What Is Trichotillomania?

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Trichotillomania is a disorder that involves recurrent hair pulling. This can be from the scalp, eyebrows, or any other part of the body that has hair on it. As a type of impulse control disorder, the urge to pull hair can range from mild to severe and is often tied to negative emotions. 

People with trichotillomania often pull their hair to relieve those feelings of negativity, stress, and worry – for some, it can even bring up positive feelings. Though trichotillomania can be done consciously, some sufferers do report engaging in automatic hair pulling (i.e. pulling their hair subconsciously while watching TV or performing other tasks).

Trichotillomania often develops in early childhood or early teens. In rare cases, trichotillomania can occur or even develop into trichophagia – the impulsive act of eating the hair that is pulled out. 

Trichotillomania is nothing to feel embarrassed or ashamed about, but it can greatly impact your social life and cause a lot of distress. There’s no need to go through it alone though – treatment is available and you can recover and build healthy coping mechanisms that help resist the urge to do this. Here, we take a closer look at trichotillomania, its causes, and the kinds of treatment options available.

what is trichotillomania

What Are the Symptoms of Trichotillomania?

Though everyone will experience the disorder differently, there are a few signs to look out for.  The most common symptoms of trichotillomania include:

  • Impulsive habits and body-focused repetitive behaviours (nail-biting, hair pulling, and skin picking)
  • An incessant urge to pull hair
  • Bald patches
  • Noticeable hair loss
  • Efforts to cover up bald patches (i.e. with extensions or false eyelashes)
  • Isolated social life 
  • Playing with pulled-out hair
  • Engaging in specific hair rituals
  • Feelings of euphoria or pleasure after pulling out hair
  • A sense of building tension before pulling hair

Causes of Trichotillomania

Though there is no one set cause of trichotillomania, medical experts speculate that it is caused by a combination of genetic and environmental factors such as low self-esteem and related disorders (ie. obsessive-compulsive disorder). 

Risk Factors for Trichotillomania

The most common risk factors or situations that can trigger trichotillomania include:

Genetics and family history – those with a family history of trichotillomania are more likely to develop the hair-pulling disorder than those without.

Age – trichotillomania is most often diagnosed in children and teenagers, so young people and adolescents are at greater risk of developing the disorder than others.

Related and underlying disorders – people with trichotillomania often have underlying mental health conditions such as obsessive-compulsive disorder (OCD), depression, and anxiety.

Emotional stress and anxiety – stressful situations and emotional distress can be triggers for trichotillomania (the disorder often brings about feelings of release, relief, and happiness in response to these stressful events).

How Is Trichotillomania Diagnosed?

Unlike other mental health conditions, there’s no one test or procedure that’s carried out to make a diagnosis of trichotillomania. It’s commonly diagnosed via symptoms and treatment will depend on the severity of those symptoms and age. During a diagnosis, a doctor will also be able to screen for any underlying mental health disorders – if anything does present, then treatment will be adjusted accordingly.

If your young person has a bad habit of pulling their hair, it’s best to seek treatment as soon as possible. It may seem mild at first but it’s key to remember that it is a certified mental health disorder and can cause skin damage and emotional distress if left untreated. 

what is trichotillomania

Treatment for Trichotillomania

With effective treatment and support, trichotillomania can be stopped in its tracks. Even if this isn’t always the case, trichotillomania treatment will help young people develop coping mechanisms that can be used to work through triggers and feelings of stress in a way that doesn’t involve pulling hair. The most common treatments include:

Habit Reversal Therapy

Habit reversal therapy, also known as habit reversal training, is a type of therapy designed to help those with trichotillomania develop less harmful and damaging habits to hair pulling. It’s one of the most popular treatments for trichotillomania and often focuses on redirecting your energy and movement elsewhere (i.e. clenching your fists or clapping your hands instead of hair-pulling).

Cognitive-behavioural Therapy

Cognitive-behavioural therapy is a type of talk therapy that focuses on acknowledging and spotting negative behaviours and thought patterns – such as pulling hair – and replacing them with healthier thought patterns and behaviours.

Acceptance and Commitment Therapy

Acceptance and commitment therapy is a type of behavioural therapy that’s designed to help those with trichotillomania accept themselves and their disorder, letting go of feelings of shame or embarrassment. 

