Heath Lambert: Our guest this week on the podcast is Dr. Keith Palmer, a fellow with the Association of Certified Biblical Counselors, and a pastor in Granbury, Texas. We’re here to talk with him this week about the problem of hair pulling, and Keith, I think there are a lot of people who would be listening to this and would be surprised to know that when we talk about the problem of hair-pulling, we’re talking about an actual problem. We don’t hear about this every day, explain it to us.
Keith Palmer: Well, thanks for allowing me to be here. First of all, I was surprised too the first time this issue came my way. As I did research and got to know a little more about it, it was surprising to know that anywhere from two to five percent of the whole population struggle with this issue and all experts agree that that’s low because it’s so under-reported. So, hair-pulling, or it’s sometimes called trichotillomania, or trick, or TTM, is a behavior characterized by sessions where people pull their hair out. The onset is anywhere between 11 and 13 years, and by adulthood, this is very interesting, 80 to 90%, of all people that struggle, are women.
Some basic characteristics of the behavior is that there is usually a strong urge or tension that builds up and then that tension is relieved or resolved through the pulling of hair from various parts of the body. There are two main kinds; this is one of the interesting features of it. There is a fully focused version, where the person is very ritualistic, they plan it out, they go through a very prescribed program, and then there’s another version where the person is only semi-focused on it. Almost when you talk to people about it, they’ll describe it as being in a trance or maybe they’re half asleep, even, so they don’t even realize fully what they’re doing. It often occurs during sedentary activities like watching TV, reading, trying to fall asleep at night, sitting in class, trying to do homework, and oftentimes too there’s a search for the perfect hair to pull.
So, the journey, the investigation leading to pulling of the hair is part of the package and once it’s pulled, the individual often examines the hair, chews it, or even ingests the hair and that leads to other medical problems that we’ll talk about. Obviously, bald spots are a big problem with this sort of thing, infections or wounds, and actually, trick is related to skin picking. So, people that pick at their skin, psychologists would understand that as being in the same realm of issues and infections and wounds can happen there. Digestive blockage, if they actually ingest their hair, that can be a medical emergency.
Then there are spiritual issues, emotional issues, like shame and guilt, isolation, as they do this privately, depression and anxiety because of dealing with this and thinking about it. They can have peer problems as they don’t want to be around their friends, they don’t want to go out in social context because of how they look; self-image problems. It promotes secrecy avoiding social activities and interference at work and school. The number one issue that I’ve seen in this is just dealing with the shame and embarrassment associated with the behavior.
Heath Lambert: You were talking about the search for the hair; help us understand what that search entail? What are people looking for when they’re searching for the hair?
Keith Palmer: Usually an imperfection of some degree. They’re looking for one that feels just right, or maybe feels very wrong and that leads them to remove it; it’s very unique to the individual. You just have to do a lot of asking questions and listening trying to understand.
Heath Lambert: It provides some sort of “fulfillment” to remove it? What would that fulfillment be?
Keith Palmer: Well, there’s a physiological thing. First of all, when you pull a hair out of your body, your body reacts to that, so there’s a physiological reaction, but also, when you talk to people that struggle with this, pulling resolves this tension that’s been building up, to pull the hair, at least in some people, and in others, it doesn’t resolve the tension and leads to pulling more and pulling more. It is very much specific to the individual; you really have to get to know people and how they particularly struggle with it.
Heath Lambert: Are we talking about people pulling one hair, certainly, the search for the right hair would be pulling one here, but are we talking about people grabbing a handful of hair and pulling it out?
Keith Palmer: Usually, that’s not how it happens. Usually, it’s one at a time. There is the search comes in trying to find the right one and then we’ll try to find another one. So, it tends to be pulling from the same area of the body, but usually one at a time.
Heath Lambert: And that’s where the bald spots come from, correct?
Keith Palmer: Correct.
Heath Lambert: So, is there a particular area that is popular?
Keith Palmer: The scalp would be the number one location. There are others on the body, but the scalp would be the number one.
