The Dilemma of Stigma: Hardship in Treatment of Trichotillomania

Examining the treatment of trichotillomania (TTM), a hair pulling disorder, has been ignored in the field of sociology compared to the effort put in clinical psychology and psychiatry. Little is known about how patients cope with this mental illness, as well as the reason why the recurrence after treatment is so common. It is important to look through how these patients of minority approach to its treatment because not only the construction of illness, but also the action/choice of the patients to seek help is affected by the social facts. I investigate 1) how some TTM patients do not seek for medical treatment even when the patients realize they are doing something abnormal to their hair, and 2) what makes them feel hopeless regarding the cure of the disorder. Using grounded theory by in-depth interviews with patients met in online trichotillomania community in South Korea, I found that self-labeling, trivialization, and self-attribution were the mechanism for patients to conceal the illness, which have impeded patients to reach the clinic, thus hindering the formation of medical and social discourse of TTM. The absence of discourse again leads to concealing the behaviors, forming a dilemma of stigma. Patients with medical intervention also experienced helplessness because they were discouraged to stop the behavior immediately to protect their esteem as in beauty and normality. This study contributes to the medical discourse of TTM that the social psychology of self-labeling and self-attribution resulted by the normality discourse exist as an important facet of treatment besides the psychiatric model, and it further aims to investigate the ways to mitigate the pains of the TTM patients.