Trichotillomania is a disorder involving irresistible and recurrent urges to pull out eyebrows, hair from the person's scalp, or other areas of the affected person's body, despite attempts to stop. Hair-pulling from the scalp often times leaves patchy bald spots which causes significant distress and may interfere with work or social functioning. People with the disorder might go to great lengths to disguise their loss of hair. For some people, trichotillomania might be mild and generally manageable. For others affected by this disorder, the compulsive urge to pull hair is overwhelming. Some treatment options have assisted people with reducing their hair pulling, or to stop.
Symptoms of Trichotillomania
A number of symptoms of trichotillomania exist. Among these symptoms are the ones listed below.
- Chewing, biting, or eating pulled-out hair.
- A sense of relief or pleasure after pulling hair.
- Playing with pulled-out hair, or rubbing it across the face or lips.
- An increasing sense of tension prior to pulling hair, or when you attempt to resist pulling.
- A preference for particular types of hair, rituals that accompany hair-pulling or patterns of hair-pulling.
- Shortened hair, or thinned or bald areas on the scalp or other areas of the body, to include missing or sparse eyebrows or eyelashes.
- Repeatedly pulling out your hair, usually from your scalp, eyelashes or eyebrows; although it may be from other body areas and sites over time.
The majority of those with trichotillomania also pick their skin, chew their lips, or bite their nails. At times, pulling hairs from pets or dolls, or materials such as blankets or clothes, might be a sign. Most people with trichotillomania pull their hair in private and usually attempt to hide the disorder from other people. For people with trichotillomania, hair-pulling may be:
Automatic: Some people pull their hair without realizing they are doing so. They may pull their hair when they are bored, watching television, or reading.
Focused: Some people pull their hair intentionally in order to relieve distress or tension. For example; the affected person may pull their hair out to gain relief from the overwhelming urge to pull their hair. Others might develop elaborate rituals for hair-pulling, such as finding a particular hair, or biting hairs they have pulled.
A person with trichotillomania might do both automatic and focused hair-pulling depending upon their mood or the situation. Certain positions or rituals may trigger hair-pulling such as resting your head on your hand, or brushing your hair. Trichotillomania is a long-term disorder; without appropriate treatment, symptoms can vary in severity over time. For example; the hormonal changes of menstruation may worsen symptoms in women with the disorder. For some people, if treatment is not received, the symptoms can come and go for weeks, months or even years at a time. On rare occasion, hair-pulling ends within a few years of beginning.
Causes of Trichotillomania
The cause of trichotillomania is unclear at this time. Yet like a number of complex disorders, trichotillomania most likely results from a combination of environmental and genetic factors. Abnormalities in the natural brain chemicals, 'serotonin,' and, 'dopamine,' might play a part in the disorder.
Risk factors for Trichotillomania
Some different factors tend to increase a person's risk of trichotillomania. These risk factors include the following:
- Additional Disorders: People with trichotillomania might also experience other disorders such as anxiety, depression, or obsessive-compulsive disorder (OCD).
- Family History: Genetics might have a role in the development of trichotillomania and the disorder may occur in people who have a close relative with the disorder.
- Negative Emotions: For many people with trichotillomania, hair-pulling is a means of dealing with negative or otherwise uncomfortable feelings such as anxiety, stress, loneliness, tension, frustration or fatigue.
- Positive Reinforcement: People with this disorder often find that pulling out hair feels satisfying and provides a person with a certain measure of relief. Due to this, they continue to pull their hair to maintain positive feelings.
- A Person's Age: Trichotillomania usually develops just prior to or during a person's early teenage years, most often between the ages of 11 and 13 and is often a lifelong issue. Infants also can be prone to hair-pulling, although it is usually mild and goes away on its own without treatment.
While many more women than men are treated for trichotillomania, it might be because women are more likely to pursue medical attention. In early childhood, girls and boys seem to be equally affected.
