Trichotillomania, also known as trich, is a disorder that involves the compulsive urge to pull out one’s own hair. It can affect people of all ages, but often starts in childhood or the teen years. For those living with trich, it can be a frustrating condition where hair pulling comes and goes in cycles. A big question for many trich sufferers is “How fast can trich come back after I’ve stopped pulling?” Here are some quick answers:
– For some, trich symptoms may come back in a matter of days or weeks after stopping hair pulling. Triggers like stress can quickly restart the urge to pull.
– In other cases, it can take months for trich to return after a period of remission. It depends on the individual and their personal triggers.
– Generally, the longer someone goes without pulling, the less likely trich is to come back as intensely. But there’s always a chance of relapse.
– With treatment and continued effort, periods between relapse can be extended more and more over time. But vigilance is needed as triggers can still reignite hair pulling.
What is trichotillomania?
Trichotillomania is classified as an obsessive-compulsive disorder. It involves the recurrent urge to pull out one’s own hair, often from the scalp, eyelashes, eyebrows or other parts of the body. Hair pulling is usually preceded by mounting tension and is followed by a sense of relief or pleasure after the hair is removed. While it can sometimes be a temporary condition, for many trich becomes a chronic disorder that comes and goes over a lifetime.
Some key facts about trichotillomania include:
– Onset often occurs in childhood/adolescence, between ages 9-13. But trich can begin later in adulthood as well.
– It affects approximately 1-2% of the population, but many cases likely go unreported due to embarrassment.
– Hair pulling most often occurs in private and sufferers go to great lengths to hide evidence of their trich.
– Damage from hair pulling includes bald patches, skin irritation, and damaged eyelashes/eyebrows.
– Trich sufferers may pull hair from any part of the body that grows it, but scalp, eyelashes and eyebrows are most common.
-It is classified as an OCD-related disorder in the DSM-5, but was previously considered an impulse control disorder.
– Treatment usually involves therapy focused on behavior modification. Medications are sometimes used as an adjunct treatment.
– There is no known cure, but many people achieve periods of remission when trich symptoms significantly improve or disappear entirely.
Triggers and risk factors
What causes trichotillomania or leads to relapse of symptoms? There are a number of potential triggers and risk factors believed to play a role:
– **Stress and anxiety** – Stressful life events, trauma, or high general anxiety levels appear to trigger hair pulling for many. Pulling may function as a self-soothing mechanism.
– **Perfectionism** – The tendency toward perfectionism and inflexible thinking correlates with trich. Trying to control urges and behaviors very rigidly tends to backfire.
– **Genetics** – Studies show family history and genetics account for about 85% of risk. Having a relative with trich makes you more vulnerable.
– **Age** – Onset often occurs around puberty but can begin anytime. Childhood and adolescence are high-risk periods.
– **Gender** – Women are 3-10 times more likely to have trich. Estrogen may interact with neurotransmitters implicated in OCD.
– **Emotional reactivity** – Emotional highs and lows can contribute to hair pulling in response to stress or boredom.
– **Substance abuse** – Drugs and alcohol are associated with worse trich severity. They lower inhibitions to resist urges.
– **Physical sensation** – The tactile feeling of hair pulling can be rewarding and addictive on its own.
How fast do trich symptoms return after stopping?
The speed at which someone relapses after a period of remission varies greatly but tends to follow some general patterns:
– **Initial days/weeks are high risk** – The earliest days and weeks after stopping pulling carry the highest chance of relapse. Triggers like stress quickly restart trich.
– **Persisting months/years brings more stability** – The longer someone goes without symptomatic hair pulling, the less likely it is to restart as easily.
– **Average time to relapse is a few months** – For most, relapse occurs within a few months of remission on average if vigilance lapses.
– **Years of remission possible but not guaranteed** – It’s possible but not assured for remission to last years without relapse if trich is well managed.
– **Latent urges resurface during vulnerable times** – Even after years pull-free, latent urges often resurface during times of life stress.
– **Self-monitoring and support help extend remission** – Tracking behavior and having support makes relapse less likely and lengthens remission.
Relapse risk chart
| Time since stopping | Risk level |
| 1-4 weeks | Extremely high |
| 1-3 months | Very high |
| 4-11 months | High |
| 1-3 years | Moderate |
| 3+ years | Low but recurrent |
As this chart highlights, the relapse risk is highest in the first few weeks and months. But over multi-year timespans, risk remains as triggers persist. Ongoing vigilance is required.
Personal accounts of trich relapse experiences
Individuals with trichotillomania who have gone through periods of remission and relapse describe their personal experiences:
“Less than one month for urges to return”
Lily, age 23, manages trich focused mainly on eyelash pulling and has gone through several relapse episodes:
“The time it takes before I relapse really varies each time I stop pulling. But on average, I’d say the very strong urges return within 3-4 weeks after I’ve stopped. Sometimes it’s less than a month. For me, getting through that first month pull-free seems to be the biggest hurdle. If I can get past a month, I have a better chance of going longer without relapsing again.”
