I had an interesting conversation with a family last week that sparked an interesting question: Just because someone has trich, does it need to be corrected? A little background might help.
The call was in reference to a 14 year old girl that has trich; she mainly pulls her eyelashes and eyebrows, but occasionally pulls from the back and sides of her head as well. The girl’s mother did most of the talking during the initial part of the conversation, explaining to me how long this had been going on and how bad she felt about how her daughter looked and worried about her being made fun of at school.
I then proceeded to ask the daughter a simple question: “Do you want to stop pulling?” She replied, “No.” Her mom was audibly stunned, but I pressed on and asked her why. This young girl explained that she enjoyed pulling and that she didn’t feel at all ashamed of how she looked. On the contrary, she told me that she liked looking different than the other kids at school. She also said that she liked that other kids noticed her missing eyelashes, eyebrows and even patches of growth on her head – she enjoyed being different.
We talked some more about this, and it was apparent that this young woman and her mom had never had this discussion before. We ended the conversation with me asking them to continue this conversation offline and that we would follow up in one week.
This conversation brought up a very interesting dilemma for me – I know that the urge to pull has a basis in neurotransmitter imbalance and that optimizing neurotransmitter levels can lead to a complete elimination of the urge to pull. I also know that many other disorders are related to imbalances in neurotransmitter levels, including depression, anxiety, migraines, insomnia, and chronic fatigue and that optimizing neurotransmitter levels can minimize the occurrence of these disorders. But what if a person enjoys pulling and doesn’t show any other clinical manifestations of any of these other disorders – what should we do then?
The obvious answer is that people only change if they want to; in this instance, this young woman liked to pull, so it is incredibly unlikely she will do anything to stop at this time. But the question remains – does trich always need to be corrected? What do you think?
