There is a strong and well-supported connection between borderline personality disorder and self-harm. Two insidious forms of self-harm that often go unnoticed or downplayed – either in conjunction with BPD or on their own – are trichotillomania (pulling out the hair) and dermatillomania (picking at the skin). Both of these conditions are not very well understood at the present time. What is known is that there is a definite – but mysterious – connection between distress/anxiety and an unhealthy focus on self-grooming (to the point of self-harming).
When you think about it, healthier forms of this actually pattern exist: even well-adjusted people will often absently run their hands through their hair, bite their nails or rub their forehead/chin/etc. when stressed or thinking hard. Similarly, even animals have this instinct and will scratch or lick themselves in excess under stressful situations – sometimes to the point of injury.
*****WARNING: This is a disturbing topic, as is self-harm in general, so if you find this gross, upsetting or triggering in any way, please stop reading.*****
The fact is that even those who HAVE trich and derm usually find it gross, upsetting and triggering. No one is comfortable, open or happy about their OCD habit of self-harm, however “mild” that self-harm may be according to other people’s standards. I remember being so horrified at what I was doing when I started these behaviours, and I am no less horrified today, over twenty years later. Something about the behaviour is so obviously fucked up. I grew more and more terrified that my nutso behaviour would be exposed in some way or, worst of all, that someone would even openly point it out or ask me about it. Feelings of anxiety, shame and distress surrounded the very things that I had adopted to deal with anxiety, shame and distress.
I won’t go into too many details here, because frankly, like I said, it’s quite disturbing and gross, even to me who understands it and suffers from it. But basically, trich can involve pulling hair from any part of oneself: eyelashes, eyebrows, body hair, and, for the majority of trichotillomaniacs, the hair on the head. It can even involve pulling hairs from someone else – often a child or pet rather than someone who is aware of what’s going on. Dermatillomania involves a similar cognitive process but instead of fixating on hairs and the destructive act of pulling them out, the sufferer focuses on ‘imperfections’ on the skin and picks/scrapes/irritates them, inevitably making these ‘imperfections’ far, far worse.
Oddly, for me, it was trichotillomania – a behaviour I had never observed or heard of – that I adopted first. By about 8 years old I was pulling out my eyelashes. Soon I had done the inevitable: pulled them all out. So I moved on to my eyebrows. It was horrible and alienating and made me feel like even more of a freak at school. Other kids noticed and I would just sit in silence, shrivelling with self-loathing and shame as they stared and discussed it. I had nothing to say: no understanding or explanation that I could possibly offer. I only knew that I couldn’t help it, and the more I wanted to stop, the less I seemed able to. The result was that I felt swamped by mental, emotional and now physical manifestations of my “otherness” – an awareness that I was wrong, strange, screwed up, and didn’t belong.
There are countless articles on trich and derm, and a bazillion approaches to therapy: medication, hypnosis, CBT, etc. etc. You can google either of the conditions and get an ocean of information on the topics, as well as supportive online communities for sufferers. However, it’s hard to bridge the gap between conscious thought/realization and subconscious urges/behaviours. As anyone who has had trich or derm can attest, the conditions are both adamantly driven by the subconscious. Often, your hand will be acting out the habits long before you realize what’s happening. For this reason, most therapies start from a basis of becoming consciously aware of the behaviours. Once you’re conscious, you can consciously stop (is the argument).
Soooo much easier said than done.
I believe there are two primary reasons for trichotillomania and dermatillomania. The first is self-punishment. It’s obvious when you think about it: anxieties and shame stem from the fear of not being good enough because of our (perceived) imperfections. Those imperfections can’t be removed from our minds/personalities with any kind of ease, but they can be attacked on our physical skin/bodies. In this way, we seek an outlet to literally pick away at our flaws, to subtly attack and de-construct ourselves.
The second reason for trich/derm is one that I can’t take credit for thinking up, because I found it in this excellent article by Dr. Fred Penzel (it only pertains to trich, specifically, but actually applies to both conditions in theory). His basic idea is that pulling out the hair is a built-in, instinctive method of stimulus regulation. When we are over-stimulated (i.e. exhausted, stressed, upset, or over-excited), the focus on the ritual act of anticipating and causing sensations (by pulling hairs or whatever) serves as a way to calm and soothe the system. On the opposite end of the same spectrum, when we are under-stimulated (bored, depressed, physically caged in by a sedentary life, etc.), the sensations caused by pulling serve to stimulate our system.
I find this fascinating and totally plausible. When I think of the main two times I really, really struggle with derm and trich, they are: when I’m stressed about the possibility of failure of some kind (sitting working on a paper, trying to fill out a resume or job application, having a difficult/confrontational conversation, worrying in general); and/or when I’m tired/spaced out/not paying attention to life (watching tv, reading, etc.). In essence, when I am way over-stimulated and when I’m way under-stimulated.
Based on Penzel’s article, I decided to adopt an active approach to de-stressing and stimulating my own nervous system – namely, I either go straight to bed or get up and do something else the second I start feeling any urge to pull or scratch. If getting up every five seconds simply isn’t an option (i.e. when I’m working on a paper that has to be done or something), then I grab a squeezie stress ball, chew gum, drink water/tea, or pet the cat (if I can force it to sit on my lap while I work that is!). Just getting up to grab a glass of water or head to bed sends a signal to the nervous system that distracts from self-harm urges – something else is going on and your body can focus on that.
While I’m not 100% successful or ‘cured’ yet, I have had a drastic reduction in ‘episodes’ of trich and derm. And when I do slip up, I try to practice self-compassion rather than sink under the same old emotions that only prompt more self-harm.
I hope this post helps someone as much as finding out about trich/derm helped me – please feel free to message me if you have any questions about either condition, tips for stopping, etc.
Cat xxxxx
Half of a Soul - Life with BPD 