“Usually takes 5-6 months of remission before failure”
James, age 35, has gone through varying periods of remission from trich over the past decade:
“I’ve had time periods where I went for about a year without pulling as a teenager, and then only 6 months as an adult. But on average, when I really dedicate myself to stopping, I seem to get about 5-6 good months under my belt before something triggers me and the trich starts again. The longest I went was maybe 2 years in college. For me, it’s been rare for remission to last over a year, even though I try.”
“Can come back after years in seemingly random way”
Michelle, age 27, has pulled from her scalp compulsively for years but has achieved periods of remission:
“I can stop pulling for months or even years at a time before it returns. But when it comes back after years away, it takes me off guard and feels totally random. Just last month after nearly 2 years pull-free, I mindlessly started doing it again for a few weeks due to work stress. For me, those latent urges always lie below the surface waiting to pop up during vulnerable times, regardless of how long it’s been.”
Factors that allow trich to return quickly
What tends to set the stage for trichotillomania to comeback rapidly after someone has stopped? Here are key factors:
– **High general stress** – Stress overwhelms coping abilities and reactivates pulling.
– **Insufficient treatment** – Under-treated trich more easily relapses when therapy ends.
– **Stopping medication** – Quitting medication without weaning off often prompts return of symptoms.
– **No self-monitoring** – Not tracking behavior means not catching relapse soon enough.
– **Lowered awareness** – Letting guard down and not noticing small slips.
– **Isolation and secrecy** – Lack of support and accountability makes relapse more tempting.
– **Poor coping habits** – Unhealthy coping mechanisms like avoidance, drug use, etc.
– **Overconfidence** – Feeling “cured” despite ongoing risk of relapse.
Ways to prevent rapid reoccurrence
On the other hand, tactics that help forestall quick relapse include:
– Keeping stress low and maintaining self-care.
– Staying in therapy even during remission to reinforce skills.
– Slowly weaning off medications with a doctor’s help.
– Using strategies like journaling and apps to monitor behavior.
– Requesting external monitoring and feedback from others.
– Developing healthy coping habits to replace pulling.
– Accepting the potential of relapse and catching it early.
How long should trich remission last to be considered stable?
At what point can someone feel their trichotillomania is fully in remission in a stable long-term way? There are a few benchmarks:
– **3-6 months** – Refraining from pulling for at least 3 months shows good short-term control. Risk still high.
– **6-12 months** – Stopping hair pulling for 6 months to a year marks significant progress lowering relapse risk.
– **1-2 years** – Once able to achieve 1-2 years pull-free, prognosis greatly improves for long-term stability.
– **5+ years** – After about 5 years in solid remission, trich seems very unlikely to return to previous severity levels.
– **Permanent remission uncertain** – Full lifelong remission remains difficult to predict and hair pulling can recur to some degree.
– **Ongoing self-monitoring key** – Continued tracking of behavior remains prudent to help sustain remission.
Relapse likelihood by remission duration
| Pull-free duration | Risk of relapse |
| Less than 3 months | Almost certain |
| 3-6 months | Very high |
| 6-12 months | Moderately high |
| 1-2 years | Moderate |
| Over 5 years | Low |
This table reiterates that with increasing time free from pulling, the risk of relapse does diminish. But some ongoing vulnerability persists in many cases.
Tips for sustaining long-term trich remission
For individuals seeking to maintain trich remission in a lasting way, these strategies help prevent relapse:
– **Learn your triggers** – Keep a log to identify situations that increase pulling risk for you personally. Avoid or manage these triggers.
– **Monitor closely** – Periodically record behavior details like how often, where and why you pull. Make notes of any small slips.
– **Create accountability** – Enlist others to support you and help keep you honest if you’ve relapsed.
– **Practice self-soothing** – Try healthy, adaptive ways to manage stress and anxiety instead of pulling hair.
– **Focus inward** – Boost self-understanding and self-acceptance rather than criticizing yourself.
– **Make lifestyle changes** – Ensure good sleep, nutrition, exercise and social connection. Reduce alcohol use.
– **Continue therapy** – Keep using proven CBT, ACT and mindfulness techniques to maintain gains.
– **Consider maintenance meds** – Discuss with your doctor occasional medication use to prevent significant relapse during high-risk periods.
When to seek help for recurring trich
If trichotillomania returns after a period of remission, how do you know it’s time to pursue help again? Look for:
– Hair pulling that persists daily/almost daily for over a month
– Inability to stop pulling despite making repeated attempts
– Pulling that lasts over an hour per day
– Noticeable hair loss or damage from pulling
– Pulling that causes significant distress or impairment
– A pattern of relapse, remission and recurrence
Getting professional help is advised if any of the above return and persist. Don’t assume recurring trich is untreatable. The right help can improve the length of your remission periods.
Conclusion
How soon trichotillomania returns after a period of remission can vary widely. For some it recurs within weeks, while others may go years before relapse. On average, most experience strong urges return within 1-6 months without vigilance. But even after years without symptoms, latent triggers can reignite hair pulling. Ongoing monitoring, lifestyle balance and therapy are key to sustaining long-term remission from trich. With patience and diligence, periods between relapse can be gradually extended.
