Trichotillomania

a condition that involves urges to pull out one’s own hair from the scalp, eyebrows, eyelashes, and other areas of the body, despite trying to stop.

Ritika Dhaliwal

Trichotillomania, also called hair pulling disorder, is a condition that involves urges to pull out one’s own hair from the scalp, eyebrows, eyelashes, and other areas of the body, despite trying to stop. It leaves one with bald patches of the scalp, which causes distress in social and work functioning. Although it does not cause any physical distress, the emotional distress is overwhelming. People with hair pulling disorders, go to great lengths to disguise the loss of hair including wearing wigs and drawing on the eyebrows.  

When trichotillomania first starts to develop, usually during puberty, most individuals don’t even realize they are pulling their hair out. It happens almost automatically without any conscious effort. Unlike other anxiety disorders, which are associated with specific situations, researchers have come to believe that trichotillomania is a combination of genetics, hormones, emotional regulation, neuroanatomy, and environmental factors that drive an individual to pull their hair out.

The severity of the disorder depends from person to person. While it may be mild and manageable for a few, it may be compulsive and overwhelming for others. A US-based study done in 2017 estimated the prevalence of the disorder to be between 0.4 to 2% in the general population.

Trichotillomania is usually associated with emotional regulation. people with trichotillomania pull hair as a means to cope with negative emotions and feelings like stress, anxiety, loneliness, frustration, or even boredom. They find the act of pulling out hair satisfying and it provides them with a feeling of satisfaction. they continue to pull the hair out to maintain the positive feeling of satisfaction.

S was a 24-year-old female. She had recently finished her masters in sociology. Most of her friends had found jobs or had cleared exam for further studies. she wanted to study Ph.D. but couldn’t clear her exams. with all her friends far away and nothing to look forward to, she started developing feelings of loneliness and persistent sadness. The feelings would go away when she would visit her family but they would soon return. She tried writing exams for 1 year but did not succeed. slowly she found herself pulling her hair. Her attention was drawn towards the same by her maid who would often find chunks of hair under her bed and near her sofa. She soon started noticing her hair pulling behavior and the feelings of satisfaction that followed. She realized it was a problem and approached her doctor who referred her to a psychiatrist. She was diagnosed with depression and given treatment and psychotherapy for the same. With the treatment for depression, her hair pulling also stopped.

 

Symptoms of trichotillomania:

  • Pulling out hair repeatedly from scalp, eyebrows, and eyelashes

  • Resistance to pulling hair is marked by an increase in tension while pulling hair out results in satisfaction and relief

  • Noticeable hair loss on the scalp

  • Sometimes the hair that is pulled out is bitten or chewed and even swallowed, leading to further complications

  • Significant distress at work, school or in social situations

 

Many people with hair pulling disorders may also pick their skin, pull hair out of dolls or pets, bite nails or chew their lips. Additionally, pulling hair out of clothes or blankets can also be a sign as most people with this condition pull their hair in private to hide the disorder from others.

 

Causes:The exact cause of trichotillomania is unknown. But like many complex disorders, trichotillomania probably results from a combination of genetic and environmental factors.

: A psychiatrist may ask the client certain questions and examine the hair loss. Depending upon the symptoms, which are compared to the DSM 5 (Diagnostic and Statistical Manual for Mental Disorders), he may then diagnose Trichotillomania and prescribe treatment. the psychiatrist will also examine if the condition is comorbid with other mental health issues like stress, anxiety or depression.

Treatment: A combination of medication and therapy is usually used in the treatment of trichotillomania. It may help the client completely stop or reduce the hair pulling.

  • Medications: Commonly prescribed medications include anti-depressants, anti-anxiolytics, or sometimes even antipsychotics.

 

  • Psychotherapy: A few techniques proven to be helpful for trichotillomania are as follows:

    • Habit Reversal Training: These help the client to recognize the situations where they are most likely to pull out their hair and to substitute the hair pulling with other behaviors instead.

    • Acceptance and Commitment(ACT): This is used to help the client accept their urges to pull out hair without acting on them.