What is Trichotillomania?
by Ariel Taylor
Trichotillomania, or hair pulling disorder, involves the irresistible urge to keep pulling out hair from the scalp, eyebrows and even other parts of the body.
For some, the symptoms may be mild, but for others, they can be overwhelming. It is not just a bad habit but a long-term disorder that needs treatment. Some treatment options help people to reduce hair pulling or to stop it altogether.
Causes of trichotillomania
There does not seem to be one specific cause. The reason why people start with this addictive behavior appears to be unique to their situation. In some cases, onset is associated with a traumatic event such as illness or divorce.
Some people start in childhood after suffering abuse, others begin as teenagers but some only start when they are adults. It is classified as an impulse control disorder that appears to have multiple causes, both genetic and environmental.
Some factors make people more susceptible to the disorder – for instance, females seem to suffer from it more than males.
Symptoms of trichotillomania
A sign that you have trichotillomania is when you repeatedly pull out hair from your scalp, eyebrows, eyelashes, or anywhere else you have hair. You may not even realize you are doing it or you may pull it out intentionally to relieve distress.
You may feel an increase in tension as you try to resist pulling and a sense of relief afterward. You may prefer to pull out certain types of hair such as coarse, wiry hairs.
Rituals may go together with the hair-pulling. You may chew, bite or even eat the pulled out hair. You may try to resist pulling hair out with no success.
The behavior results in thinning or bald spots on the scalp or sparse eyebrows and eyelashes. It can also cause scarring and other kinds of damage. The scalp or skin may become infected. Constant hair pulling can permanently affect the growth of hair.
The cosmetic damage caused by this condition often leads to intense feelings of shame and self-blame. It affects self-image just as much as the loss of hair from chemotherapy or normal balding.
The hair pulling happens in private and sufferers may try to hide the condition from others by wearing wigs, scarves, fake eyelashes, unique hairstyles, hats or makeup to try and disguise the hair loss. Some sufferers may even avoid going to the hairdresser for years.
Specific factors may cause symptoms to fluctuate in severity. For instance, hormonal changes can worsen the symptoms in women. Symptoms for many people come and go, and this can happen over weeks, months, or even years at a time.
Sometimes trichotillomania has complications. Those who eat their hair may end up with a massive hairball in the digestive tract. Over the years this may cause vomiting, weight loss, and intestinal obstruction.
Diagnosis of trichotillomania
There is no specific test for trichotillomania and diagnosis is based on the signs and symptoms.
Early diagnosis is helpful, and treatment can prevent any further negative impact on social functioning. It may also help to prevent the development of certain conditions that are often comorbid with trichotillomania such as depression.
A general practitioner will thoroughly assess the patient. This will include taking an in-depth history. An input of a family member may be helpful. Trichotillomania often presents with other disorders that can help with the diagnosis.
Younger patients may suffer from anxiety, disruptive behavior and other body-focused repetitive behavior such as nail-biting. Teenagers and adults often suffer from anxiety disorder, phobias, mood disorders, substance abuse or eating disorders.
If a general practitioner diagnoses trichotillomania, the patient is usually referred to a psychologist or psychiatrist for treatment.
Treatment of trichotillomania
Finding any cure for trichotillomania continues to be a challenge.
However, there are many treatments available to alleviate the symptoms. This usually includes a combination of therapy and medications.
Habit Reversal Therapy is a behavioral therapy technique that appears to be successful in treating this disorder.
Habit Reversal Therapy involves replacing the bad habit with something that does not cause harm. It may include learning to identify when and where you have the urge to pull.
You will learn to relax and perform some other action that eases the tension without hurting yourself. This may just be a simple action like making a fist. Therapy can also address any unhelpful thinking that causes stress and triggers the behavior.
Some clinical trials have revealed that behavioral therapy is more efficient than some drugs, such as fluoxetine. Another study involved the use of a medicine called sertraline. When it was used on its own, patients did not respond, but in combination with HRT, outcomes were successful.
N acetyl cysteine (NAC) has been tried with some success in the treatment of trichotillomania. It can be obtained from a pharmacy and does not require a prescription, but special care needs to be taken with the dosage. An SSRI (serotonin uptake inhibitor) is an antidepressant medication that may be useful in curbing intense urges.
Ariel Taylor is a writer and mental health advocate with background in psychology and personal experience fighting mental illness.
The views and opinions expressed in this post are those of the author and do not necessarily reflect all or some of our beliefs and policy. Any links on this page do not necessarily mean they have been endorsed by Defying Mental Illness.
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