a woman pulling her hair | Hair Pulling Disorder

What is trichotillomania?

People with trichotillomania have an overpowering urge to pull out their hair.

Most individuals pull out their scalp hair. However, a few people may also pull hair out of eyelashes, eyebrows, or beards.

Some people with trichotillomania might also eat the hair they pulled out. This condition is called trichophagia. It can lead to significant problems in the gastrointestinal tract.

Who does trichotillomania affect?

Doctors suspect that too many people have trichotillomania but they never report it.

According to an article, researchers estimate that trichotillomania affects around 0.5% to 2% of the total population.

Trichotillomania seems to be equally prevalent among both genders during adolescence. However, adult females are much more likely to report the condition than males.

Symptoms of Hair Pulling Disorder

A person with trichotillomania may experience certain behavioural and physical symptoms:

repetitive pulling of their hair, sometimes being unaware of it
a sense of relief after pulling
inability to stop hair pulling
anxiety and stress linked to hair pulling
counting or twisting hairs
trichophagia
skin irritation or tingling in affected areas
noticeable bald patches due to hair pulling

Causes and risk factors

Doctors are unaware of the causes of a person developing trichotillomania.

Some people report that hair pulling helps to ease boredom or stress. According to an article in the American Journal of Psychiatry, some people may pull out their hair as a way to handle adverse emotions.

Doctors do know about certain factors that can increase the risk of developing trichotillomania. These risk factors are:

Genetic history: A person who has a parent or sibling with trichotillomania is more likely to have this condition.

Childhood trauma: A person who has experienced childhood trauma may be more likely to have trichotillomania.

Doctors are also working to know about the changes in brain function or chemistry that could cause trichotillomania. Certain changes may impact a person’s ability to control impulsive behaviours, such as hair pulling.

How do I stop compulsive hair pulling?

Treatments

Many people who have trichotillomania do not take medications or treatment for their condition.

Some people may not be aware that they have a medical condition, and may simply consider hair pulling as a bad habit. Others maybe not be willing to have a diagnosis for a variety of reasons.

Doctors do not diagnose many cases of trichotillomania, which means there is so little information regarding the effective treatments available.

However, limited research suggests that specific behavioural therapies and medications may benefit people dealing with the condition.

Behavioural therapy

A case study indicates that habit reversal therapy (HRT), which is a kind of behavioural therapy, might be significant in treating trichotillomania. Habit reversal therapy has five stages:

Awareness training: The person recognises the psychological and environmental factors that might trigger an episode of hair-pulling.

Competing response training: The person practices replacing the hair-pulling behaviour with other different behaviour.

Motivation and compliance: The person engages in activities and behaviours that recall the importance of sticking with habit reversal therapy. This may include getting praise from family and friends for progress being made during the therapy.

Relaxation training: An individual practices relaxation techniques, like meditation and deep breathing which help to lower stress and linked hair pulling.

Generalization training: The person practices their new skills in distinct situations so that the new behaviour becomes automatic to adapt.

As per a review, most experts agree that HRT should be the first-line treatment alternative for trichotillomania.

Medications

A 2013 review investigated the efficiency of various medications in treating trichotillomania.

The review had eight trials, seven of which were placebo-controlled. The drugs investigated across the eight trials are:

SSRI (a class of antidepressants)
clomipramine (tricyclic antidepressant)
naltrexone (opioid antagonist)
olanzapine (antipsychotic)
N-acetylcysteine

The reviewers identified olanzapine, N-acetylcysteine, and clomipramine as the only few drugs to have a good treatment effect on trichotillomania.

However, the studies used very small sample sizes and did not even report information on its side effects.

Further controlled clinical trials are required to know the safest and most appropriate drug treatments for trichotillomania.

Links with other mental health conditions

Trichotillomania can be seen in the Diagnostic and Statistical Manual of Mental Disorders Version 5. This manual is mostly used by mental health experts to diagnose mental health-related conditions.

The DSM-5 classifies trichotillomania as an OCD. Previous versions of the manual classified it as an impulse control disorder.

According to the National Organization for Rare Disorders, few people with trichotillomania also have other signs or conditions, including:

anxiety
attention deficit hyperactivity disorder (ADHD)
depression
obsessive-compulsive disorder (OCD)

Sometimes, when a doctor treats any of these conditions, the person’s trichotillomania also improves.

Take Away

Trichotillomania is a rare medical disorder that can immensely affect a person’s quality of life.

Many people are not aware that treatments are available for trichotillomania. HRT is very effective and is the first-line treatment in most cases.

Researchers are continuously evaluating medications that may lower the symptoms of trichotillomania.

If a person thinks they have trichotillomania, they consult their doctor for a diagnosis. The doctor may refer them for specialist treatment, such as behavioural therapy which can enhance a person’s quality of life.