Amy Schumer has a secret she no longer wants to keep — she’s been living for years with the hairpulling disorder trichotillomania.
“I think everybody has a big secret and that’s mine,” Schumer told the Hollywood Reporter in an interview earlier this week. “And I’m proud that my big secret only hurts me, but it’s been what I’ve carried so much shame about for so long.”
Schumer has battled with this mental health condition since her teen years, when it got so bad that she needed to wear a wig to cover the bald spots, she said in the interview. She gets real about what trichotillomania looks like in Life Beth, the new dramedy on Hulu that she created, wrote, and directed. In flashbacks to adolescence, Schumer’s character, Beth, confronts clumps of hair on the bathroom floor and navigating high school with an ill-fitting wig.
Her newly revealed secret will resonate with a lot of people. Trichotillomania may affect as much as 4 percent of the population, according to MedlinePlus. And women are four times more likely than men to develop this condition.
What Is Trichotillomania?
When people have trichotillomania, they have an irresistible urge to pull out hair — often from their head but sometimes also from eyelashes, eyebrows, or other areas of the body, according to the Mayo Clinic. It’s not uncommon for people to try to hide the condition, or deny they have it.
The condition belongs to a group of disorders known as body-focused repetitive behaviors, which can involve damaging the body by pulling, picking, scraping, or biting the hair, skin, or nails, according to the TLC Foundation for Body-Focused Repetitive Behaviors.
Most often, it begins during late childhood or puberty, affecting boys as much as girls, according to the foundation. But by adulthood, the vast majority of cases are in women.
It doesn’t look the same for everyone. The severity of hairpulling, and the amount of baldness or thin patches on the head or other areas of the body can vary, the foundation notes. Many people, however, make efforts to camouflage the condition by using scarves, wigs, hats, or makeup.
Some people also avoid social situations when the condition might be discovered, the foundation explains. This could mean staying home on windy days when a hat might blow off, avoiding trips to the pool or beach, shying away from physical intimacy, or skipping doctor appointments.
People can feel escalating tension when they try to fight the compulsion to pull out hair, and then feel a sense of relief or pleasure once the hair comes out, according to the Mayo Clinic. It’s not uncommon for people to bite, chew, or eat pulled out hairs.
For some, it’s an automatic behavior they don’t even realize they’re doing, the Mayo Clinic notes. For others, it’s an intentional habit that helps relieve tension or stress, and can involve elaborate rituals to find the right hair to pull or to handle hair once it’s removed.
It can be a way to manage negative emotions or process uncomfortable feelings like anxiety, boredom, loneliness, or stress. And it can also be a way to produce positive emotions like a sense of pleasure or relief, which can drive people to continue hairpulling to summon these feelings, according to the Mayo Clinic.
Risk factors for trichotillomania include a family history of the condition, extreme or chronic stress, or certain other mental health conditions such as anxiety, depression, or obsessive-compulsive disorder. Roughly four in five people with trichotillomania have at least one other mental health disorder, according to a study published in 2020 in Psychiatry Research.
If you can’t stop pulling out your hair, or you feel ashamed of how you look after the hair comes out, you should talk to your doctor about treatment, the Mayo Clinic recommends.
Getting Help for Trichotillomania
There are no lab tests for trichotillomania, and doctors typically diagnose the condition with a look at the person’s medical history and a physical exam, according to the Cleveland Clinic. Doctors may, however, run tests to rule out other causes of hair loss, such as thyroid disorders, anemia, or certain autoimmune disorders.
The most common treatment is a form of behavior therapy known as habit reversal training. This requires patients to identify situations or feelings that can trigger the urge to pull hair, then develop a different response. This type of therapy is also used to control behaviors like overeating, smoking, and nail-biting, according to the American Psychological Association.
Once people pinpoint what triggers their urge to remove hair, they may learn relaxation techniques to reduce some of the tension associated with this urge, according to the Cleveland Clinic. Then, they learn new activities to do when the urge strikes, whether it’s making a fist with their hand to avoid pulling hair or doing something else to distract from this compulsion.
In some instances, very intense urges may be treated with a type of antidepressants known as selective serotonin reuptake inhibitors (SSRIs), according to the Cleveland Clinic. But the evidence to date on medication for trichotillomania is mixed, according to an analysis published in 2021 in the Cochrane Database of Systematic Reviews.