The urge to pull out one’s own eyelashes feels involuntary yet compulsive. The act of pulling is often an attempt to find temporary relief from an uncomfortable internal state, which quickly leads to feelings of shame and a desire to stop. This behavior is far more common than many people realize and frequently involves hair from the scalp, eyebrows, or other body areas besides the eyelashes.
Understanding Trichotillomania
The repetitive pulling of one’s own hair, including eyelashes, is formally classified as Trichotillomania (TTM), or Hair-Pulling Disorder. This condition is categorized as a Body-Focused Repetitive Behavior (BFRB) within the diagnostic manuals used by mental health professionals, characterized by recurrent hair pulling that results in noticeable hair loss. A diagnosis requires not only the act of pulling and the resulting hair loss but also repeated, unsuccessful attempts to decrease or stop the behavior, causing significant distress or impairment in daily life.
The experience of TTM is not uniform and is generally divided into two styles of pulling. Focused pulling is intentional, often preceded by a mounting sense of tension, anxiety, or an uncomfortable sensation, with the pulling providing a sense of relief or gratification. In contrast, Automatic pulling occurs with little to no awareness, often while a person is engaged in sedentary activities like reading, watching television, or simply resting. Many individuals experience a combination of both focused and automatic pulling styles depending on their environment and emotional state.
Psychological and Environmental Triggers
The pulling often serves as a maladaptive method of emotional regulation. Negative emotions such as stress, anxiety, frustration, or intense boredom can trigger the urge, with the act of pulling providing a brief, though temporary, sense of relief from this tension.
Some individuals report that the pulling is also triggered by positive feelings, as the resulting sensation can be satisfying or pleasurable. The sensory experience itself is a powerful driver; some people describe an uncomfortable, “itch-like” sensation in the hair follicle that is only alleviated by the removal of the lash.
Environmental cues also play a significant role in initiating the pulling episode. Activities that require low attention, such as lying in bed or sitting at a desk, can lead to the less-conscious, automatic pulling style. Specific locations, like being alone in a bedroom or bathroom, or the presence of tools like mirrors or tweezers, can also act as powerful triggers.
Physical Effects and Emotional Impact
Chronic eyelash pulling results in a range of physical consequences, most notably the noticeable loss of lashes, medically termed madarosis. Eyelashes are crucial for protecting the eyes from dust and debris, so their absence increases the risk of foreign bodies entering the eye. Constant trauma to the eyelid margin can lead to inflammation, a condition known as blepharitis, which causes redness, irritation, and crusting around the eyelids.
With repeated pulling, there is a risk of permanent damage to the hair follicle. This can result in non-scarring madarosis where regrowth is still possible, or, in more severe cases, scarring madarosis where hair loss is irreversible. The repeated plucking can distort the growth of the remaining lashes, sometimes leading to trichiasis, where the lashes grow inward and scratch the surface of the eye.
The visible hair loss can lead to profound feelings of shame, embarrassment, and lowered self-esteem. This distress frequently causes individuals to engage in avoidance behaviors, such as withdrawing from social situations or applying excessive makeup to conceal the missing lashes. This emotional isolation often perpetuates the cycle of anxiety that fuels the pulling.
Effective Strategies for Seeking Help
The most successful approach to managing TTM is through behavioral therapy, specifically Habit Reversal Training (HRT), which is considered the first-line psychological treatment. HRT is a multi-component therapy that helps a person become more aware of the pulling behavior and learn alternative actions.
Habit Reversal Training (HRT) Components
- Awareness training: The person learns to self-monitor and precisely identify the specific sensations, thoughts, and situations that precede the urge to pull.
- Competing response training: This involves selecting a physical action incompatible with the pulling, such as making a tight fist or clasping the hands together, and holding it until the urge subsides.
- Stimulus control: Techniques focus on modifying the environment to reduce the likelihood of pulling, such as wearing gloves or using tactile substitutes like stress balls during high-risk activities.
While behavioral therapy is the primary treatment, medication may be used as a complementary tool, particularly if other mental health conditions like severe anxiety or depression are also present. Selective Serotonin Reuptake Inhibitors (SSRIs) are the most commonly studied class of medication, though their efficacy for TTM alone is mixed, with some studies showing them to be no more effective than a placebo. Consulting a mental health professional who specializes in Body-Focused Repetitive Behaviors is the most important step to develop a personalized and effective treatment plan.