Re-entering The World with Anxiety Eyebrows

It started as a pet name for the approximately three hairs scattered across my otherwise-empty brow bones: my Anxiety Eyebrows. What happened to the rest of them, you ask? Oh, I pulled them out. Mm-hmm, all of them. Hundreds of hairs, over and over, fingers animated by some unconscious, unignorable forceby some part of my brain that swore freeing the exact right hair from the exact right follicle would soothe the stress-induced ache in my pores.

I do this constantly and compulsively, weekly if not daily. My rational mind knows that picking doesn't work, of course. I know the added stress of annihilating my own eyebrows (What did I do? Why am I like this? Should I get bangs?) will provoke another episode. I know the ache will come back and my brows might not. Doesn't matter. Reason is no match for the fleeting euphoria of ripping a hair from its root!

This news hasn't gotten the attention of, say, maskne or the Botox boom, and I have to imagine it's because trichotillomania (seemingly) doesn't lend itself to a cutesy little catchphrase. Or maybe it's because compulsively picking your eyebrows clean in an attempt to alleviate a phantom pain in your hair follicles seems like an unspeakably strange thing to do. In any case, it's time to take my pet name public and normalize the defining beauty look of These Unprecedented Times: Anxiety Eyebrows.

Trich, as it's known in the picking community, is a body-focused repetitive behavior. The Diagnostic and Statistical Manual of Mental Disorders defines it as the recurrent pulling out of one's hair, resulting in hair loss despite repeated attempts to decrease or stop hair pulling. This isn't over-plucking every so often, says Amy Wechsler, a psychodermatologist who is double board certified in dermatology and psychiatry. The damage makes [the] disorder, she emphasizes. It's causing scarring, it's causing hair loss, and it's not easy to stop. (The same goes for other BFRBs, like dermatillomania, or skin picking, and onychophagia, better known as nail biting, both of which are also on the rise.) Sufferers tend to favor a specific areatheir scalp, eyelashes, bikini line, wherever. Many, like me, take their urges out on their brows.

Hair pulling can be on the spectrum of anxiety disorder and worsen during periods of anxiety, Weschler notes. Since the start of COVID, there's been an uptick in every anxiety disorder, trich included. (Honestly, the pandemic has already taken so muchlives, jobs, the quiet peace of never knowing the word Cuomosexual. Must it take our eyebrows too?)

If you're new to the Anxiety Eyebrows club, let me be the first to welcome you. I developed trich in high school, meaning I've dealt with pulled-bare brows for more than half my life, and I have some thoughts to share.

First, more people pick than you think. Most people that do this to themselves think they're the only ones that do it, and they feel alone and isolated, but it's really common, Wechsler says. It affects up to 2 to 5% of the population in some studies. That number may very well be higher. Many trichotillomania cases are misdiagnosed and underreported due to the secretive and embarrassing nature that is associated with compulsive behavior disorders, says Bridgette Hill, a certified trichologist and founder of Root Cause Scalp Analysis.

Because BFRBs are underreported, they're also understudied. Experts haven't identified one clear cause for trichotillomania. It's likely a mix of genetic, biological, and behavioral factors, per a recent report from The New York Times, which can be triggered by a single traumatic event; or general stress, anxiety, or depression; or sometimes nothing at all. Some say the condition is related to obsessive-compulsive disorder, although that's up for debate. Either way, I've found the comparison to OCDa more talked-about mental illnesscan help contextualize the all-but-uncontrollable nature of trich: This is not a bad habit or a personality quirk. It's a psychological disorder.

That said, a picking episode isn't always the frantic, panicked experience you might imagine. Many go into what could be called a trich trance, completely oblivious to what they're doing and how long they've been doing it. But while picking may be mindless, it's never meaningless.

It's no accident that when people are anxious and do these repetitive behaviors, they're done to the skin, hair, or nails, Wechsler says. The brain and the skin are made from the same embryological layer of cellsthey're kind of hardwired togetherso there's something about feeling a physical symptom that can sometimes decrease a mental symptom of anxiety. This hardwiring is more formally known as the skin-brain axis, the network responsible for splashing our deepest feelings across our faces. Embarrassment manifests as blushing, fear manifests as blanching, stress manifests as stress skin. And for some mental anguish manifests as the pore-deep pain that precipitates Anxiety Eyebrows.

Our sense of psychic well-being is inextricably linked with our skin, writes Marc Lapp in The Body's Edge: Our Cultural Obsession With Skin. The skin provides our psyches with a metaphor for protection, a boundary against an inimical world. It makes sense then that when we feel the boundary between our inner selves and the outer world has been breachedby a global health crisis that forces us to face our mortality, perhapswe might, in turn, breach the boundary of our skin.

