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Trichotillomania Hair Pulling Disorder


Characterized by the irresistible urge to pull hair from the scalp, eyebrows and other areas of the body, Trichotillomania, also known as hair pulling disorder or hair picking disorder is a mental disorder. 

Also known as compulsive hair pulling or high hair pulling, Trichotillomania causes long term urge to pull one’s hair despite attempts to stop this behaviour and is accompanied by a brief positive feeling after pulling the hair. Although hair pulling can happening anywhere, the scalp and the area around the eyes are most commonly affected. It is seen that people suffering from this disorder can go to great lengths to disguise the loss of hair due to this compulsive behaviour. 

Trichotillomania hair pulling disorder is estimated to affect one to four percent of the world’s population. It begins mostly in childhood or adolescence. Some people suffer from it only mildly but in some cases, it can be severe.

What Cause Trichotillomania?

Trichotillomania hair pulling disorder may result from a complex combination of genetic and environmental factors, the exact cause is still unclear. Factors that increase this risk are –

  • Family History
  • Genetics play a part in the development of hair pulling disorder. It can run in families and if you have a close relative with this disorder, it may occur in you.

  • Age
  • For most people, Trichotillomania hair pulling disorder develops just before adolescence, mostly during early teens, often between the age of 10 -13 years and might go on lifelong.

  • Comorbidities
  • Comorbid psychiatric conditions such as depression, anxiety, obsessive compulsive disorder are extremely common in trichotillomania. It also occurs frequently with skin picking disorder.

  • Stress
  • Trichotillomania may be triggered in some people under stressful situations. It also overlaps highly with Post traumatic stress disorder.

    Hair pulling action in people suffering from trichotillomania hair pulling disorder can be dependent on your state of mind; sometimes it’s simple a method to cope with mood swings otherwise, a method to attain peace of mind.  

    The hair pulling action can either be focused and intentional or even automatic and unintentional in others. The same person could be doing both intentional and unintentional hair pulling, depending on how the surrounding environment is affecting their mood:-

    • Focused - Pulling hair intentionally to relieve any kind of stress. Some people might even calculate the number of hairs pulled out in order to avoid overdoing it! 
    • Automatic - Some people might be involuntarily pulling their hair when involved in everyday activities such as watching TV or when they’re bored without even realizing it.

    Trichotillomania hair pulling disorder might even be related to various emotions and could be a tool that the person is using to cope in certain situations - 

    • Positive emotions - Hair pulling might feel satisfying and relieving. To remain positive, the behavioural hair pulling continues.
    • Negative emotions - To deal with stress, anxiety, tension or frustration, hair pulling might be a way out for some people. It could be their way of dealing with an uncomfortable and negative frame of mind such as loneliness or boredom.

    Certain positions such as brushing of hair or resting the hair on the hand may trigger trichotillomania. It has been seen that women suffer from this disorder more than men. However, at younger ages, both boys and girls are seen to be equally affected. Trichotillomania in toddlers is also not uncommon. Trichotillomania beard hair pulling is rather an uncommon and very rare phenomenon since the beard hair cannot be easily plucked.

    Diagnoses of Trichotillomania 

    The primary characterization of trichotillomania hair pulling disorder is the constant urge to pull one’s hair. Though hair pulling can happen in any region, the most commonly impacted sites are the scalp, eyebrows and eyelashes. Other symptoms of trichotillomania hair pulling disorder may include – 

    • Repeated attempts to decrease or stop the behaviour often unsuccessfully.
    • Distress in social and occupational situations.
    • Increasing tension when trying to resist pulling hair or before pulling hair.
    • Feeling relief and pleasure after pulling hair.
    • After pulling the hair, biting, chewing or eating it.
    • Noticeable hair loss, visible bald patches, thinned and shortened hair on the scalp and sparse eyebrows.  Trichotillomania eyelashes might be missing hair strands and look discontinuous.
    • Playing with pulled hair.
    • Pulling hair of only a certain type or texture. Having rituals and preferences around the hair pulling behaviour.
    • Pulling hair in private and trying to hide this behaviour from others.
    • Trichotillomania is also accompanied by skin pulling, nail biting, lips chewing in many people.
    • Pulling hair from pets and dolls, clothes and blankets may also be a sign of trichotillomania.

