It is normal for people to twist, pull and play with their hair. But for some people this behavior becomes excessive and begins to cause baldness, scarring, infection, and shame. For anyone with this problem, the embarrassment and emotional pain can be overwhelming and cause them to avoid socializing and intimacy with other people.
The first thing you should know about this trichotillomania is that you are not alone. There are thousands (perhaps millions) of people out there who suffer in silence wearing hats, wigs, makeup, long sleeves and pants in the summer and all kinds of other items in the hopes of hiding what they are doing to themselves because they cannot stop. Although these disorders are not talked about openly because of the shame associated with them, you should know that there are professionals who can help, as well as support groups, medications, and therapies to help you stop.
As a fellow sufferer, please understand that this is not a matter of willpower or “just not doing it,” but a real, diagnosable disorder with real treatment options out there. Please take the time to read the information below and follow the links if you feel that you need help with one of these disorders.
Definition Of Trichtotillomania:
Trichotillomania (TTM) is a disease in which people feel the irresistible urge to pull out their hair. The urges seem uncontrollable and are often made worse by stress or other emotional upsets. It affects 2-4% of the population.
People who suffer from TTM will pull, pluck, or twist their hair until it comes out. Others may use instruments to achieve this goal. Sufferers will pull hair from any part of their body: scalp, face, arms, legs, or any combination of these areas. Some people may also have the compulsion to eat the hair. Less common is unconscious (or sleep-induced) hair pulling, in which the person doesn’t consciously realize he or she is doing it.
The act of hair pulling is usually followed by a period of intense self-blame, shame and sometimes anger because the puller knows that this behavior is in some way self-damaging, yet they feel helpless to stop.
Trichotillomania is more often seen in women, but can inflict either sex.
Diagnosis of Trichotillomania:
Trichtotillomania is an impulse-control and anxiety disorder. It is not simply a bad habit or “quirk”. One of the important distinctions in diagnosing hair pulling as TTM is that it causes the person significant emotional distress. The person doesn’t WANT to pull the hair, but he or she simply cannot stop.
According to the Diagnostic and Statistical Manual of Disorders, all 5 of these criteria must be present in order to correctly diagnose hair pulling as Trichtotillomania:
- Recurrent plucking of one's hair resulting in noticeable hair loss
- Increasing build-up of tension immediately before the plucking
- Sense of relief or reduction in tension when the hair is pulled
- The problem is not better explained by an alternative mental or medical disorder
- The problem results in significant distress or impairment to the individual in social, vocational or other areas of life
What Other Conditions Occur With Trichotillomania?
Many hair pullers also suffer from Obsessive Compulsive Disorders. Some professionals believe that TTM is part of the OCD spectrum. Additionally, there is a high incidence of this disorder among people suffering from Body Dysmorphic Disorder, and is sometimes considered as a symptom of that disorder.
TTM is not a widely discussed disorder, and it may feel shameful to admit. Many people who have it do not know that there is help available.
Causes Of Trichtotillomania:
TTM is a newly diagnosed disease and its exact causes are unknown. However, many professionals have theories about what may cause the disorder.
Some sufferers of TTM tend to feel “zoned out” while pulling which leads some professionals to believe that it is a way for these people to “escape” from feelings of stress, sadness, anxiety or even boredom. Additionally, most report that rather than feeling pain when hair is pulled or plucked, they tend to find it pleasurable, which researchers believe is due to the release of dopamine in the brain. From the Trichotillomania Learning Center website:
“While the underlying biology is not clearly understood at this time, we do know that people with Trichotillomania generally have a neurologically based predisposition to pull their hair as a self-soothing mechanism. The pulling behavior serves as a coping mechanism for anxiety and other difficult emotions.”
Additionally, there is evidence that TTM may be genetically based. It has been demonstrated in other animals that the natural grooming tendency which helps to keep their (and our) bodies free of dirt, bugs and other parasites can go haywire, leading to bald patches and skin damage. Scientists researching this phenomenon have detected a small mutation on one specific chromosome that is not present in animals who do not suffer from this problem. Indeed, science may be on the brink of discovering the true cause of this and other related disorders.
Symptoms of Trichotillomania:
The most common symptoms are hair loss and bald patches, which vary in appearance from barely noticeable to total baldness in affected area.
Less obvious symptoms include:
- Uneven hair or damaged skin around hair.
- Missing eyelashes or eyebrows
- Eye infections (if pulling eyelashes)
- Sores on the scalp or other body areas where hair is removed
- Ingrown hairs
- Wearing hats, scarves or glasses to hide areas where hair has been removed
- Avoidance of activities where the head may get wet
- Gastrointestinal blockages (from ingested hair)
Treatment for Trichotillomania:
- Medication: SSRI’s (antidepressants) are standard treatment for Trichotillomania. Because many of the sufferers also suffer from anxiety, depression, OCD and other disorders, antidepressant treatment is almost always explored as an option.
- Cognitive-Behavioral Therapy (CBT) is a form of therapy that seeks to alter behavior by identifying the precise factors that trigger hair pulling and learning skills to interrupt and redirect responses to those triggers. CBT should only be performed by a provider trained in the methods of CBT.
- There are also many online support groups available. Some have adapted the 12-step program of Alcoholics Anonymous to help people to “quit” hair pulling. Links to some of these sites will be provided below.
Additional Resources for Trichotillomania:
National Alliance on Mental Illness (NAMI): 1-800-950-NAMI (6264)
Trich.org Providing help and support for those suffering from hair and skin picking disorders
The OCD Center of Los Angeles A private, outpatient treatment center for those suffering from any form of OCD
Trichotillomania by Dr. David Penzel with links to his practice and book
Find a support group in your area