Trichotillomania, also called hair pulling disorder, is a condition in which a person experiences repeated urges to pull out their own hair from the scalp, eyebrows, eyelashes, and other areas of the body. This often leads to the person developing bald patches of the scalp. Although trichotillomania does not initially cause any physical distress, it can eventually lead to pain, and the emotional distress can be overwhelming. People with hair pulling disorders may feel conscious about the bald patches and attempt to disguise the loss of hair by wearing a wig or drawing eyebrows onto their face.
When trichotillomania first starts to develop, usually during puberty, most individuals don’t realize they are pulling their hair out. It happens almost automatically, without conscious effort.
The severity of the disorder can vary from mild and manageable to compulsive and overwhelming for others. A US-based study in 2017 estimated the prevalence of the disorder to be between 0.4 to 2% in the general population.
People with trichotillomania pull hair as a means of coping with negative emotions and feelings like stress, anxiety, loneliness, frustration, or even boredom. They find the act of pulling out hair satisfying and continue to pull their hair out to maintain the positive feeling.
The exact cause of trichotillomania is unknown. It is likely to be influenced by a combination of genetic and environmental factors.
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
Chewed or swallowing of the hair that has been pulled out
Significant distress at work, school or in social situations, caused by the hair-pulling or loss of hair
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.
A diagnosis of trichotillomania is usually made after a series of medical tests and a comprehensive physical investigation to rule out other possible causes for hair loss. Before making a diagnosis, the psychiatrist will also examine if the condition is comorbid with other mental health issues like stress, anxiety or depression.
Usually, a combination of medication and therapy is used in the treatment of trichotillomania. This may may help the client completely stop or reduce the hair pulling.
Medication:Commonly prescribed medications includes anti-depressants, anti-anxiety drugs, anxiolytics, or sometimes even antipsychotics.
Psychotherapy: A few techniques that have proven to be helpful in treating trichotillomania are:
Habit Reversal Training: This helps the client recognize the situations where they are most likely to pull out their hair and helps them to substitute the hair pulling with other behaviors.
Acceptance and Commitment Therapy (ACT): This is used to help the client accept their urges to pull out their hair without acting on them.