Trichotillomania – a pretty long and complicated sounding word to describe a particular mental illness that is also sometimes called a hair pulling disorder.

Officially, trichotillomania is considered an impulse control disorder similar to kleptomania, pathological gambling or pyromania. It involves a recurrent and overwhelming urge to pull out one’s hair, often leading to patches of baldness. Usually, it is the hair on the scalp that is most affected, but other hair such as eyelashes, eyebrows and beard are also often subject to pulling in this condition.

Sometimes, individuals with this disorder also chew or swallow their pulled hair – a behaviour that is labeled tricophagy.

Although the use of the suffix ‘mania’ in the disorder’s name might imply that a person gets great enjoyment out of pulling out his or her hair, this is somewhat of a misconception.

Typically, individuals with this and other conditions like it feel an increasing sense of tension and anxiety immediately before pulling out their hair or when they are really trying to resist the habit. This anxiety dissipates somewhat while hair is being pulled and then gradually builds up again afterward.

Far from enjoying the experience, individuals with this condition feel significant distress about their behaviour and also experience difficulties in social, work and other areas of their lives as a result. Many people with trichotillomania avoid intimate relationships and try to hide their hair pulling behaviour.

Usually trichotillomania begins near puberty although symptoms can develop earlier or later. An exact cause is unknown, but it is believed that biological and environmental factors play a role. Sometimes, hair pulling can be triggered by a stressful event such as a change of schools, abuse, family conflict or trauma. In other cases, changing hormones associated with puberty may trigger symptoms.

On a biological level, some researchers believe trichotillomania involves a disruption in the chemical messenger systems in the brain. Genetic predisposition is also thought to be involved as it seems individuals with anxiety or other psychiatric conditions in their family are more likely to develop trichotillomania.

As with most other psychiatric disorders, individuals with trichotillomania often experience co-existing conditions as well. Obsessive compulsive disorder (OCD) is something that very often exists with trichotillomania. Symptoms such as compulsive counting, checking or washing may exist alongside hair pulling behaviour. In fact, OCD has many similarities to trichotillomania and some consider hair pulling to be a subtype of OCD.

Other impulse control problems are common in those experiencing an urge to pull out their hair – these could include nail biting, thumb sucking, head banging or compulsive skin picking.

Depression is another commonly co-existing psychiatric condition for those with trichotillomania. This could be due to a biological connection between the two conditions or the depression may exist as a result of the low self esteem and distress caused by hair pulling behaviour.

Although an exact cause is not fully understood, there are some effective treatments available for trichotillomania. Usually a combination of cognitive behaviour therapy and medication provides the most relief from symptoms.

In therapy individuals learn to track their symptoms and behaviour, increase their awareness of when hair pulling occurs and learn various techniques to reverse the habit. These techniques usually involve getting the individual to engage in behaviour that is incompatible with hair pulling at times when the hair pulling is most likely to occur or as soon as they are aware of it having occurred. It becomes such a well entrenched habit that it often occurs unconsciously and every attempt is made to bring it to conscious awareness as much as possible. Only when the individual is aware of what they are doing do they have some chance of changing the behaviour.

Medications that are helpful in treating anxiety and obsessive compulsive disorder also seem to help those with trichotillomania – and combining these effective mediations with the skills learned in a structured course of therapy can help individuals manage their condition.

If you or a loved one experience an overwhelming urge to pull out your hair – speak with your doctor about it and get referred to a mental health professional. You don’t need to let this continue to disrupt your life.


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