Trichotillomania (Hair Pulling)

You suffer from very strong urges to pull out your hair, urges too strong and persistent to be resisted; and since you pull the hairs of your scalp, eyebrows and other parts of your body so often, you have noticeable bald patches or hairless areas on your body.

You feel a great tension before pulling or as you try to resist these urges and when you succumb to your urges your tension turns into pleasure, relief or gratification; and if you’re like many with this disorder, you go to great lengths to conceal your hair loss and so many of the people in your life have no idea of your debilitating condition.

If you suffer from mild trichotillomania, you probably feel frustrated by your disorder, but you can likely control your urges through awareness and concentration. In more serious cases, the urges felt are overpowering and can result in deep feelings of shame and even a curtailment of normal daily activities. People with noticeable hair loss may go to great effort and expense to hide their hairless areas and may avoid also social contact to minimize feelings of embarrassment and shame – in some cases these feelings make it difficult to work or socialize outside of the home, or get needed medical or dental care.¹

Do You Have Trichotillomania?

According to the APA’s manual of mental health disorders trichotillomania is a form of impulse control disorder, to meet a diagnosis of Trichotillomania, you must:

1. Recurrently pull your hair out and this hair pulling must result in noticeable areas of hair loss

2. Feel amplifying tensions just before the hair pulling or as you try to resist the impulse to pull your hair.

3. As you pull your hair out, you must experience pleasure or relief

4. Not have a dermatological or medical condition which explains your need to pull your hair out

5. Not have another mental health disorder which better explains your hair pulling

6. Feel significant distress due to the condition or the disorder must limit your performance at work, in relationships or in other important areas of your life*²

Who Gets Trichotillomania?

In children, trichotillomania occurs equally in both boys and girls, but by adulthood, women are more likely to experience the disorder.

No one knows the exact occurrence rate, though in one study of college students, the disorder was found to occur in 0.6% of students. The Trichotillomania Learning Center puts the incidence rate at a slightly higher 1% to 3% of the general population, or 3 to 9 million Americans. ³

Adults with the disorder often report first onset in adolescence. Some people experience symptoms chronically and continuously, while others experience active periods followed by periods of remission. The site of hair pulling on the body will often change over time. Without treatment, the disorder generally persists chronically, for a lifetime (the exception being small children, who sometimes experience a period of hair pulling that later goes away).

People with a close relative with the disorder are at greater risk themselves to also experience it. ⁴

Swallowing Hair

Some people with Trichotillomania will eat the hairs that are pulled from the body. This can result in hairballs (trichobezoars) which can in turn result in intestinal blockages requiring surgery to remove, and which can be fatal.

Trichotillomania Treatments

Because people with this condition frequently experience other co-occurring mental health disorders, like depression or anxiety, it is useful to receive a complete psychiatric screening to ensure comprehensive treatment.

The two most common treatments offered for trichotillomania are:

1. Cognitive behavioral therapy (CBT)
2. Medication

Cognitive Behavioral Therapy for Trichotillomania

With CBT, you are taught ways to control the way you think to control your behaviors (hair pulling). You might be taught, for example, to become more aware of what types of emotions or behaviors trigger your urges to pull hair, and once you can recognize these triggers, you can take conscious steps to minimize them in your life (for example, if you pull hair unconsciously as you watch TV, you may need to substitute more active recreational pastimes for that high-risk activity).

You may also be taught stimulus control procedures that make hair pulling difficult, such as learning to clench your hands into fists as you experience urges, or be encouraged to wear clothing or devices that make hair pulling difficult, such as hats, or certain kinds of gloves.⁵

As stress can sometimes trigger hair pulling, therapists may also teach and encourage stress management techniques.

Medication

Anti depressant medications, such as the SRRIs and other types of medications are sometimes prescribed to assist in symptoms control. These medications seem to be most effective when used as an adjunct therapy to cognitive behavioral therapies.⁶(Because many people with this disorder suffer from co-occurring mental health problems, treatment with anti-depressants sometimes results in increased mood or reduce anxiety, as a beneficial side effect).

Helping Yourself - Self Help for Trichotillomania!

You can take action to reduce the severity of your condition on your own.  According to Ruth Golomb LCPC of the Behavior Therapy Center of Greater Washington, steps you can take to control your hair pulling include:⁷

• Figure out your hair pulling profile – try to understand (and record) what makes you pull, where you typically pull, why you feel urges to pull and at what times of day you feel these urges. Also try to understand if your urges are caused primarily by a need to feel tactile sensations, by environmental, cognitive or emotional cues or by the feeling that your hands have a mind of their own.

• Give yourself something to ‘fiddle’ with instead of pulling, such as a string of beads, silly putty, a bristly brush, some string, etc.

• Give yourself a sensory overload without needing to pull hair – try a cold cloth on the face, strong mints, eating seeds, menthol scents, a firm brush, etc.

• Wear gloves on your hands or band aids on your fingers, use a tight tension bandage on your elbow that makes bending uncomfortable, wear a hat, a scarf or put your hair in a towel, etc.

• Change your environmental routine – use a different bathroom, sit in a different chair, change the lighting etc.

• Change your emotional states – practice relaxation techniques, meditate, do yoga, write a journal, etc.