Trichotillomania is the medical term for hair pulling disorder which can also be referred to as trich or TTM.  It originates from three Greek words, Tricho which means hair, Tillo which means pull and Mania, excessive behaviour or activity.  It’s a mental health condition where people have an overwhelming urge to pull out their hair, no matter how hard they may try to resist.

Trichotillomania is a form of BFRB’s (body focused repetitive behaviours) such as skin picking and nail or cheek biting and can often be triggered by anxiety or stress.  It can cause people who have the condition to feel stressed, anxious, ashamed or embarrassed, and negatively affect their school, work or social life, as they can go to great lengths to try and hide any damage it has caused.  Whilst the condition can start in infancy this is generally as a form of self-soothing so most children grow out of the habit and it causes no lasting effect.

The more serious and severe forms start to develop around the ages of ten to thirteen.  In children it can affect boys and girls equally but in teenagers and young adults it can affect as many as nine out of ten females compared to males.  It can also start in adulthood in certain cases.  The condition is fairly rare and is believed to affect around only one to three percent of the population at some point in their lives.  However as many people with the condition do not advise their doctors figures could be higher.

Causes and risk factors for trichotillomania

As with many mental health conditions the causes for someone developing trichotillomania are not fully understood.  It is however more likely to be as a result of a combination of factors rather than a single cause.  These can include both genetic and environmental factors which could include:

·      A persons age as it starts in childhood and infants can also do it as a form of self-soothing

·      Having a family member that has the condition

·      It’s believed to be linked to hormonal changes in puberty

·      Chemical imbalances in the brain

·      Boredom can sometimes be a trigger which then becomes a habit

·      Your gender, females are more likely to develop it, although this could just be that more women than men tell their doctor that they have the condition

·      If you are suffering with stress or have suffered trauma, abuse or a bereavement

·      If you suffer from other mental health conditions including autism, anxiety, depression, or OCD (obsessive compulsive disorder) you could be more at risk

Signs and symptoms of trichotillomania

The main symptom of the condition is hair pulling to the point that it results in noticeable hair loss or bald patches.  People will usually use their fingers to pull out their hair but they can also use tweezers or other tools to do so.  There are two types of hair pulling:

Automatic

Where you are not aware that you are pulling your hair, for instance when you are distracted because you are watching television, reading a book or studying, it can also be a response to being bored.

Focused

When you know that you are pulling your hair but are unable to stop yourself, it can be used as a way to self-sooth or reduce feelings of stress.  People can have rituals when they are focus pulling such as twisting their hair around their fingers, pulling or playing with it.  They might smell it or even taste it; people can feel a sense of calm or relief after focus pulling.

Other symptoms of trichotillomania can include:

·      A feeling of tension or anxiousness when they either try to resist the urge to pull their hair or are actually pulling it

·      Having a sense of relief, satisfaction or pleasure after they have pulled their hair out

·      Suffer with social anxiety when they are around friends or colleagues because of their hair pulling

·      Playing with the hair they have pulled out by rubbing it on their face or lips or in between their fingers

·      Avoid situations that might draw attention to their hair like going to the hairdressers, swimming, using public changing rooms or sleeping over at friends’ houses

·      Family tensions due to their hair pulling

·      Twisting or twirling the hair

·      Pulling it between their teeth or chewing on it

·      Having a preference for certain types or textures of hair

·      Changing their appearance to hide signs of their trichotillomania such as wearing scarves, hats or wigs

·       Inspecting their hair root or scalp after pulling their hair

·      Pulling hair from toys or pets or fibres from clothing

Areas where people pull their hair

People who suffer from trichotillomania will usually pull their hair out a strand at a time and generally from the same area, but in extreme cases may pull several strands at a time. They can pull hair from any part of their body but the most common areas are generally the:

·      Beard

·      Eyebrows

·      Eyelashes

·      Genital area

·      Scalp

Associated conditions or risks

Constant pulling can cause a variety of problems and permanent damage to the follicle which can affect regrowth.  Other conditions that they may develop can include:

·      Alcohol or drug misuse

·      Anxiety

·      Bald patches

·      Depression

·      Low self-esteem

·      Permanent hair loss

·      Scarring on the head or body

·      Skin infections

·      Skin damage sever enough to require skin grafts

People with trichotillomania can also have other BFRB’s and around twenty percent of people with the condition will also develop a condition called trichophagia also from the Greek, tricho meaning hair and phagia meaning eating.  Eating the pulled hair can lead to symptoms such as nausea, vomiting and stomach aches and in severe cases it can lead to blockages in the digestive tract similar to hair balls in animals.  These can be extremely serious and require surgical intervention and in some cases can lead to fatalities.

Diagnosis

Trichotillomania is an easy condition to diagnose as the symptoms are clearly visible, however your doctor will need to rule out any other physical condition that could be the cause of your hair loss.  They may also need to run image testing scans if they suspect you may have a blockage if you also have trichophagia.

Treatment

Can consist of medication or therapy or a combination of both.

Medication

There are no medications available specifically for the treatment of trichotillomania but the most commonly prescribed medications are antianxiety and antidepressant medications.

Medications such as atypical antipsychotics, anticonvulsants and nutraceuticals whilst not specifically designed for the condition can be helpful in some cases.

Therapy

You doctor can refer you to a mental health professional who can use a variety of therapies either on their own or in combination, these can include:

Acceptance and commitment therapy

Will help you to accept your hair pulling urges without acting on them.

Cognitive behavioural therapy

Helps you to recognise your negative thoughts and behaviours and replace these with positive ones.

Group therapy

Can be helpful for some people who might benefit from talking to people who also have the condition in group therapy sessions.

Habit reversal therapy

One of the main treatments for the condition it helps you to replace your negative and harmful practice of hair pulling by replacing it with something like clenching your fists instead when the urge to pull your hair arises.

 Self-care

A lot of people who have trichotillomania can find the condition challenging as they can often feel isolated as they feel embarrassed to socialise especially if the condition is noticeable.  It can help to join a support group where you can talk to other people who suffer from the condition.  They can provide support and understanding and are able to share advice on how they have been able manage the condition.

There are other things you could also try to do to help you to resist the urge to pull, such as:

·      Try using a fidget toy to distract yourself

·      Squeeze a stress ball

·      Practice breathing techniques until the urge subsides

·      Try wearing a scarf or tight fitting hat

·      Taking a soothing bath or exercising

·      Wear gloves or put plasters on your fingers

You might find it helpful to keep a diary of when you pull your hair so that you notice anything that triggers it.  Make sure you take any medication as prescribed and attend your therapy sessions to help manage your symptoms. Written by Jan, Jeana and Wendy at Barnsley Hypnosis and Counselling (UK). For more free Information click above link.