Pulled Too Thin by Olga Vvedenskaya

Stressors such science-related immigration, different study standards, urgency to do everything fast and efficiently, impostor syndrome, lack of help from colleagues and bosses, and tremendous pressure to finish my PhD, forms a thorough but not exhaustive list of things which have increased my anxiety manifestation during my academic career. In my case, this manifestation took the shape of trichotillomania, but it can take shape as many things, ranging from person to person, be it depression, bipolar disorder, all the way to obsessive-compulsive disorders.

Trichotillomania, which I will call trich here, also known as hair pulling disorder, is a mental disorder characterized by a long-term urge that results in the pulling out of one’s hair. Simply speaking, a person has an urge to pull their hair from their scalp, eyebrows, eyelashes, beard and basically any other area of the body. Most importantly, any efforts to stop this behavior usually fail. Wikipedia barely covers what it is like to live with trich – a few words about symptoms, possible causes, possible treatments – but does not really describe the personal path of people with trich. The relative lack of knowledge about trich upsets me because this disease is much more common than one would expect: trichotillomania is estimated to affect up to 4% of the population. In the photos below you can see my trich journey from childhood to present day.

Living with Trich – Childhood Years and School Time

I actually do not remember myself not pulling my hair. The first time I remember thinking about it was when I was around 4 years old in a summer camp. Apparently, the stress of not being at home during the whole summer was too much for me to handle without pulling my hair. So the cleaning lady who used to wash the floor noticed the hair and tried to talk to me about it and convince me not to pull my hair. How much sense can you talk into a four year-old child after all?

My mom apparently noticed that I pull my hair around that time as well, when I started to have bald spots on my scalp. She scolded me; later on she also claimed she took me to doctors, but I only remember being at a doctors’ once during childhood. The doctor asked in front of mom if everything was okay in my life. I said yes, things were fine.

Somehow when you are four years old it does not occur to you that having alcoholic parents is not normal, or that having a physically abusive father isn’t either. Weirdly enough, this also did not occur to be one of the causes of my stress for my mom as well, so the family simply decided that I should have a short haircut (see photo 1). This also added some insecurities to me, because I was constantly seen as or called a boy, which upset me. The only support I got was the one from my grandpa and sister. However, the trich situation was too much for them to handle due to the lack of knowledge and understanding in post-soviet Russia. I have to admit that I am extremely lucky to have my twin sister. She has always, and still supports me, and without her I am not sure where would I be now.

I was lucky that I have a sort of mild trich, managing not to pull my hair by having a short boy haircut. Of course my mom never forgot to mention that my twin sister was so good for not pulling her hair, and that I should follow her example. That did not really help me.

Everyone in the family was visibly annoyed by me pulling my hair, so I had to hide it for most of my life. I felt shameful of this ‘habit’, as they called it. I also felt like I was the only one in the world with this problem.

School times were pretty much the same, except for my mom divorcing my dad, so we were not really exposed to physical domestic violence anymore. On the other hand, constant comparison in school grades and achievements promoted my imposter syndrome a lot, so trich was basically always with me. Once in a while I tried to grow the hair and relapsed every time. Teenage problems were bad themselves, like they are for every person on the planet, and this whole situation overlapping with trying to hide that you are poor and that your parents are alcoholics was pretty difficult for me. I was constantly pulling my hair.

Med School

I did not manage to get into the medical university on the first attempt, so I had to take a gap year. This was difficult time for me and my trich spiraled. I got into the medical school on the second attempt, and, of course, every exam or intermediate evaluation was a struggle from a mental health point of view, because I thought I was not good enough.

Interestingly enough, I actually studied really well, worked as a technician in the lab, did some science and participated in some social activities. This sort of paid off and eventually I got an opportunity to work on my MD thesis in the USA. I managed to pass all the exams for the 5th and 6th year of med school during one year and went to the U.S. for a whole year to work on my thesis. As you can imagine, all my mental issues worsened during this year abroad: I had migraine attacks, and my hair pulling got worse. However, I had some time away from my whole previous life and used this opportunity to think and reflect on a lot of things.

PhD in Berlin

I got back to Moscow, defended my MD thesis, and half a year later started my PhD in Berlin. Now I see that I did not properly work on my issues prior to moving; that is why I basically had a second experience of post-moving migraines, and hair pulling, of course, stayed with me.

Around two years into my PhD I started to think of maybe trying therapy. A friend of mine actually suggested it. Somehow it had not occurred to me as a possibility at all, so I am extremely grateful for this suggestion. Since I did not know any doctors in Berlin, I simply googled therapists nearby and made an appointment with one who spoke English. It was a total disaster: the doctor was literally mean to me, nearly yelled at me saying how ugly I looked when I pull my hair, and said that I should simply stop pulling my hair by myself and there wasn’t much he could do. I left his office and cried in the practice bathroom for around 20 minutes. I felt horrible, like this whole thing was my fault. After this situation I decided to talk to the doctors I trust, so I talked to my best friend from med school.

