Olga Khazan: Tell me about when you started skin picking and when you stopped. Did that overlap with the hair pulling at all?

Lindsey Muller: The skin picking started when I was in kindergarten. The nail biting, I would say, started around the same time. I don’t remember that as well because it was a much more minor behavior, meaning that it didn’t result in a lot of attention given to me by my parents with them telling me to stop. The skin picking was something they were much more concerned with. Then I stopped picking—again, I don’t remember an exact date, but I would say it was probably around sixth or seventh grade, which was right before I picked up the hair pulling. The nail biting definitely overlapped and persisted all the way through high school and into college while I was also pulling my hair.

Khazan: What were some of the emotions underpinning these behaviors for you? You talked about perfectionism and boredom, but what was going on in your brain at the time?

Muller: Growing up, I was definitely a perfectionist. As a result, I put a lot of pressure on myself, even more than my family or friends put on me. I definitely had high expectations for myself, and I think that played a role in me just always feeling so tense. And that drove the urges, which I acted upon with the hair pulling.

But I also think that the sensory component was really big and really key. I was so used to being so busy and constantly doing, doing, doing, because I was a perfectionist and a Type-A personality, and I still am today. But I think that because of that, I was always used to and so focused on craving that sensory stimulation, so whether it’s mental challenge or physical activity, or doing, seeing a lot of things on my to-do list or my agenda.

So whenever I had down time, or what I like to call free time or unstructured time, that’s really when the behavior picks up. Because it was like, “Okay, now what do I do? I don’t really have anything going on right now, and I feel like I should be doing something.” I had a hard time just sitting idly.

Khazan: Working on the computer was especially a trigger for you—especially with the hair pulling, you talk about the area around the computer chair being covered in your hair. Why is it that the computer work in particular, at times when you were alone, would lead to that?

Muller: It’s interesting, I never associated it with any type of loneliness or isolation. It was more like, “I’m alone right now, no one is going to see me, I’m not going to feel embarrassed, I’m not going to get caught.” I almost felt there was more of an excuse to do it at the time when I was by myself.

But as far as the computer, even when I was reading, it was the type of thing that if I was doing something that I wasn’t really tuned into or interested in, and it was more of a passive activity, which the computer and reading typically are, I needed something else to supplement that to increase my level of stimulation. It was during middle school and high school and that was back when AOL was really big, and I remember a lot of time spent sitting at the computer and waiting for someone to respond back to me. I would type a response, and then I was sitting and waiting, that’s when I would pull. And then I would type again and respond to them. So there was a lot of that that. I recall that pattern.