    Trichotillomania hair pulling disorder is chronic and if untreated, the symptoms may fluctuate in severity over time, they may come and go. This period of absence of symptoms can last for weeks, months or even years.

    When to See A Doctor?

    Trichotillomania hair pulling disorder may have a serious impact on your life. Some mental and physical complications that the hair pulling condition can lead to include -

  • Emotional distress
  • People report that their trichotillomania behaviour makes them feel shame and embarrassment.  They might be dealing with low self-esteem, anxiety and depression. They might also be dealing with alcohol or drug abuse due to a combination of these distresses which fuels them further.

  • Social and Occupational functioning
  • Hair loss embarrassment may make it difficult for people suffering from trichotillomania hair pulling disorder to face social and occupational life. They might be using wigs or false eyelashes to disguise their looks and thus, lack of self-confidence makes them avoid social activities and even intimacy for fear of the discovery of their condition. 

  • Skin and Hair Damage
  • Persistent hair pulling causes significant damage to the hair and the skin. It can cause scarring and leading to infections. Permanent hair growth can be affected if bald patches start to appear at the site of constant hair pulling.

  • Hairballs
  • Some people suffering from trichotillomania hair pulling disorder tend to consume the pulled hair. This may lead to the formation of large hairballs in the digestive tract over the years and can cause weight loss, vomiting and even fatal intestinal obstructions.

    If you are experiencing negative repercussions in your social and occupational life because of this disorder and are feeling embarrassed by your appearance, do talk to your doctor. You might be trying to get out of this habit but if you have been unsuccessful after repeated attempts, it is time to seek medical advice. Trichotillomania hair pulling disorder is a mental disorder and it can lead to serious mental and even physical complications as we’ve seen above. It is highly unlikely that it will go away by itself, without any treatment.

    Treatment for Trichotillomania

    Treating trichotillomania hair pulling disorder requires time as most of the treatments need a lot of practice. While you try these treatments, the symptoms may come and go. So, you have to be careful and not get discouraged. Some of the techniques that are useful in hair pulling disorder treatment are-  

  • Habit reversal therapy
  • The primary hair pulling treatment is habit reversal. You have to identify the situations and triggers which cause you to pull hair and then substitute other behaviours such as clenching of fists or snapping. Some people use journals to make a list of such triggers and also use other methods to increase the awareness of the possible triggers.

  • Cognitive Therapy
  • The trichotillomania cognitive behavioral therapy can be helpful for people who are pulling hair in response to a negative emotion or an uncomfortable situation. Here, patients are taught to experience these situations and let them pass without pulling hair.

  • Self-awareness training
  • Here, you are required to become more aware of your hair pulling action, track the specific patterns that trigger this behaviour and work towards changing it.

  • Process-oriented therapy
  • This tracks the individual triggers and emotions that occur during the hair pulling and what kind of respite it provides in the underlying condition.

  • Acceptance and commitment therapy
  • In this therapy, the patients are asked to experience the urge to pull the hair and then accept the urge without acting on it. This helps to deal with the negative emotions and learn that the urge does not have to be responded to always.

  • Exposure therapy which can also be called trichotillomania OCD therapy as it is widely used to deal with OCD is also helpful.

  • Family Therapy might help the parents in responding better to the symptoms and manage the disorder better if their kids are suffering from it.

  • Group Therapy is helpful for people who feel isolated when suffering from Trichotillomania. Interacting in a groups can be helpful, especially when you meet people experiencing a similar struggle. In a way, it makes one feel that they aren’t alone and gain moral support from the rest.

  • Deep breathing training can help you cope with stress and enable relaxation and focus.

  • Relaxation Training helps the patients focus better and calm their mind in response to situations that may otherwise trigger hair pulling. 

  • Medication

  • There is no approved medication for treating trichotillomania. A class of drugs known as SSRI (Selective Serotonin Reuptake Inhibitors) and SNRI (Serotonin-Norepinephrine Reuptake Inhibitors) can be used to relieve accompanying anxiety but these have significant side-effects. Trichotillomania therapy through habit reversal and other cognitive therapies is most effective.

    Some individuals learn to manage the symptoms of trichotillomania hair pulling disorder while others need more extensive treatment. Help must be sought as soon as possible and the therapy should be taken uninterrupted since there is a chance of the symptoms relapsing.

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