Trichotillomania, often called hair-pulling disorder, is a body-focused repetitive behavior (BFRB) characterized by the urge to pull out one’s own hair. While pulling can occur from any body region, a common and particularly distressing form is the pulling of eyelashes. This behavior is considered an impulse control disorder, where the individual experiences growing tension before pulling and a subsequent sense of relief or satisfaction afterward. Although the condition can be confusing, it is a recognized mental health disorder for which numerous effective strategies and professional treatments exist.
Identifying Emotional and Environmental Triggers
Understanding the specific situations and internal states that precede eyelash pulling is the primary step toward managing the impulse. Pulling episodes are categorized as either focused, where the person is fully aware of the action, or automatic, which occurs without conscious realization. Focused pulling often serves as a coping mechanism in response to negative feelings, such as tension, anxiety, or stress. The act provides a momentary sense of release from these emotional states, reinforcing the behavior.
Automatic pulling frequently happens during sedentary activities when the individual is distracted or bored, such as watching television, reading, or working at a computer. In these instances, the hands are often idle, and the pulling is performed without conscious thought. Identifying a specific eyelash that feels “out of place” or different can also trigger the onset of a pulling session.
Journaling the context of each pulling event is an effective way to pinpoint triggers, noting the time, location, activity, and preceding mood. Recognizing patterns, such as pulling most often in a bedroom mirror or during periods of fatigue, allows for the proactive modification of those environments. Learning to associate the urge with a specific internal or external trigger is the first step in interrupting the behavioral cycle.
Immediate Behavioral Strategies for Impulse Control
When the urge to pull an eyelash arises, immediate behavioral strategies help control the impulse by introducing a “competing response.” This technique is designed to make the act of pulling physically difficult or to substitute the action with a harmless alternative. Sensory substitution methods occupy the hands and fingers, diverting their function away from the eye area.
Holding a stress ball, using a fidget toy, or engaging in a simple activity like knitting or doodling can effectively redirect the motor impulse. Another strategy is the use of physical barriers, which prevent the fingers from accessing the eyelashes. Wearing soft cotton gloves or applying petroleum jelly to the fingertips serves as a simple, effective deterrent.
Mindfulness techniques involve recognizing the urge without acting on it, allowing the feeling to pass. This practice encourages the individual to delay the impulse by a set period, such as five minutes, focusing on deep breathing or a grounding exercise. A technique known as decoupling involves redirecting the hand from the eye to another location, such as clenching the fist, as soon as the urge is felt. These actions are designed to break the conditioned response and create a pause before the pulling behavior begins.
Therapeutic and Medical Treatment Options
For cessation of eyelash pulling, professional intervention is considered the most effective course of action. The preferred psychological approach is a form of Cognitive Behavioral Therapy (CBT), with Habit Reversal Training (HRT) being the most established method. HRT works by systematically increasing awareness of the pulling behavior and teaching the individual to use a competing response whenever the urge is felt.
A full HRT program involves several components, including awareness training to identify precursors to pulling and the development of a substitute behavior that physically prevents the act. Acceptance and Commitment Therapy (ACT) is another evidence-based approach that helps individuals accept uncomfortable thoughts and urges without attempting to control or act on them. ACT focuses on redirecting energy toward value-driven actions rather than engaging in the repetitive behavior.
While no medication is specifically approved for the treatment of trichotillomania, certain pharmacological agents may be used to manage underlying symptoms. The over-the-counter supplement N-acetylcysteine (NAC), which modulates glutamate levels in the brain, has shown promising results in clinical trials. Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), may also be prescribed, particularly when the pulling is accompanied by anxiety or depression.
Managing Eyelash Regrowth and Damage
The physical act of repeatedly pulling eyelashes can damage the hair follicle, but in most cases, the lashes will regrow once the pulling stops. Chronic pulling can lead to inflammation, infection, or, in rare instances, scarring of the eyelid margin, which may result in permanent hair loss. Eyelashes have a natural growth cycle, and when pulled out prematurely, they must restart this cycle, which typically takes several weeks to a few months.
Promoting healthy regrowth requires gentle care of the eye area and avoiding anything that might irritate the recovering follicles. This means temporarily avoiding the use of eye makeup, especially mascara and eyeliner, as these require rubbing for removal. Applying specialized eyelash growth serums or natural oils, such as castor oil, can help condition the remaining lashes and stimulate new growth.
Maintaining a supportive environment for regrowth involves managing stress and ensuring adequate nutrition, as these factors affect hair health. During the regrowth period, cosmetic solutions like temporary false eyelashes or the careful use of eyeliner can help mask the missing lashes. Managing the physical damage requires consistent cessation of the pulling behavior, allowing the natural healing process to take effect.