Probably the single greatest source of problems in any relationship is when one partner sets out to change the other. The most successful relationships are based upon unconditional acceptance. This is necessary because all human beings are naturally imperfect, so each partner must accept the other as they are, with all their strengths and weaknesses, if they are to get along. Please understand that accepting does not mean liking. It just means acknowledging that these things exist. Certainly, we all have things we would like to change about our partners, but we learn to live with them because: 1) it is not within our power to make such changes in them; and 2) we hope that they will accept our own problems, weaknesses and deficiencies.
Truly loving someone doesn't mean being merely in love with the image of the perfect partner you would like to make them into. That ideal person doesn't, and never will, exist. Your partner is an ordinary, fallible, mistake-making human being, just as you are. To set yourself up to judge them as if you yourself were some kind of superior being is to egotistically imagine that you are godlike and totally free of all faults.
Throw away your blueprint! BFRBs are a part of your partner's life. They own it. It is chronic, and it is something they carry with them. It will not simply go away because you don't like it. Many things that we do not like exist in life. In order to have a relationship with this person who has BFRBs, you must accept that it is a part of the total package. Your partner may attempt to change this behavior, or they may not. In the end, it is totally up to them. The only one who can change them is them. In any case, you cannot change them. Period.
Please don't misunderstand. Everyone with BFRBs would like to get rid of this problem, but not everyone is ready or able to do so at a particular time, for a wide variety of reasons. For example, proper help may simply not be available where they live. Don't criticize. Those with BFRBs feel badly enough about themselves already without that, and their self-image is usually very low. I have heard many sufferers describe themselves as "weirdos" and "freaks." Imagine having to explain to the people in your life that you have actually pulled out large patches of your own hair because it feels good. Also, it is important to understand that one of the purposes these behaviors serve is to soothe the nervous system. If you insult, threaten, or criticize, the stress you will be creating will only result in increased behaviors as they try to calm themselves.
Look at it this way: this is the person you love and have joined your life to. As far as we know, the problem is biological in origin and probably genetic. It is not simply a bad habit or vice. Don't confuse the fact that they have pulled out their hair themselves with the notion that it was a deliberate act on their part. They are not to be blamed for having it in any way. It's true that they are responsible for helping themselves, but how can you justify making them feel bad about it, and what purpose do you think it will serve? What if something else that wasn't their fault damaged their appearance, such as an accident? Would you still refuse to be seen with them in public?
It might help to examine the source of the difficulties you are having with your partner's problem and look into yourself. Ask yourself these questions: could it be that rather than empathizing with your partner and feeling sympathy for what they are going through, you are only concerned in a self-centered way with what others will think of you when you are with this person whose hair is missing? Do you worry that you will be seen as responsible in some way, or that you will be considered abnormal by association? Do you feel that this change in their appearance has somehow magically made this person you may have spent years with into someone that you suddenly don't know and can't tolerate being with any more? Is this person's hair all there is to them and is their appearance all you are in love with?
Even if you do accept the pulling, and your partner is actively working on getting self-control, it is not your responsibility to see that they are successful. Recovering from trich takes a lot of work and effort, and can be a difficult task. It is a very stubborn problem. Unless you want to make a difficult job even more difficult, don't nag them constantly. Don't try to punish them with your anger, silence or absence at times when they have slips or setbacks. Don't try to use guilt, with such statements as, "Our relationship would be great if it weren't for your hair pulling," or "If you really loved me, you'd stop." One of my personal favorites is the spouse who said, "I stopped smoking. Why can't you stop pulling?" As one of my patients told their impatient partner, "Don't you think I want to stop pulling and that I really hate being partially bald? Do you really believe I like walking around without hair, knowing that I did this to myself, and not being able to explain to other people what actually happened to me?"
Avoid the childish use of sarcasm and name-calling. It is an inappropriate way for one adult to treat another adult, and as a way to get someone to improve, it's crude and simply won't work. Finally, don't threaten to leave them. If you really feel you absolutely can't understand or accept it, and can't control your frustration with them, then leave. It is probably kinder in the long run.
A second major source of difficulty in these relationships is when one partner is supportive but somehow becomes directly responsible for controlling the hairpuller's behavior. You can't want them to improve more than they do. If they can't do it themselves, it is simply no good. They won't learn if you try to do it for them. Even if you could get them to stop pulling every time you caught them at it, what would happen when you weren't around? Also, if you were to somehow take total responsibility for their problem, it would relieve them of ever having to take responsibility for it themselves, so they wouldn't. You cannot stand guard over them twenty-four hours a day. If your partner actually prefers that you take control of their behavior because they imagine that they are too weak to learn to control themselves, resist the temptation. You'll be doing them a big favor by allowing them to be fully responsible for themselves. Try not to get into the bad habit of calling their attention to their pulling. Don't waste your time whistling, snapping your fingers, waving, or otherwise signaling whenever you see them reaching to pull. Resist the urge to grab their arm. Suppress your impulse to yell or call out. Learning to be aware that you are pulling, and then stopping, takes a lot of work, even when you're motivated. If your partner isn't motivated, rest assured that nothing you can do will make the slightest bit of difference.
So having said all this, how can you truly be of help? The answers lie in the previous discussion. First, accept that the problem exists and that it is not their fault that they have it. Second, understand that it is not your responsibility to get them recovered—it is entirely in their hands. It is purely up to them to change their behavior. Stay out of it and give them space to do what they need to do. Keeping their stress down will enable them to do a much better job. What you can do is to give unconditional support for their efforts to help themselves, and always be aware of how difficult it must be for them to live with this problem and fight it every day. Accept their lapses, bad days, and slip-ups. There may be disappointing times when weeks of new hair growth is suddenly pulled out in one episode. This is not unusual and must be viewed as one of the potholes on the road to recovery. They may feel really discouraged at times and believe that they cannot do it. Your belief in them can go a long way. If a pep talk is appropriate to the person and the situation, give one by all means. Just be careful not to overdo it.
Couples encounter many obstacles in their lives together. This will just be another. Whether we like them or not, we are forced to accept them. Life is not like a card game where you can throw down your cards and ask to be dealt a new hand. Remember that to get through this, or any difficulty, it must be the both of you combining your efforts against the problem, rather than each other.
Dr. Fred Penzel is a licensed psychologist who has specialized in the treatment of Trichotillomania and OCD since 1982. He is the executive director of Western Suffolk Psychological Services in Huntington, Long Island, New York, a private treatment group specializing in trich and O-C related problems, and is a founding member of The TLC Foundation for Body-Focused Repetitive Behaviors' Science Advisory Board. Dr. Penzel is the author of "The Hair Pulling Problem," a self-help book dedicated exclusively to trich, as well as "Obsessive-Compulsive Disorders: A Complete Guide To Getting Well And Staying Well," a self-help work covering TTM and other O-C spectrum disorders.