost do anything. I almost made it like a challenge for myself. And that worked for me.

At the same time, hearing my story can definitely arouse a lot of anger and frustration in other people who have been pulling for so long and haven’t gotten to that point. So I realize that my situation is very individualized, and other people haven’t gotten to that place in their life or had that same experience. So I think there are a lot of different ways to work through trichotillomania, to work through the urges, and for me, that’s what worked. I want to make sure that’s recognized—I know that what worked for me isn’t a one-stop shop for everybody.

Khazan: What would you say to people going through this same thing—if not with hair pulling, then with nail biting or whatever other repetitive behavior they want to stop doing?

Muller: I would say that, number one, just because you’re dealing with it right now doesn’t mean you’re forever going to have to deal with the behavior. It’s something that’s able to be worked through and overcome.

Relapses are common; relapses are expected. I went through many relapses where I really felt like I was on my way and then I slipped up, and each slipup was worse than the time before. Allow for the opportunity to make mistakes from time to time because we are human.

The behavior is not necessarily the problem, the behavior is the messenger. The behavior is some type of warning or red flag that there’s something else in your life that’s out of alignment. If you look at the behavior as being a messenger of that, there’s less focus placed on the behavior and more focus placed on figuring out on what in your life needs to be met or fulfilled.

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