Trichotillomania

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Trichotillomania is also known as compulsive hair pulling. Trichotillomania is characterized by repetitive pulling out of one's own hair. Hair pulling can include any region of the body in which hair may grow; the most common of hair pulling are the scalp, eyebrows, and eyelashes. Hair pulling can occur at any time. There are times when hair pulling happens in a goal-direct manner and also in an automatic manner in which the individual is less aware. Hair pulling can occur in states of relaxation and distraction (like when reading a book or watching television) but can also occur when in a stressful circumstance.

Signs

• Repeated hair pulling, biting, chewing, or eating pulled-out hair
• Playing with pulled-out hair or rubbing it across the lips or face
• The urge to pick is uncontrollable or feeling tense before pulling hair
• Bare patches where the hair has been pulled out
• Not being able to go out in public without covering up the pulling site e.g. wearing scarves, hats, or sunglasses.

When does it start?

People often start compulsive hair pulling around the ages 12-13. It is not uncommon for it to start at a much younger or older age. It can be triggered by a stressful event such as: trauma, abuse, change of school, family conflict or death of a parent or loved one. Symptoms can also be triggered by pubertal hormonal changes.

Diagnosis

• The repeated pulling out of one's hair resulting in noticeable hair loss
• An increasing sense of tension immediately before pulling out the hair or when resisting the behavior
• There is pleasure, satisfaction, or relief when pulling out the hair
• The condition is not accounted for by another mental disorder and is not due to a general medical condition (i.e., dermatological condition)
• The condition causes significant distress or impairment in social, occupational, or other important areas of functioning.

Trichotillomania effects

Trichotillomania will have a tremendous impact on your mental health, particularly if it is left untreated. Some of the psychological effects that may be experienced include:

• Low self-esteem or poor body image due to hair loss and skin damage
• Increased feelings of depression or anxiety
• Feelings of shame and embarrassment

It can also have negative consequences of your social life. Social effects of trichotillomania include:

• Increased isolation and withdrawal from loved ones due to embarrassment
• Lack of enjoyment in hobbies or activities once enjoyed
• Decreased performance in work or school
• Avoidance of social situations in order to hide resulting hair loss

Treatment

It can be treated by a combination of education, behavior therapy, and medications. Each individual will need to be evaluated to determine the best treatment depending on their circumstances. In behavior therapy, people learn a structured way of keeping track of the symptoms/triggers, increase their awareness of pulling, and create substituting incompatible behaviors to interrupt the pulling response.