More than a soft armor, though, the skin is the only place where the mind can sense the body, Lapp continues, making it the primary canvas on which our cultural and personal identity is drawn. This plays into my own personal theory about why trichotillomania affects women significantly more than men, in a four- to-one ratio: Women are subject to disproportionate psychological pressure to look a certain way, whether that means concealing our flaws, enhancing our features, or expressing ourselves (a cosmic and comically large undertaking!) through foundation, contour, and brow powder. Our basic human rightssocial treatment, career opportunities, financial income, legal outcomesare often informed by how well we adhere to societal beauty norms; in turn, our internal sense of self is often informed by our external appearance. (Consider: What we see as self-care is more often superficial care: manicures and pedicures, facials and sheet masks, injectable neurotoxins, new lipsticks.) Many psychic disturbances that concern self-image come to be played out at the body's edge, an often muted sensory wasteland between ourselves and the outer world, Lapp writes.

The subconscious self, aching to be seen, acts out on the surface. (After all, we pay more attention to our faces than our feelings.) And so an identity crisis becomes an eyebrow crisis.

The psychic-identity-to-skin pipeline also explains why Anxiety Eyebrows cause clinically significant distress or impairment in social, occupational, or other important areas of functioning, as recorded in the DSM-5. The distress isn't from picking, per se; in my experience, it's from the aftermath of picking. Seeing my mental illness plastered across my forehead fuels the disconnect between my inner self (Why would I do this to me?) and my outer self (The real me has full eyebrows!). It forces me to grapple with how others will perceive me sans eyebrows (Will they think I'm a freak?) and how I perceive myself (Am I a freak?). It's all stressful enough to trigger a fresh session.

I'd like to believe that our Anxiety Eyebrows will grow back once things get back to normal, but it's probably more complicated than that. One, what even is normal? Two, post-pandemic anxiety is real, and for trich-sters, that pretty much means post-pandemic picking. And finally, there is no professionally agreed-upon, FDA-endorsed treatment for trichotillomania yetjust lots of ways to manage it.

The first step, as a certified trichologist, is to address this as a mental- health and behavioral condition, not a hair condition, Hill says. To reduce the frequency and severity of hair-pulling episodes, she recommends seeking out a mental-health professional, joining a support group, or trying Keen, a smart bracelet that essentially trains you out of your triggers. Wechsler says cognitive behavioral therapy, talk therapy, acupuncture, and hypnosis have helped her patients. Dietary changes can supposedly make a difference, which makes sense, since the skin-brain axis is part of the larger gut-brain-skin axis, and most things that affect the gut go on to affect the brain and skin. You can try milk thistle and NAC supplements, load up on antioxidants, and cut down on sugar. (I haven't experimented with this myself; I love sugar more than I love my eyebrows, I guess.) In The Body's Edge, Lapp notes that massage can restor[e] linkage between the external sensorium and the inner self, which is surely the most luxurious option.

For me, regular old meditation has been effective. I try to practice for 10 minutes a day, a few days a week, and when my Anxiety Eyebrows are particularly empty, I add visualization to the mix. I close my eyes and imagine a white light filling my body as I breathe in; when I breathe out, I picture the light radiating from my brows.

It's the deeper soul care that's been truly life- and brow-changing, though things like feeling my emotions instead of glossing over them; making time for a cleansing cry whenever I need it; divesting from hustle culture and finding purpose outside of my work; divesting from beauty culture and finding worth outside of my appearance; connecting with nature and getting my feet in the dirt; cultivating community and dreaming of collective liberation; and releasing old emotional trauma through breath work. The point of all this, I guess, is to bridge the gap between my inner and outer worlds. (It helps that most of the above activities alleviate anxiety too.)

To be honest, no amount of deep breathing can keep my fingers from my face when I'm already in the throes of an episode. I've tried to curb in-the-moment pulling by slathering my brows in Vaseline (which doesn't work), using ice cubes to numb the area (which does work), and simply repeating the mantra I'm okay (which can go either way). I think it's helpful to cover the area, Wechsler adds. Sometimes the picking is done in a semiconscious state, and if you feel something like a Band-Aid, it can cause a little wake-up like, Oh, I'm not supposed to do that.

Here's where the covering-up part comes in, although when you're talking about a mental disorder affected by the interplay between one's psychological and physical identity, it feels less like covering up and more like avoiding a major trigger. I swear by a great brow pencil (Hourglass Arch Brow Sculpting Pencil is my go-to), a growth-stimulating serum (VegaBrow Volumizing Serum), professionally-trimmed bangs (Francisco Miranda at Liquid Hair Salon gives me the shaggy fringe of my dreams), and microblading.

Microblading is a semipermanent [tattooing] method that gives a natural brow look to your face, says Delphine Breyne, a microblading artist in New York City. I consider it part of my mental-health routine. I mean, the goal is to focus less on my appearance, to not obsess over what I look like, right? With a set of full, fake brows quite literally tattooed to my face, I don't have to think about my own brows, worry that my trich is showing, or sneak off to the bathroom for touch-ups. They're just there. They don't take up brain space.

And that's brain space I can use to do the inner work of separating my soul-deep identity from my Anxiety Eyebrows.

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