Trichotillomania (also known as Hair Pulling disorder) is usually characterized by compulsively and repetitively pulling out one’s hair. This condition is part of a group of self-grooming behaviors called Body-Focused Repetitive Behaviors (BFRBs) that result in damage to one’s own body. Though childhood cases occur equally in boys and girls, by adulthood, astonishing 80-90 percent of cases reported are women. Symptoms include repetitive pulling out of hair leading to noticeable hair loss, pleasure or satisfaction after pulling out hair and tension when resisting the behavior, repeated attempts to stop the behavior and social embarrassment or shame because of the behavior resulting in avoidance of public situations and contact with people. This condition is categorized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as an “obsessive-compulsive and related disorder.” It is important to note trichotillomania may be a symptom of another psychiatric condition and it is not helpful to hear “just stop doing it.”
What are the symptoms?
Besides repeated hair pulling, other symptoms may include:
- Feeling tense before pulling hair or when trying to resist the urge to pull hair
- Feeling relieved, satisfied, or pleased after acting on the impulse to pull hair
- Distress or problems in work or social life due to hair pulling
- Bare patches where the hair has been pulled out
- Behaviors such as inspecting the hair root, twirling the hair, pulling the hair between the teeth, chewing on hair, or eating hair
Many people who have trichotillomania try to deny they have a problem and may attempt to hide their hair loss by wearing hats, scarves, and false eyelashes and eyebrows.
What are the causes?
The cause of trichotillomania is unclear. But like many complex disorders, trichotillomania probably results from a combination of genetic and environmental factors.
Risk factors
These factors tend to increase the risk of trichotillomania:
- Family history. Genetics may play a role in the development of trichotillomania, and the disorder may occur in those who have a close relative with the disorder.
- Age. Trichotillomania usually develops just before or during the early teens — most often between the ages of 10 and 13 years — and it's often a lifelong problem. Infants also can be prone to hair pulling, but this is usually mild and goes away on its own without treatment.
- Other disorders. People who have trichotillomania may also have other disorders, such as depression, anxiety or obsessive-compulsive disorder (OCD).
- Stress. Severely stressful situations or events may trigger trichotillomania in some people.
Although far more women than men are diagnosed and treated for trichotillomania, this may be because women are more likely to seek medical advice. In early childhood, boys and girls appear to be equally affected.
How Is Trichotillomania Diagnosed?
Trichotillomania is diagnosed based on the presence of its signs and symptoms. There is no specific test for it.A doctor might refer someone who has symptoms of trichotillomania to a psychiatrist or psychologist, who can interview the person and see if they might have an impulse control disorder.
What is the treatment?
Research on treatment of trichotillomania is very limited. However, some treatment options have helped many people reduce their hair pulling or stop entirely.
Therapy
Types of therapy that may be helpful for trichotillomania include:
- Habit reversal training. This behavior therapy is the primary treatment for trichotillomania. You learn how to recognize situations where you're likely to pull your hair and how to substitute other behaviors instead. For instance, you might clench your fists to help stop the urge or redirect your hand from your hair to your ear. Other therapies may be used along with habit reversal training.
- Cognitive therapy. This therapy can help you identify and examine distorted beliefs you may have in relation to hair pulling.
- Acceptance and commitment therapy. This therapy can help you learn to accept your hair-pulling urges without acting on them.
Therapies that help with other mental health disorders often associated with trichotillomania, such as depression, anxiety or substance abuse, can be an important part of treatment.
There is no proven way to prevent trichotillomania, but getting treatment as soon as symptoms start can be a big help. Learning stress management is also a good idea, since stress often triggers the hair-pulling behavior.
