Trichotillomania may be triggered by anxiety and stress. People with trichotillomania feel a strong urge to pull out their hair, particularly on the scalp and eyebrows but sometimes in other parts of the body too. They then feel relief and gratification from their hair-pulling.
To be formally diagnosed with the condition, individuals must endorse distress and functional impairment as a result of their pulling behaviors. Treatment involves cognitive-behavioral therapy and sometimes medication like SSRIs (including olanzapine) and the anticholinergic clomipramine.
What is Trichotillomania?
Trichotillomania is an impulse control disorder that affects about 1.5-2% of the population. It is commonly associated with other mental health conditions, such as depression, anxiety, attention deficit hyperactivity disorder (ADHD) and substance use disorders. It can also occur alone or in combination with other body-focused repetitive behaviors such as skin picking, nail biting and eyebrow pulling.
People who have trichotillomania pull their hair, often to the point of noticeable bald spots or scarring. The behavior is difficult to stop and may cause emotional distress, embarrassment or even social isolation. It can be triggered by stress, boredom or other factors such as the presence of certain physical health problems. It usually develops in early adolescence, although it can start at any age. The condition is more common in females, but men and children are equally affected and the severity of the symptoms varies between individuals.
Researchers are studying ways to prevent trichotillomania by targeting brain changes that lead to the impulsive behavior. In the meantime, behavioral therapies and medications are currently used to treat trichotillomania. Behavioral therapy for trichotillomania focuses on changing thoughts that trigger the behavior and replacing them with more realistic ones. Various techniques, such as habit reversal training and aversion therapy, have been shown to be effective. Medications that target the glutamate system, such as n-acetyl cysteine and olanzapine, have been found to be helpful for many people with trichotillomania.
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Other treatments include hypnotherapy and homeopathy. Hypnotherapy is a type of psychotherapy that helps people to understand the emotions linked with trichotillomania. It also encourages patients to replace negative thought patterns with positive ones. Homeopathy involves the administration of highly diluted medicines that are believed to stimulate the body’s healing process.
Symptoms
Trichotillomania often develops in the early teens, especially around the age of 10. It can be a lifelong problem. In some cases, it occurs along with other mental health conditions such as depression and anxiety.
The main symptom of trichotillomania is pulling out hair to the point that it causes bald patches and thinned hair. The pulling may be focused and deliberate or it may be a kind of automatic response to boredom or stress. Some people with trichotillomania also pick their skin, bite their nails or chew their lips. Usually, they are unaware that they are doing this. They may try to hide the pull from others. They might even make up stories about why they are doing it (such as that it relieves tension or makes them feel better).
It is common for people with trichotillomania to swallow the hair they pull. This can cause digestive problems such as stomachaches, throwing up, blockages and ulcers. Usually, this hair is undigested but sometimes, it can become a tight wad or ball called a trichobezoar, which can lead to other health problems including intestinal infections.
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Sometimes people with trichotillomania will wear wigs or use other styling techniques to cover up their hair loss or bald patches. They may also be reluctant to disclose their trichotillomania because they feel ashamed or embarrassed. Some people with trichotillomania report a lot of distress and anxiety over their condition, which can impact their lives in many ways. They may avoid social activities, experience poor work or school performance and have difficulty with intimate relationships.
There are some medicines that can help with trichotillomania but it is important to talk to a doctor or mental health professional about treatment options. In addition, there are many behavioral therapies for trichotillomania and treatments that target other mental health conditions that often occur with this condition. These include cognitive therapy and therapies that teach healthy coping skills. These treatments can improve the quality of life for people with trichotillomania. They can help them stop their impulsive behaviors and learn to manage their symptoms.
Diagnosis
Trichotillomania is a mental health condition that involves recurrent, noncosmetic hair pulling resulting in bald spots. It is most common in adolescence, but it can begin at any age and may occur in people of either gender. People with trichotillomania feel an urge to pull their hair, but they do not enjoy or gain pleasure from the action, and are unable to stop. The symptoms are often chronic and recurrent, although the disorder is treatable with behavioral therapies.
To be formally diagnosed with trichotillomania, a person must endorse subjective distress and functional impairment caused by their hair-pulling behavior. They must also have tried to decrease or stop their pulling but were unable to do so. In addition, they must have engaged in rituals around their hair-pulling that are arousing or pleasurable, such as choosing which hair to pull, touching, looking at, smelling, or playing with the hair that has been pulled.
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Many people with trichotillomania engage in other self-destructive behaviors, such as picking at their skin or biting their nails or lips. These can lead to scarring, which makes it harder for the hair follicles to grow back. People with trichotillomania may also experience other emotional and physical problems as a result of their hair-pulling, including depression or anxiety, poor sleep or eating habits, fatigue, and stress.
Symptoms of trichotillomania usually appear in early adolescence and are more likely to affect girls than boys. They can continue into adulthood, and they can become more frequent or severe with age.
The cause of trichotillomania is not known, but it is thought to be related to an imbalance in certain neurotransmitters. This may be due to genetics or environmental factors, such as family and peer conflicts, a history of trauma, or psychological distress.
A medical professional can screen for trichotillomania by asking questions about a person’s behavior and lifestyle. They will ask if the person has tried to reduce or stop their pulling and whether it has negatively affected their life or self-esteem. They will also ask about any other behavior or feelings the person is experiencing.
Treatment
Trichotillomania is a chronic condition, and adults who develop it have a worse prognosis than children. But treatment can improve the symptoms and your quality of life. Treatment options include therapy and medications. Psychotherapy, also known as cognitive-behavioral therapy, can help you learn to cope with your urges. It can also teach you healthy ways to think about your trichotillomania. Medications may help control the anxiety and depression that can accompany trichotillomania. These are called antidepressants and may include selective serotonin reuptake inhibitors (SSRIs) or clomipramine, which have been shown to be effective for treating trichotillomania in some studies. Other medications, such as atypical neuroleptics and partial glutamate modulators, have shown promise in small-scale trials. But they need larger study sizes to be proven effective.
Many people with trichotillomania have rituals or routines related to their hair pulling, such as choosing which hair to pull, or smelling, looking at, playing with, or eating the hair they pull out. They often feel soothed or gratified by these rituals. In addition, many people with trichotillomania are often embarrassed about their behavior. They may hide bald patches or hair loss with hats, scarves, or wigs. And they might avoid social situations because of their self-consciousness about the hair pulling.
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Stress, including major life events, family conflict, or serious illness, can trigger trichotillomania. So can severe boredom, lack of interest in activities, or feelings of isolation and anxiety. People with trichotillomania also are more likely to have other mental health conditions, such as depression, anxiety, or obsessive-compulsive disorder.
Some people with trichotillomania find that certain medications, such as antidepressants or atypical neuroleptics, can help control their urges to pull. But they aren’t approved by the U.S. Food and Drug Administration specifically to treat trichotillomania.
A variety of techniques can help you manage your trichotillomania, such as habit reversal training and other behavioral therapies. These therapies teach you to recognize when you are about to pull your hair and substitute other behaviors, such as clenching your fists or rubbing your face. They can also include cognitive therapy to examine and challenge beliefs you have about your hair-pulling, or treatments that address other conditions that occur along with trichotillomania.