Group Therapy

Group therapy is a great way of getting those with trichotillomania connected to a group of people that truly understands and relates to what they are going through. During group therapy sessions, a therapist will encourage attendees to open up and contribute to the discussion. As well as showing young people that they’re not alone in their disorder, it’s also a space to learn from others, share coping strategies, and develop new friendships.

Meditation and Mindfulness

Meditation and mindfulness are often used in alternative treatment programmes to help those with trichotillomania better manage symptoms, no matter where they might be. This often involves breath work and guided imagery sessions. The purpose of meditation and mindfulness is to focus on the present and move thoughts away from hair pulling.

Medication

Though there are no ‘formally approved’ medical treatments for trichotillomania, certain medications and antipsychotics can help relieve symptoms and urges. The most popular types of medication prescribed include antidepressants, atypical antipsychotics, and amino acid supplements such as N-acetyl-cysteine. 

In cases where an individual has an underlying mental health condition in conjunction with trichotillomania, other medication may also be prescribed.

What Happens if Trichotillomania Is Left Untreated?

Left untreated, trichotillomania can have a negative and long-lasting impact on children and adolescents. 

  • Skin and hair damage

People with trichotillomania often have skin and hair damage, resulting in bald patches, a lack of hair growth, and scarring. This can have a knock-on effect on a young person’s self-esteem and can even cause infection if an area is repeatedly having hair pulled out of it.

  • Emotional distress

Those who regularly pull hair often report feelings of emotional distress, shame, embarrassment, and humiliation. 

  • Digestive problems

In cases where trichotillomania does develop into trichophagia, the digestive tract can become damaged by the constant need to ‘break down’ hairballs that are being ingested. Over time, these hairballs can cause weight loss, vomiting, and in some instances even lead to death.

  • Social isolation

Feelings of shame and worrying about what others might think about their appearance stops many with trichotillomania from engaging in regular social activities (i.e. going out or avoiding job opportunities)

How To Cope With Trichotillomania at Home

Alongside treatment, young people can also engage in healthy habits at home to better manage their disorder and keep their symptoms under control. 

  • Meditation and mindfulness

Regularly practising meditation and mindfulness can help those with trichotillomania better manage feelings of stress, anxiety, and worry as they come up. It can also help them focus on the present, especially in moments when they are being triggered or feel intense urges coming on.

  • Journalling

Another great stress reliever, journaling can help people with trichotillomania express their thoughts and emotions in a healthy and creative way. Finding an enjoyable outlet can also help move their thoughts away from hair pulling, instead channelling their energy into something positive.

  • Stress-management toys and techniques

Stress-management toys such as fidget spinners, stress balls, and fidget strips can all be used to redirect the focus onto something other than hair pulling in moments where a young person is being triggered or feels an urge to pull their hair. 

  • Identify triggers

Those with trichotillomania may also find it helpful to acknowledge their triggers, identify them, and make a mental note of them somewhere. This will help them avoid situations, events, people, or places that trigger them into pulling their hair.

  • Support groups

Some people with trichotillomania may find support groups a useful tool in coming to terms with their disorder and letting go of shame. The great thing about support groups is that they can be done online or in person, giving young people the option to choose what they’re most comfortable with. Support groups are also a good place to develop new friendships and learn from others.

Compassionate Mental Health Treatment at The Wave

Here at The Wave, we understand just how difficult it can be to live with trichotillomania on a day-to-day basis. We’re here to let you know that there’s nothing to be ashamed about and that you don’t have to go through this alone – our treatments and medical staff will guide you on your journey to wellness. Alongside trichotillomania, we also treat a wide range of other mental disorders such as obsessive-compulsive disorder, anxiety, and depression. We also always maintain a ‘whole-person’ approach when it comes to treatment, so your wellness plan will always be personalised to suit your unique needs and medical history.

Don’t suffer in silence – get the help you need today. If you’d like more information, get in touch with our care team. They’ll be more than happy to answer any questions you may have and will walk you through our process.

Fiona - The Wave Clinic

Fiona Yassin is the founder and clinical director at The Wave Clinic. She is a U.K. and International registered Psychotherapist and Accredited Clinical Supervisor (U.K. and UNCG).

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