A Tech-Driven Solution for Compulsive Scratchers, Pickers, and Twirlers

Erin Stewart — Social Adventures

At wearable tech company HabitAware, Aneela Idnani Kumar has two job titles. The first, marketing/design lead, is easy enough to understand. But her other position, “chief trichster,” is a less conventional designation. “Trichster” is a colloquial term for a person who compulsively pulls out hair as part of a disorder known as trichotillomania. In fact, Kumar’s disorder formed the basis of the health-related company, whose first product, Keen, is a bracelet that helps users address compulsive behaviors.

Kumar explains that she’s dealt with trichotillomania for more than 20 years. Hair pulling can leave obvious evidence—over time, some trichsters develop very thin hair, or even bald spots. Nonetheless, she says, “I spent most of that time hiding this issue because I thought I was damaged.” One day, in 2015, Kumar’s husband noticed that she no longer had eyebrows. That was when the mobile app designer began talking publicly about her problem, and searching for solutions.

Trichotillomania is part of a larger group of disorders called “body-focused repetitive behaviors,” or BFRBs, that can cause people to compulsively damage their own bodies. Other BFRBs include distressing levels of skin picking; nail biting; lip, mouth, or tongue biting; nose picking; and hair cutting. Research from the University of Wisconsin-Milwaukee estimates that BFRBs affect almost 14 percent of the population, with nail biting being the most common behavior. Anxiety and stress seem to be frequent drivers, but according to the TLC Foundation for Body-Focused Repetitive Behaviors, people can also engage in BFRBs out of boredom, depression, or frustration.

HabitAware’s Keen bracelet vibrates to alert users when they’re engaging in a behavior they’ve trained the technology to recognize via an app.

That awareness is an important first step to recovery, especially since the damaging behaviors are often so ingrained that they’ve become automatic. “I had a desire to just get notified of when I was doing it,” Kumar says of her own compulsive hair pulling. She developed what she calls an “ugly” prototype, which she tested on herself; the wristband went to market in 2016.

Research from the University of Michigan has shown that wearable technologies can be effective in increasing users’ awareness of BFRBs. That said, Keen is not recommended in lieu of treatment from a psychologist or other mental health professional, nor has it undergone clinical trials to confirm its effectiveness. Anecdotal reports are promising though, and Kumar says some Keen users have even been referred to the device by their mental health practitioners. (HabitAware also works with doctors in its product development.)

In a 2017 article for Prevention magazine, writer Sarah Klein described how the device addressed her own annoying habit—compulsive hair twirling. She found that after the device sounded a few “false alarms” (it vibrated when she wasn’t twirling her hair), it learned to better target the behavior. On the third day of wearing Keen, she only twirled her hair once. “I found that even just strapping the thing on my wrist made me more aware of my habit,” she reported. “Lifting my hand to my head, I might catch a glimpse of the bracelet and pin my hand back down to my side.” Klein noticed a lasting change in her behaviors even when she returned the device after her trial.

Keen was inspired by cognitive behavioral therapy, in which individuals examine automatic and subconscious thoughts and practical ways to change their resulting behavior. According to the TLC Foundation, there are many possible treatment options for BFRBs, but cognitive behavioral therapy—which urges patients to analyze the circumstances surrounding each time they catch themselves in compulsive behavior—is best supported by research. Other options include medication, habit reversal training (where one learns to replace behaviors with another activity, like drinking a glass of water), and acceptance and commitment therapy, which explores the emotional context for unwanted behaviors. “Although no one treatment has been found to be effective for everyone, a number of treatment options have shown promise for many people,” the TLC Foundation says on its website.

Despite the fact that BFRBs are common, Kumar says that since Keen’s launch, “the biggest challenge has been getting more people to understand why what we are doing is important. People can’t see mental disorders, which makes it hard for them to understand why pulling out hair can be debilitating. But we are changing that.”

Before its launch, HabitAware donated 2 percent of proceeds from its pre-order campaign to the TLC Foundation. Kumar explains that public awareness can have a material impact on people struggling with BFRBs. “Physical defects can bring about social judgment and possibly bullying, which leads to more internal mental stress that then increases the behavior.” In particular, she wants to redress common myths and attitudes surrounding compulsive body disorders. “It’s not really a choice,” she points out. “We can’t ‘just stop.’”

“By sharing my story and the stories of our users, we hope to cultivate understanding and reduce the shame and judgment people with BFRBs feel,” Kumar says. “As a business person, financial success obviously matters. But as a person, the achievement that fuels me is knowing we are helping people get their lives back.”