Heath Lambert: Then the ingesting of the hair, are they swallowing one hair at a time or they swallowing a bunch of hair at once? What’s going on?
Keith Palmer: I believe it varies but what I’ve read and what I’ve experienced in counseling would typically be one at a time and sometimes they ingest the hair, sometimes they’ll just bite part of the hair and then discard it.
Heath Lambert: When you’re talking about digestive issues, obviously, your internal organs don’t handle processing hair very well.
Keith Palmer: It builds up in your digestive tract and then you could potentially have a blockage and that’s a medical emergency.
Heath Lambert: So, I’m listening to you describe this problem that we said at the beginning of the podcast, my guess is, a lot of people would hear that this is a problem and be surprised to find that it’s a problem. After discovering that it’s a problem, I think this is the exact kind of issue that when people say, “surely you don’t think the Bible is about all kinds of counseling, do you”? I think this is the exact kind of issue they’re thinking about. What in the world does the Bible have to say to understand this problem?
Keith Palmer: It’s a great case study in whether we really believe our theology or not, the sufficiency of Scripture, the adequacy of Scripture. We believe the Bible is the sufficient resource for all counseling problems and this struggle really is no different. There are sufficient resources in the person and work of Jesus and his inspired authoritative Word, to provide answers, both understand the behavior and to minister to those who are struggling. So, the first thing I would say is that pulling hair, picking skin, biting nails, and similar behaviors, are not in and of themselves, moral issues. That’s where the Bible gives us categories to understand, is a behavior a moral issue is an a-moral issue.
However, in this particular situation, this behavior can become a moral issue in certain circumstances. So, for example, if this behavior becomes a means of dealing with the problems of life against biblical counsel or against God’s instructions, then it becomes a sinful thing to do. For example, many people that struggle with this are dealing with unpleasant feelings, life problems, anger, anxiety, worry, depression, stress, feeling out of control, or even unconfessed sin, and the Bible has a great metaphor for things like that, when we run away from God instead of running to him. I love how the Psalms uses the metaphor of a false refuge, and that’s what this is, this can become a false refuge, a place to run. When we feel out of control, or we feel like our anxiety is overwhelming us, and of course, Psalm 119:8, says that it is better to take refuge in the Lord than, to trust in men or to turn to other false refuges. So that would be one case where this could become a moral issue or a sin issue.
Another circumstance that could become a moral issue would be when the behavior becomes enslaving, and that’s exactly what we usually see with a behavior like this. 1 Corinthians 6:12 says, “all things are lawful for me. Not all things are profitable. All things are lawful for lawful for me, but I will not be mastered by anything”. Of course, that’s not unique to this issue, but this struggle tends to become a master. People become enslaved to it. It is at that point the Bible would say, okay, now this is becoming a moral issue and we need to think about spiritual resources to change.
A third situation where this issue could become a moral issue, a spiritual issue is when the behavior damages your body. 1 Corinthians goes on to tell us that a believer’s body is the temple of the Holy Spirit and we’ve been bought with a price, and therefore, we should glorify God in our body. So, not always, but in many cases, people are damaging their body; bald spots that take months, even years to recover or if they’re getting infections, if they’re picking their skin, digestive problems, if they’re ingesting the hair. So, if it’s damaging their body, we would say, “that’s not honoring to the Lord”, and we need to repent and see grace to change.
A final way, where this could become a real moral issue is if the behavior leads to or feeds other behaviors that are overtly sinful in some way. So, for example, a failure to love neighbor because I’m too embarrassed to go out and minister to my brother or sister. So, a situation like that. Another thing the Bible teaches about this, and I call it front-end issues and back-end issues, there are usually clear spiritual issues that lead to a person engaging in this behavior and the Bible would speak to that. We’ve talked about some of those already anxiety, stress, worry, wanting control, things like that, but they’re also backend issues, things that come as a result of this behavior. So that would be the shame, the guilt, the secrecy, the lying, and deceit, enslavement; trick can lead to difficult emotions, and further, sinful behavior. Now, in some cases, people that struggle with this may not be able to point to a precipitating issue, but nonetheless, they deal with those back-end issues in the Bible is full of answers for those spiritual issues.
