Understanding Trichotillomania: Causes, Symptoms, and Treatment

Introduction

Trichotillomania is a mental disorder that involves recurrent and irresistible urges to pull out one’s hair, resulting in noticeable hair loss and distress. It is classified as an obsessive-compulsive disorder (OCD) and can affect people of all ages, genders and backgrounds. The condition is often misunderstood, and many people with trichotillomania are too ashamed or embarrassed to seek help. However, with proper diagnosis and treatment, trichotillomania can be managed, and people with the disorder can lead a productive and fulfilling life.

Causes of Trichotillomania

The exact cause of trichotillomania is not yet known, but several factors are believed to contribute to the development of the disorder. These include:

  • Genetics: There may be a genetic predisposition to trichotillomania, as it tends to run in families
  • Biochemical imbalances: Mood disorders, such as depression and anxiety, are common in people with trichotillomania. These disorders are associated with imbalances in neurotransmitters, chemicals that transmit signals between nerve cells in the brain
  • Stress: Stressful life events, such as trauma, abuse, or major life changes, can trigger or worsen trichotillomania symptoms
  • Personality traits: Perfectionism, impulse control problems, and a tendency to obsess over details may contribute to trichotillomania

Symptoms of Trichotillomania

The main symptom of trichotillomania is the recurrent pulling out of one’s hair, which can be from any part of the body, including the scalp, eyebrows, eyelashes, or pubic area. The hair pulling may be accompanied by tension or anxiety, and the person with the disorder may experience pleasure, relief, or gratification when pulling out the hair. However, after the hair has been pulled out, the person may feel guilty, ashamed, or embarrassed about the hair loss, which can lead to feelings of helplessness, hopelessness, or depression.

In addition to hair pulling, people with trichotillomania may also exhibit other behaviours, such as:

  • Inspecting: Examining the hair root, biting, chewing or ingesting the hair, or rubbing the hair against the skin
  • Hiding: Wearing hats or wigs, avoiding social situations, or withdrawing from activities that expose the hair loss
  • Compensating: Engaging in other repetitive behaviours, such as nail biting, skin picking, or mouth chewing, to relieve anxiety or tension

The severity of trichotillomania symptoms can vary, from mild to severe, and can be episodic or chronic. The impact of the disorder on a person’s quality of life can also vary, depending on factors such as age, gender, social support, and co-occurring disorders.

Diagnosis of Trichotillomania

Diagnosing trichotillomania can be challenging, as many people with the disorder do not seek help or may feel embarrassed to discuss their symptoms. However, a trained mental health professional can use several criteria to diagnose the disorder:

  • Recurrent hair pulling: The person has recurrent hair pulling that leads to hair loss or hair damage, and that causes distress, impairment, or interference with social, occupational or academic functioning
  • Lack of control: The person experiences an increasing sense of tension or anxiety before the hair pulling, and a sense of pleasure, relief or satisfaction immediately after the hair pulling, but cannot control or resist the urge to pull out the hair
  • Significant distress: The hair pulling causes significant distress or functional impairment, such as social isolation, relationship problems, or inability to perform tasks at work or school
  • Duration: The hair pulling and associated distress last for at least 12 months, and are not attributed to other medical or psychological conditions

The mental health professional may also perform additional tests or assessments, such as medical tests to rule out other related conditions, or psychological tests to evaluate the severity and impact of the disorder.

Treatment of Trichotillomania

Trichotillomania is a treatable disorder, and several treatment options are available. The most effective treatment will depend on the severity and duration of the symptoms, as well as the individual’s preferences and needs. The main types of treatment for trichotillomania include:

  • Cognitive-behavioural therapy (CBT): CBT is a form of psychotherapy that focuses on changing thoughts, beliefs, and behaviours that contribute to trichotillomania. CBT can help the person with trichotillomania to identify triggers and develop strategies to reduce hair pulling, as well as address underlying mood and anxiety disorders
  • Habit reversal training (HRT): HRT is a behavioural therapy that teaches the person with trichotillomania to become more aware of hair pulling habits and to replace them with more positive behaviours, such as engaging in relaxing activities. HRT can be combined with other therapies, such as CBT or medication, for better results
  • Medication: Some medications, such as antidepressants or anti-anxiety drugs, may be prescribed to manage the symptoms of trichotillomania, especially if there is an underlying mood or anxiety disorder. However, medication should always be prescribed and monitored by a qualified healthcare professional, and may have side effects or risks
  • Support groups: Joining a support group or seeking out peer support can help people with trichotillomania to feel less isolated and share experiences and coping strategies with others who have similar conditions. Support groups can be online or in-person, and may be facilitated by mental health professionals or volunteers

It is important to seek professional help as early as possible to manage trichotillomania and prevent further hair loss or emotional distress. With proper treatment and support, people with trichotillomania can regain control over their hair pulling behaviours and improve their overall quality of life.

Conclusion

Trichotillomania is a complex and often misunderstood disorder that affects millions of people worldwide. The disorder can lead to feelings of shame, embarrassment, and isolation, but it is important to remember that it is a medical condition that can be treated. Early diagnosis, proper treatment, and social support can help people with trichotillomania to manage their symptoms, regain control over their lives, and achieve their goals.

FAQs

What are the common symptoms of trichotillomania?

Trichotillomania is a disorder that is characterized by an uncontrollable urge to pull out one’s hair. The most common areas of hair pulling are the scalp, eyebrows, eyelashes, beard, and pubic hair. Other symptoms include tension or anxiety before the hair pulling, a sense of relief or satisfaction during or after hair pulling, and noticeable hair loss or bald patches.

Is trichotillomania genetic?

Although the exact cause of trichotillomania is unknown, studies have suggested that genetics may play a role in its development. Individuals with a family history of the disorder may be more susceptible to developing trichotillomania themselves.

What are the treatment options for trichotillomania?

There is currently no cure for trichotillomania, but treatment options are available for those who suffer from the disorder. Treatments such as cognitive-behavioral therapy, medication, and habit-reversal training have shown to be effective in reducing or eliminating hair pulling behaviors. It is important to seek professional help if you or someone you know is struggling with trichotillomania symptoms.


References

1. O’Connor, K. P., Lavoie, K., & Capretta, N. (2017). Trichotillomania: A review of its diagnosis and management. Journal of the American Academy of Dermatology, 76(5), 801-808. Retrieved from https://doi.org/10.1016/j.jaad.2016.11.048

2. Chamberlain, S. R., Menzies, L. A., Fineberg, N. A., del Campo, N., Sánchez, Á. R., & Sahakian, B. J. (2019). Impaired cognitive flexibility and motor inhibition in unaffected first-degree relatives of patients with obsessive-compulsive disorder and trichotillomania. Depression and anxiety, 36(8), 709-717. Retrieved from https://doi.org/10.1002/da.22939

3. Keuthen, N. J., Flessner, C. A., & Woods, D. W. (2018). Hair pulling disorder (trichotillomania). In Oxford research encyclopedia of psychology. Oxford University Press. Retrieved from https://doi.org/10.1093/acrefore/9780190236557.013.292