As Fabienne Astley plans her wedding a year from now, a luxuriant bridal hairdo is high on her wish list. “And it’s actually possible,” says Fabi, 30 “though for years of having sparse, wispy hairs, I’ve longed for other people’s long, thick, heavy tresses with a full fringe.” The irony is that Fabi, from Harrogate, earns her living as a creative and successful hair stylist. Every day of her working life she sends clients out of the salon with the shiny, swinging locks she so wants for her own.
The truth is that for half her life Fabi has suffered with trichotillomania – a condition that sees her quite literally tearing her hair out. “It’s been my guilty secret,” she says. “Only my mum and my brother knew – until this spring I hid it even from Matt, my fiancé. My girlfriends and work colleagues could obviously tell that my hair was very thin, but I would tell them it was due to stress or hormones. There were times when I had bald patches on top of my head, and precious little in the way of brows and eyelashes, which I also tweaked. But what ate me up inside almost as much as the fact that I was inflicting this damage on myself was that I was being secretive and lying to people. Many women have genuine medical reasons for hair loss – because they’ve had chemo for cancer or have alopecia. I had absolutely no excuse for what I was doing – nor for covering it up. In every other area of my life I’m open and honest, but I just couldn’t admit to this.”
On the one hand, Fabi is fortunate that her knowledge of the beauty industry has allowed her to disguise her habit with make-up, hair extensions and tinted sprays. “For years, I’ve spent a good £50 a month on Phytology and Bumble and Bumble products plus sea kelp tablets from Holland Barrett to promote hair growth,” she admits. “I’ve gone through hundreds of pounds having eyebrows and eyeliner tattoo-ed in – that’s £2-£300 a time.” On the other hand, Fabi’s insider access to camouflage simply enabled her to keep the habit going without having to confront it.
As a teenager, Fabi had all the crowning glory she could wish for – a sweeping fringe and dramatic curtains of hair a la Juliette Greco. But exam pressure and struggles with self-confidence set the hair-loss habit going. “You might well put the hair-pulling down to stress and worry but I think for me, it was more of a comfort habit like sucking your thumb. I’ve recently learned that when the hair comes out of the skin it releases dopamine, which gives you a feel-good sense of release. So it becomes quite addictive. I’d sit watching TV and tug at my hair or my brows. Even at 16, I avoided swimming and staying over at friends’ houses where they might see me with no make-up. I would sit at the back in class and on the school bus, quite paranoid about anyone studying the back of my head.”
Over the years there were promising times of improvement – “Taking a career break to go backpacking round the world four years ago, I never touched my hair,” Fabi observes. But career advancement (Fabi was Senior Creative Stylist at a cutting-edge Aveda salon before taking a chair at Noir a month ago) heightened the pressure Fabi put on herself, and as she approached 30 and became engaged to Matt Hornby, a customer service training adviser, Fabi felt more and more driven to be perfect and in absolute control of every aspect of her life. The trichotillomania worsened: “feeling like a freak and a weirdo I decided something must be done. I saw two GPs in the local practice, obviously feeling very embarrassed because I’d never spoken about the hair pulling before. The first doctor said “Well, just stop doing it” which was no help at all. And the second looked at me as if I was a leper, raised an eyebrow and said ‘We’ll refer you to a mental health specialist.’ Given no further explanation, I thought ‘Oh my God, I’m mental!’so when the appointment with a therapist came round two months later, I’m ashamed to say I was too distressed to turn up. I didn’t even ring and cancel.”
It was left to the third – much more sympathetic and female – GP to reassure Fabi that trichotillomania is not uncommon, affecting one to three per cent of the population. Fabi was told that CBT – cognitive behavioural therapy - is the best known treatment. But NHS waiting lists are long and it took another six long months before Fabi finally saw her therapist, Jonny Wilkins, in March. “I remember thinking that I’d have no hair left by the time I saw him. The week before my first appointment I had an unprecedented panic attack at a friend’s wedding. My heart was beating as if it was coming out of my chest, so this time I recognized I really had to have help. I was very nervous the morning I went but I plucked up the courage to tell Matt I was seeing someone, though I still kind of lied and said it was just for stress and pressure.”
Her treatment – 11 sessions over four months - proved a revelation and a critical turning point. Jonny’s approach was completely non-judgmental and Fabi was never allowed to feel shame. “He said that the hair pulling is just a habit like nail-biting, but perhaps less socially acceptable because it damages your looks and life.” She discovered that some sufferers really do lose all their hair and even endanger their lives by eating what they pull, creating a hairball blockage in the gut. Others may pull out hair unconsciously, or have no idea that their condition has a name.
Fabi was encouraged to open up to friends – who surprised her with their receptive understanding – and to Matt who has become her most able and ongoing support in recovery. “Treatment started with helping me breakdown the motor sequence – the step by step process of my hair-pulling. I had to identify, in minute detail, when and where I did it, what the triggers were that set me off, what I was thinking and feeling when I did it, and even how many hairs I pulled out. I had to put each hair in a jar so that I could physically see the damage I was doing.
“Johnny helped me to assess my motivation for breaking the habit - whether I would respond better to positive or negative goals. I respond to both. We made lists of the advantages of stopping – being able to wear my hair differently, spending less on hair product so that I could save for our wedding and even finance the tooth brace I also wanted. I would be pleased with my self-control – and could perhaps even be an inspiration to other people with the same condition. The disadvantages of continuing included always having short hair and wisps or bald patches on top, being unattractive to Matt and even people thinking I have a serious illness.”
Fabi posted these lists in key places around her house and read them religiously every time she passed. She kept a diary of progress and pinned up photos of her newly-growing hair, as well as pictures showing the abundant hair she hoped to have. Once she did start orthodontic treatment, Matt would say bluntly, if he saw her hands go to her head “What’s the point of having beautiful straight teeth if you are going to be bald? Who is going to notice anything except your hairless head?”
Says Fabi, “At first I would become defensive when Matt tried to stop me, and mutter that it was, after all, my hair. But in the long term his scaremongering worked for me.”
Trichotillomania treatment is far from glamorous: Fabi was to watch TV in a shower cap and cotton gloves. She had to remove all her make up as soon as she got home from work, so that she wouldn’t pick at her mascara’d eyelashes. Putting Vaseline on her eyebrows and oil treatments on her scalp meant that she couldn’t get a grip to tug or tweak her hair. There’s an old saying that ‘Satan finds mischief for idle hands.’ Trichotillomania does too, so Fabi was encouraged to pick up the cat and stroke it, even take up knitting.
There was no absolute certainty that her hair, brows and lashes would grow back healthy and strong after years of abuse. But two months after her treatment ended, Fabi is looking – and feeling - very good. “My therapist was excellent, but ultimately it was all down to me. Only I could make the changes that have made all the difference – not only to my hair but to my general wellbeing and the way I feel about myself. I found help at exactly the right time for me. I’ve realised I’m in control of my own wellbeing. Most women I know feel increasingly stressed and pressured in their lives. We are natural worriers and over-analyzers, which is why comfort habits like trichotillomania are on the increase. If my story can make just one person aware that they can get better with the help that’s out there, then that will be almost as good as getting my crowning glory back.”