What Is Trichotillomania: Risk Factors and Treatment
Trichotillomania is a type of mental disorder, which involves an irresistible and recurrent urge to pull out one's hair from the scalp and other parts of the body with hair, in spite of having the desire to stop. Due to hair pulling, the scalp tends to have patchy bald spots, which can lead to a significant amount of distress. It can also interfere with one's work and social interactions.
Individuals who have trichotillomania may put in a lot of effort to disguise their hair loss. Some individuals may have a manageable or mild urge to pull hair while others tend to be compulsive when it comes to pulling their hair. There are treatment options that have helped people lessen their hair pulling problem. When the disorder is properly treated, some people with trichotillomania may even completely stop pulling their hair.
The exact cause of this mental disorder is still unclear. However, like most complex mental disorders, trichotillomania is probably a result of a combination of environmental factors as well as genetic issues.
Below are some of the signs and symptoms of trichotillomania:
- Having an increasing tension right before hair pulling. It can also occur when an individual is trying to resist the urge to pull hair.
- Trying to bite, chew, or eat the strands of pulled hair.
- Repeated instances of pulling hair from the scalp, eyelashes, or eyebrows. Hair pulling can also be done from other parts of the body with hair. The sites also tend to vary from time to time.
- A sense of relief or pleasure after pulling one's hair.
- Playing with pulled hair or rubbing it on the lips and face.
- There are noticeable signs of hair loss due to hair pulling. Few of those noticeable signs would include thinned hair, shortened hair, or bald patches on the scalp and other parts of the body. Constant hair pulling can also lead to sparse, minimum, or missing eyebrows as well as eyelashes.
- Dealing with distress or trouble at work, home, school, or any social places, which are related to the individual pulling out hair.
- Having specific preferences when it comes to types of hair or having rituals that would accompany the pattern of hair pulling.
- Constantly trying to quit hair pulling but without any success.
Aside from hair pulling, there are also reported cases of individuals chewing their lips, biting their nails, or picking their skin. Another sign of trichotillomania is pulling hair from dolls, pets, and other materials, which include clothes and blankets. Certain individuals with the disorder pull their hair when they are alone to hide their behavior from others and avoid any kind of social embarrassment.
For individuals who suffer from trichotillomania, their hair pulling can be:
- Automatic: Some individuals with the disorder tend to pull their hair without even realizing that they are doing it. They normally tend to pull their hair out when they are bored, while they are watching TV, or while reading a book.
- Focused: Some people may intentionally pull their hair to achieve some kind of relief from the tension or distress they are facing. Some may even develop an elaborate ritual when it comes to hair pulling, which can include finding the right type of hair or biting the pulled hair.
It is possible that the same individual develops both automatic and focused hair pulling. It all depends on the mood and the situation of the individual. There may be certain rituals or positions, which can trigger hair pulling such as resting the head on the hand or while brushing the hair.
The disorder is also said to be related to an individual's emotions:
- Positive Emotional Feelings: Most individuals who suffer from trichotillomania find relief from hair pulling. It provides them a sense of satisfaction along with mental relief from any kind of distress. As a result, individuals with trichotillomania tend to continue pulling their hair to maintain a positive feeling within themselves.
- Negative Emotions: For many individuals with this mental disorder, hair pulling is one of the ways to cope with negativity or any kind of uncomfortable feelings such as tension, loneliness, emotional stress, physical or mental stress, boredom, anxiety attack, frustration, and fatigue.
Trichotillomania is a chronic or long-term mental disorder. Without proper treatment, the symptoms of the disorder can become severe over a period of time. If left untreated, the symptoms can come and go for a couple of weeks, months, or even years in some individuals. Although rare, hair pulling can end within a few years from the time it had started.
Below are certain risk factors, which can increase the risk of developing this mental disorder:
- Age: Trichotillomania is known to develop in an individual just before the onset of puberty or during the early teenage years between the age of 10-13 years old, which often becomes a lifelong or chronic issue. Infants are also prone to developing the habit of hair pulling. However, it is usually mild and would go away on its own without the need for treatment.
- Family History: Genes have a significant role in most complex disorders. Similarly, genetics also play a role in the development of trichotillomania. Thus, trichotillomania may happen in people who have close relatives suffering from the disorder.
- Stress: People dealing with stressful life events or situations may trigger the disorder. Stress can be physical, emotional, or mental.
- Other Disorders: Individuals who suffer from trichotillomania may also have other forms of mental disorders, which include anxiety, depression, and obsessive-compulsive disorder.
When to See a Doctor
Consult a doctor if you find yourself unable to stop pulling your hair and when you feel embarrassed by your physical appearance due to hair pulling. Trichotillomania is a mental disorder and not just a bad habit. The disorder is unlikely to get better without proper treatment.
A doctor's evaluation if an individual has trichotillomania includes:
- The amount of hair loss
- A discussion regarding one's hair loss
- Carrying out certain tests to rule out other medical conditions
- Identification of other physical or mental problems, which can be associated with hair pulling
- Utilizing the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) diagnostic criteria
There are certain treatment methods that can help individuals with trichotillomania. They include:
- Cognitive Therapy: In this therapy, any kind of distorted belief, which may have a connection when it comes to pulling hair is identified and examined.
- Habit Reversal Training: This type of behavioral therapy is considered as the main treatment for trichotillomania. This therapy would help an individual recognize the urges or triggers of hair pulling, and learn how to substitute such feelings with other behaviors instead. One example would be clenching one's fists to stop the urge of hair pulling or simply redirecting their hands to their ears instead of going for their hair. Other types of therapies can be used in combination with habit reversal training.
- Acceptance and Commitment Therapy (ACT): In this particular therapy, individuals learn to accept their hair-pulling urge without acting too much on it.
Most therapies that can help treat other types of mental disorders are also known to be associated with trichotillomania. They include anxiety attacks, depression, and substance abuse.
Currently, there are no FDA-approved medications that are specifically helpful when it comes to treating someone with trichotillomania. However, there are certain useful medications to help control the symptoms of this mental disorder.
The doctor may recommend the use of an antidepressant called clomipramine under the trade name Anafranil. According to research, another beneficial drug is N-acetylcysteine, which is an amino acid that influences certain neurotransmitters, which are related to mood. Another medication called olanzapine may also help. It is an atypical antipsychotic drug.
Do not take any medications without your doctor's advice to avoid drug interactions or side effects.
Most of the time, individuals with trichotillomania tend to feel lonely in their experience of hair pulling. It would be helpful for them to join certain support groups to meet other individuals with the same issue and discuss their experiences with people who can relate to them.