Heath Lambert: So, you have just mentioned, a whole big bunch of things going on, just a wealth of resources that when you look at this with sort of biblical lenses, you’re going to have all sorts of ways to understand what’s going on. What does the Bible have to say about helping with this problem? I can imagine that’s going to be very specifically related to what’s going on with the issue that leads to this problem, but what are some ideas you could give us about things the Bible has to say to help?
Keith Palmer: I think the first priority is just to be a loving biblical friend. Proverbs says a friend loves at all times, right? This is a behavior that is full of shame, full of embarrassment, and most people are not going to talk about it. Okay, so building the type of relationship, that true, biblical friendship that we see in the book of Proverbs, to where I might become the type of person that if there’s somebody struggling with this, they would want to trust me enough to tell me what’s going on. So, I think being a good, caring, biblical friend has to be the first thing. As a subset of that, the onset of this behavior is typically in childhood, so I think parents particularly need to be very careful how they react to this sort of situation; when a parent freaks out and overreacts, “I can’t believe what you’re doing that, why would you do that? That’s so weird”. Exceedingly, unhelpful, and adds to the shame and embarrassment that the child already feels. So when James tells us to be quick to hear, slow to speak, I think that’s a great counsel for parents that are helping their children with this sort of thing. Listening and understanding is key to helping and parents need to be committed to that and then respond in godly ways.
So, another way that we can help in this situation is to build a Biblical framework for understanding it. I think most people would hear of this issue and say, “the Bible has nothing to say about this”, and that’s one of the things I love about being a biblical counselor is an opening God’s Word and saying, “let’s see the answers here, let’s see the heart issues behind this”, and that’s one off the joys in counseling, putting the counselee in the framework of the Bible and then the Bible comes alive with enhancers at that point.
A third way would be to address those issues, those spiritual issues that we’ve talked about both front-end and back-end. The Bible teaches us how to deal with guilt, shame, anger, depression, anxiety, fear, lying, isolation, and sometimes issues that are discovered in counseling really go from a person’s past. So recognizing that there was a hurt, a struggle, and this became a way to deal with that, a false refuge, like the way the Psalms describes it, and we need to help unpack what that is and lead them to take refuge in the Lord.
I love this verse in Hebrews. It says that Jesus has been tempted in all things as we are and yet without sin. When I’m ministering to somebody, I can say to them on the basis of this Word, “Jesus knows what it feels like to have strong, urges, strong temptation to sin and so he can relate to you. You can go to Him, and He is a sympathetic high priest and yet He was without sin”. The text goes on to say, “So we go boldly to his throne of grace, to find mercy and grace to help in our time of need”. So, help your counselor to turn to the Man of Sorrows who’s experienced the weight of temptation and to find that grace to say “no” to those ungodly desires. Then maybe a fourth way we could help is to help the counselee to develop very practical prevention and temptation strategies and we can develop that based on the individual and the things that we discover, but basically, Jesus tells us in Matthew 5, “remove any hindrance that’s leading you to temptation”. So, when you get to know a person’s situation, what are one of those things? Is it isolation? Is it a certain situation? Is it a context or a behavior and activity? If we can remove that or change those things, that helps to prevent the strength and the weight of temptation.
Finally, one last way to help would be to help the counselee to grow in the normal means of grace. There may be many people that can’t relate to this, and yet, the answers the Bible gives are the same answers for any problem in life. Growing in the Word of God, growing in prayer, growing in dependence, the local church, and involvement in corporate worship, private worship I think, in this case, the best defense really is a good offense. Psalm. 119 says, “how can a young man keep his way, pure? By keeping it according to your Word”, and then it says this, “with all my heart I have sought you”. We want to train people to see God with all their heart and as they grow in grace they will see those resources come to resist the temptation.