And, although scary and difficult, I shared with her my story and the incident that happened at the doctor. She was nothing but supportive and understanding, and I felt accepted by my friend. This was a very valuable experience for me.

Meanwhile, I tried to get some knowledge about what was happening to me. I read the book “Toxic Parents”, and I would highly recommend it to everyone who has gone through a traumatizing experience in the family. I also tried to find an anonymous group in Berlin for adult children of alcoholics, but it was not possible for me due to the language barrier. I also found some Reddit support communities online (/r/Trichsters and r/Trichotillomania), which were very encouraging to read.

Of course, it took me a long time to get over this doctor’s visit. My next attempt happened nearly a year later when I developed depression, and could not get over it without medication and therapy. I found a Russian-speaking therapist in Berlin, who fit my needs at that point in my life. After around two years of therapy I was much better regarding my imposter syndrome, depression and relationship with mom, however, trich was still there. On a side note, I would like to mention that the relationship with my mom did not really get better. I just learnt how to make her to back off, and how to defend my own boundaries. I also sent a couple of educational videos about trich to my family. This helped them to finally understand that this whole disease is not my fault, not my habit, and that I really cannot control it. I am still bitter, of course, about my childhood, and I am not sure it will ever go away.

My PhD thesis writing, submission and defense is whole another story, which, as you can imagine, was accompanied by migraine attacks and increased hair pulling. My hair pulling got so bad that at a certain point I realized I do it while I am asleep. Nevertheless, it all passed, I defended (see picture 2), and I had to move to Dresden to start my postdoc. At this moment I think the progress with my Berlin therapist sort of plateaued, and therefore I simply moved to another city and dropped the therapy.

Post-Doc in Dresden

Now I am three years into my postdoc, and things for me have changed drastically. First of all, I finally got my permanent residence in Germany, and this is a huge thing for me as a non-EU immigrant. It basically means that if I am unemployed I will not be kicked out of the country and can rely on the governmental support regarding the money and job search. This, of course, makes me feel much more secure. Secondly, I am truly blessed to be in a very supportive and understanding lab. My colleagues try to accept me and each other the way we are. We have open conversations about mental health challenges, our childhood traumas and other typically stigmatized things. Most importantly, they don’t think less of me when I admit my imposter syndrome to them. They also fully support me in my professional work, and in my social work devoted to mental health advocacy in academia.

Unfortunately, my brain is not used to such an environment. My brain is used to trauma, overcoming things, being in financial trouble and overall insecurity. This, at least what I think, was the reason I developed another episode of depression a couple of years ago. Basically, while outside things looked perfect – amazing understanding partner, secure visa situation and nice job – I felt miserable. I did not have an energy for any activity outside of work, I slept on the couch in a living room and ate empanadas from the corner shop nearly every day. I did not have any energy for a social life, and of course the relationship with my partner became worse and worse. Most of us who deal with the depression also feel very guilty that they are horrible partners. Of course, this happened to me too, and my guilt increased my hair pulling drastically.

That was the time when I started to look for another therapist here, in Dresden, and I found one. It takes me around two hours one way by bus to get to her office, but it is absolutely worth it. She is also Russian, also a medical doctor, and also an immigrant. With her support and properly selected medication, I started to feel better in about a year. I am still at the recovery stage of my depression. But what is more interesting in this case, is that my trich seems to be in the remission at the moment. I am 32 years old, and it is the first time in my life when I am trying to grow my hair, and it’s going somehow (see photo 3). This is an incredible feeling of something new and exciting.

Most likely, one day I will have a relapse. I had it before, for example, when I was writing a review, and I was horrendously scared that my boss would figure out that I am a fraud. Maybe a relapse will happen if my paper gets rejected, maybe if I have some issues in my relationship? Maybe it will happen when I am under huge stress because of the global pandemic? Who knows? But at the moment I am coping with my trich for the first time in my life, and that I count as a huge success. I am blessed to have my twin sister, who fully supports me no matter what. I am blessed to have an extremely supportive, inspiring and understanding partner, who accepts me and my mental health package. I have my work and my social projects, which keep me going.

Conclusions and what you can do

I wish I could tell you an easy recipe on how to overcome your trich. Unfortunately, no one can do that, given the current state of medical development. However, I can assure you, that you can manage your traumas with the help of a proper specialist and medication. You can and you should feel better. Do not think of giving up. If one specialist did not fit your needs – look for another one, and the same goes for medication. This applies to all mental health conditions. Most of all, do not be afraid to share.

Olga Vvedenskaya

Olga was born in Moscow, Russia. She studied medicine specializing in medical biophysics in Moscow and worked on her MD thesis devoted to traumatic brain injury and mass spectrometry in the University of Pittsburgh, USA. She further did her PhD in Berlin, Germany working on multi-omics approach to research of liver cancer and pre-cancerous conditions. She continued her work in translational medicine and mass spectrometry in Dresden, working as a postdoc in MPI-CBG. Additionally, to her main job as a researcher, Olga devoted her spare to academic mental health advocacy.