Although it might not appear particularly serious, trichotillomania can have an immense impact on a person's life. Complications of the disorder can include the following:
- Emotional Distress: A number of people with trichotillomania report feeling humiliation, shame and embarrassment as well as low self-esteem, anxiety and depression.
- Hairballs: Consuming your hair might lead to large and matted hair balls in your digestive tract. Over a period of years, the hair ball can cause vomiting, weight loss, intestinal obstruction or even death.
- Hair and Skin Damage: Constant hair-pulling can cause abrasions and additional damages - to include infections to the person's skin on their scalp, or the particular area where hair is pulled and may affect the person's hair growth.
- Issues with Job and Social Functioning: Embarrassment due to hair loss might lead a person with trichotillomania to avoid job opportunities and social activities. People with the disorder might wear wigs, wear false eyelashes, or style their hair to disguise bald patches. Some people with trichotillomania may avoid intimacy out of fear their condition will be discovered.
Tests and Diagnosis
A doctor will perform a complete evaluation to determine if you have trichotillomania. The evaluation may include the following:
- Examining how much hair loss you have.
- Discussing your hair loss with you and potentially having you fill out a questionnaire.
- Elimination of other potential causes of hair loss or hair-pulling through testing as determined by your doctor.
To achieve a diagnosis of trichotillomania, you have to meet criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The manual is used by mental health professionals to diagnose mental conditions, as well as by insurance companies to reimburse for treatment. The DSM criteria for a diagnosis of trichotillomania include the following:
- Repeatedly pulling out your hair, resulting in notable hair loss.
- Repeated attempting to cease pulling out your hair, or attempting to do it less often.
- Pulling out your hair cause you significant problems or distress at work, in social situations, or at school.
- Your hair loss is not due to a skin condition or other medical condition, or the symptom of another mental disorder.
At this time, research on treatment of trichotillomania is limited. Some treatment options; however, have helped people to reduce their hair-pulling, or stop it. What follows are descriptions of treatment options for this disorder.
- Cognitive Therapy: Cognitive therapy may help a person to challenge and examine distorted beliefs they may have in relation to hair-pulling.
- Acceptance and Commitment Therapy: This form of therapy can help a person to learn to accept their hair-pulling urges without acting on them.
- Psychotherapy: Habit reversal training is the main psychotherapy for trichotillomania. The therapy helps you to learn how to recognize situations where you are likely to pull hair and how to substitute other behaviors instead. For example; a person might clench their fists for a period of time to reduce their urge to pull hair, or redirect their hand from their hair to their ear.
Medications and Trichotillomania
There are no medications that are approved by the Food and Drug Administration (FDA) specifically for treatment of trichotillomania.
Some medications; however, might help to control your symptoms. For example; a doctor might recommend an antidepressant such as clomipramine.
Other medications that research suggests may have some benefit include N-acetylcysteine - an amino acid that influences neurotransmitters related to mood, or olanzapine which is an atypical antipsychotic.
It is important to discuss with a doctor any medication they might suggest. The potential benefits of medications should always be balanced against possible side-effects.
Facts and Statistics
Trichotillomania, also known as trichotillosis or hair pulling disorder, is defined as an Impulse Control Disorder characterized by the compulsive urge to pull out one's hair, leading to hair loss and balding, distress, and social or functional impairment. Trichotillomania may be present in infants, but the peak age of onset is 9 to 13. It may be triggered by depression or stress.
- The lifetime prevalence of trichotillomania is estimated to be between 0.6% and 4.0% of the overall population.
- With a 1% prevalence rate, 2.5 million people in the U.S. may have trichotillomania at some time during their lifetimes.
- Among adults, females typically outnumber males by 3 to 1.
- "Automatic" pulling occurs in approximately 3/4 of adult patients with trichotillomania.
- Among preschool children the genders are equally represented; there appears to be a female predominance among pre-adolescents to young adults, with between 70% and 93% of patients being female.
- Trichotillomania is diagnosed in all age groups; onset is more common during preadolescence and young adulthood, with mean age of onset between 9 and 13 years of age, and a notable peak at 12 to 13 years of age.