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Someone asked me this question on FB today and I wanted to post it here. I would really like one of the psychologists to answer if possible, so I can pass the information to the young girl who asked it.
That is an excellent question, Max thanks for posting it. With trichotillomania, there is generally over-reactivity in the emotional brain systems. This leads to intense feelings, which some experience as anxiety or even depression. When the chemical stress becomes imbalanced, the feelings are so intense that they can trigger false signals in the upper brain. Pulling, for someone with trichotillomania, feels like a soothing release of depression or pain as orgasmic chemicals enter the fluid of the brain. These endorphins overwrite the over-reactive emotion triggering neurochemistry, but unlike orgasm there is no "afterglow" or continuity of good feeling, meaning the person will continuously seek that instant gratification.
Love and pull freedom