If you are suffering from alopecia or other types of hair loss, it may seem unthinkable that some people actually pull out their hair until there is noticeable thinning or baldness. They are not trying to start a new fashion trend. They simply cannot resist the urge to pull their hair out. This condition is called trichotillomania, or compulsive hair pulling. The disorder involves pulling hair from anywhere on the body, but the scalp, eyebrows, and eyelashes are commonly pulled areas.
People often show signs of this disorder starting at age 12 or 13. Hyped-up hormones are a possible trigger in adolescence. Stressful events such as family conflict, loss of a close relative, or a change of schools are sometimes connected with the onset of trichotillomania. Hair pulling may also begin in early childhood and adulthood.
Related Hair Loss Disorders
Many who suffer with this compulsion also have symptoms of OCD, or obsessive-compulsive disorder, such as frequent hand washing or checking a locked door repeatedly. Some professionals believe trichotillomania should be classified as a subtype of OCD, especially since having the symptoms of both can run in families. Currently, trichotillomania is categorized as an impulse control disorder.
Trichotillomania is thought to involve a disturbance of the brain’s chemical messengers, or neurotransmitters, that transport signals between nerve cells. It is not surprising that a depressed mood often accompanies hair pulling. Depressive disorders are linked to a problem with neurotransmitters too (i.e., dopamine, serotonin). Trichotillomania also deflates self-esteem and can cause people to isolate, which are two symptoms of depression.
Hair pullers sometimes have other compulsive behaviors like picking at their skin, continuous scratching, or nail biting. They can have moderate to high anxiety. In childhood, this disorder occurs equally between males and females.
1. Repeated hair pulling that results in visible hair loss.
2. A rising feeling of tension or anxiety just before pulling and if they resist pulling
3. When hair is pulled out, experiencing a sense of relief or pleasure
4. There is no skin condition or other medical problem to account for the behavior
5. The puller is very distressed about the disorder or daily functioning is disrupted
If trichotillomania is suspected, a doctor should do a thorough exam to determine if there is a medical cause for the disorder.
People with trichotillomania can experience mild to debilitating shame. The shame stems from not being able to stop pulling, and possibly from peers, friends, or family members ridiculing, or nagging them to stop. Sometimes relatives of a hair puller are embarrassed by the problem. Most adults with this diagnosis have relatively normal social lives, but some avoid close relationships; a result of earlier emotional scarring.
Physical complications of this compulsion are possible skin damage or infection, and many times permanent hair loss. There are some who eat their hair after pulling it out. That condition is called trichophagia and suffers may develop trichobezoars or hair balls. The trichobezoars may cause life threatening gastrointestinal problems if not surgically removed.
Medications can reduce symptoms of trichotillomania but only while the medication is taken. Antidepressants and mood stabilizers are the most commonly prescribed. Behavioral therapy is frequently recommended for hair pullers. It provides a structured way to learn and implement techniques that break the hair pulling habit, or reduce the frequency of pulling.
One example of behavior therapy is “habit reversal training.” The hair puller and therapist identify where and when the patient gets the urge to pull. Then, a different behavior is practiced in reaction to the urge, such as making and holding a fist with the hand(s) previously used for pulling. This therapy may be accompanied relaxation training to reduce the individual’s stress level.
Cognitive therapy can also help with addressing the person’s problematic thinking habits that contribute to their tension and anxiety. Patients learn to recognize distorted thoughts and replace them with realistic ones.
Like any compulsion, hair pulling is difficult to eliminate. Children sometimes outgrow the problem but later onset usually results in a chronic, life long issue. For more information, support and resources on trichotilomania, visit the Trichotilomania Learning Center website www.trich.org.