Hair Pulling, Anxiety, and Social Withdrawal in Teens

Q: Hair Pulling, Anxiety, and Social Withdrawal in Teens

Hello： The symptoms of hair pulling are often an outlet for emotions and stress, serving as a form of non-verbal expression. <br>The fundamental treatment approach should focus on reducing underlying stress or adjusting coping mechanisms for stress. <br>Given the current situatio

Hair pulling, procrastination, anxiety, social withdrawal?

Hello, doctor.
I am currently a 16-year-old high school freshman.
Since preparing for the entrance exams in my third year of middle school, I have developed a bad habit of pulling my hair.
At that time, I thought it was just due to the stress of studying for exams and that it would improve after the exams were over.
However, since then, I have been intermittently pulling my hair, and recently, I have created a noticeable bald spot on my scalp (my family and classmates have pointed it out).
Additionally, I find it difficult to concentrate on studying because of this habit.
My grades were above average in middle school, but since entering high school, I have been scoring at the bottom of my class.
Besides pulling my hair, I have a tendency to procrastinate and accumulate tasks.
I often leave clean clothes piled on my bed, and even when I have time, I don’t fold and put them away.
I tend to delay any tasks until the last minute.
I have also started to feel anxious about my social relationships.
Although I haven’t had any arguments or misunderstandings with my friends, I worry excessively that they might abandon me one day.
I have begun to refuse social interactions; new people, environments, and situations make me anxious.
I am reluctant to meet new people and feel that socializing is a waste of energy.
In class, when we change seats by drawing lots, I try to swap with classmates to return to my original seat because I cannot accept being in a different position.
I also feel a bit lethargic.
My usual sleep schedule is from 1:00 AM to 6:30 AM (my family insists that I go to bed before midnight, but I usually delay until 1:00 AM).
On weekends, I sleep as long as I can, as long as my family doesn’t wake me up.
There have been times when I slept until 11:00 AM, only to be woken up for lunch, and then I would sleep again from around noon until 6:00 PM.
I believe some of the reasons for my anxiety might include the fact that during my third year of middle school, my parents had a serious argument that almost led to divorce.
I once confided in a school counselor about it, but I have no experience with professional treatment.
Although my parents eventually reconciled and did not divorce, their arguments have become more frequent recently, and I feel anxious in this family atmosphere.

My parents are aware that I pull my hair and often tell me not to do it, but I find it hard to control myself.
Eventually, I wrapped my fingertips with protective bandages to prevent myself from pulling my hair.
When my mother saw this, she asked why I was bandaging my fingers, and I told her it was to stop pulling my hair.
She simply replied, "Oh." I feel quite sad that my parents do not recognize the seriousness of my hair-pulling issue or consider my feelings during their arguments.
Although I know I could just speak up, I believe my situation has deteriorated to the point where they should notice, and I find it difficult to express these feelings.
I would like to consult with you, doctor, because I feel that my situation may indicate a tendency toward depression that is affecting my life.
Should I see a doctor? If I need to see a doctor, must I have an adult accompany me? Thank you for taking the time to read my question, and I appreciate your response.

Niming, 10~19 year old female. Ask Date: 2024/05/05

Dr. Liang Sunyuan reply Psychiatry

Hello: The symptoms of hair pulling are often an outlet for emotions and stress, serving as a form of non-verbal expression.
The fundamental treatment approach should focus on reducing underlying stress or adjusting coping mechanisms for stress.
Given the current situation, it is advisable to seek medical attention, and it is also recommended that parents accompany you, as the family atmosphere is an important factor.
You have written very well and clearly; I suggest printing your description and questions to provide to the consulting physician for reference.
Wishing you a speedy recovery.

Reply Date: 2024/05/05

More Info

It sounds like you are going through a very challenging time, and I want to acknowledge the courage it takes to share your experiences. The issues you are facing, including hair pulling (trichotillomania), anxiety, procrastination, and social withdrawal, are interconnected and can significantly impact your daily life and mental health.

Understanding Hair Pulling and Anxiety:
Hair pulling is often a coping mechanism for dealing with stress or emotional discomfort. It can serve as a way to manage anxiety, but unfortunately, it can lead to further distress, especially when it results in noticeable hair loss. This cycle can exacerbate feelings of anxiety and low self-esteem, particularly during a time of significant life changes, such as transitioning from middle school to high school.

Your experience of procrastination and difficulty concentrating on your studies may also be linked to your anxiety. When we feel overwhelmed, it can be tempting to avoid tasks, leading to a cycle of stress and avoidance. This is common among teens, especially when facing academic pressures.

Social Withdrawal:
Your concerns about friendships and social interactions are also valid. It’s not uncommon for anxiety to make social situations feel daunting. The fear of rejection or abandonment can lead to avoidance of social interactions, which can further isolate you and contribute to feelings of sadness or depression.
Sleep Patterns:
Your sleep habits are another important aspect to consider. Sleep is crucial for mental health, and irregular sleep patterns can exacerbate feelings of anxiety and depression. It’s essential to establish a consistent sleep routine that allows for adequate rest.

Family Dynamics:
The family environment you described, particularly the tension between your parents, can significantly affect your emotional well-being. It’s understandable that witnessing conflict can lead to feelings of insecurity and anxiety. While your parents may not fully grasp the severity of your hair pulling or your emotional struggles, it’s important to communicate your feelings to them when you feel ready.

Seeking Help:
Given the complexity of what you are experiencing, seeking professional help is a wise decision. A mental health professional, such as a psychologist or psychiatrist, can provide you with the support and strategies you need to manage your anxiety and hair pulling. They can also help you explore the underlying issues contributing to your feelings of sadness and social withdrawal.

In the United States, it is often recommended for minors to have a parent or guardian accompany them to medical appointments, especially for mental health concerns. This can help facilitate communication and ensure that your family is involved in your care. However, if you feel comfortable, you can also express your desire for help directly to a trusted adult, such as a school counselor or a family member, who can assist you in seeking the appropriate care.

Coping Strategies:
In addition to professional help, there are several strategies you can try to manage your anxiety and hair pulling:
1. Mindfulness and Relaxation Techniques: Practices such as deep breathing, meditation, or yoga can help reduce anxiety and improve your overall emotional state.

2. Journaling: Writing down your thoughts and feelings can provide an outlet for your emotions and help you process your experiences.

3. Establish a Routine: Creating a daily schedule that includes time for studying, relaxation, and social activities can help you manage procrastination and anxiety.

4. Limit Social Media: Reducing time spent on social media can help alleviate feelings of comparison and anxiety related to social interactions.

5. Engage in Hobbies: Finding activities that you enjoy can provide a positive distraction and improve your mood.

Remember, it’s okay to ask for help, and taking the first step towards seeking support is a significant move towards healing. You are not alone in this, and there are people who care and want to help you through these challenges.

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