Daria used to make up excuses for the bald spot on the back of her head. Sometimes
she said her head rubbed against the headboard of her bed when she was asleep. Other times she said the baseball caps she
had to wear at her job were too tight. She knew people doubted her stories, especially family members. But she couldn't
face telling them what was really happening: She'd been pulling her hair out since she was 12.
Daria had no idea why she pulled her hair. She just knew that she couldn't stop. Many times, she did it without
even thinking. Daria's mom noticed her doing it while watching TV. The two of them did some research and learned about a
condition that some people have called trichotillomania.
What Is Trichotillomania?
Trichotillomania (pronounced: trik-oh-till-oh-may-nee-ah)
is a type of psychological condition that involves strong urges to pull out one's own hair.
Doctors used to believe trichotillomania was rare. But that thinking is now changing as experts gain a better understanding
of the condition and more people come forward for help. Trichotillomania affects more girls than guys. Most people who have
it develop it during adolescence. But trichotillomania can start in kids as young as 1 year old.
What Happens With Trichotillomania?
People with trichotillomania pull hair out at the root from places like the scalp, eyebrows,
eyelashes, or pubic area. Some people pull large handfuls of hair, which can leave bald patches on the scalp or eyebrows.
Other people pull out their hair one strand at a time. Some inspect the strand after pulling it out or play with the hair
after it's been pulled. About half of people with the condition put the hair in their mouths after pulling it. Some people
are very aware of their pulling; others seem to do it without really noticing what they're doing.
It might be hard to understand why some people would pull their own hair or eyelashes out — or why they wouldn't
just stop. But trichotillomania isn't just an ordinary habit that a person can easily stop.
Trichotillomania is a type of compulsive behavior. This means that people with the condition feel an overwhelming
urge to pull their hair. They also may have other compulsive habits, such as nail biting or skin picking. Some also have
problems like depression, anxiety, or obsessive-compulsive disorder (OCD). Compulsive behaviors like trichotillomania involve
brain chemistry and may be genetic (meaning they can sometimes run in families).
People with trichotillomania may feel embarrassment, frustration, shame, or depression about the condition. They
may worry about what others will think or say. They may feel nagged by people who don't understand that they're not doing
this on purpose. They usually try to hide the behavior from others — even their families. This can make it difficult
to get help.
Having trichotillomania can affect how people feel about
themselves. Some are self-conscious about how hair pulling affects their appearance. Because of this, they might feel less
confident about making friends or dating. Others might feel powerless to control the urge to pull or blame themselves for
not being able to stop. Feelings like these can cause a person's self-image to suffer.
Why Do People Feel Compelled to Pull Their Hair?
Doctors don't know for certain what causes trichotillomania. Some think it could
be related to obsessive-compulsive disorder since OCD and trichotillomania both involve repetitive behaviors.
Experts think that compulsive behaviors like hair pulling may be caused by an imbalance
in the brain’s chemistry. A type of brain chemical, called neurotransmitters (pronounced: nur-oh-tranz-mit-urs),
is a normal part of the brain's communication center. When something interferes with how neurotransmitters work, it can cause
problems like compulsive or repetitive behaviors.
Some people with trichotillomania
say that they notice sensations in their scalp or skin. For example, it may be a tingling feeling that can only be relieved
by pulling, like the feeling of relief that comes from scratching an itch. Some people say that they notice a satisfying
feeling when they pull their hair. Others don't even notice when they pull and do it without thinking.
Any relief that comes with hair pulling usually only lasts for a moment. The urge almost always
returns. That's because when the mind becomes used to giving in to the powerful urges that go with compulsive behaviors,
the behavior is reinforced, and then becomes a habit. The mind gets trapped in a cycle of expecting to have the urge satisfied.
The longer this goes on, the harder it can become to resist the urge.
How Do People Overcome the Hair-Pulling Urge?
Because trichotillomania is a biological brain condition, it's not something that most people who have it can just
stop doing when they feel like it. They usually need help from medical and behavioral specialists before they can stop.
With the right help, though, most overcome their hair-pulling urges. When someone is able to stop pulling, hair usually
grows back.
Overcoming hair-pulling urges may involve a specific type
of talk therapy called CBT (cognitive behavioral therapy), medication, or a combination of both.
Therapists teach people with trichotillomania special behavior techniques that help them to recognize the urge to
pull hair before it becomes too strong to resist. This can involve learning to identify situations, places, or times that
have become connected with the behavior and that act as triggers for it. The person learns ways to change or eliminate these
triggers. This can then help someone resist the urges so that they eventually grow weaker and then go away.
To gather the information necessary to do this, a therapist will usually recommend keeping
a record or diary of pulling episodes. A therapist also can help people to regain confidence and feel better about themselves.
Because the urges and habits that lead to hair pulling are so strong, someone may
feel more tension or anxiety when first trying to resist the urge. That's why it helps to work with an expert who can offer
support and practical advice about how to reverse these powerful influences.
After starting with therapy, doctors can prescribe medication if extra help is needed. Some medications can help
the brain deal better with urges, making them easier to resist. Many people find it helpful to keep their hands busy with
a different activity (like squeezing a stress ball, handling textured objects, or drawing) during times or activities when
a pulling urge is the strongest. Daria found that knitting while watching TV helped keep her hands busy at a time when she
might feel the urge to pull her hair.
Homework time was harder, though.
Daria realized that she tended to pull more as she did her homework — partly because she worried about doing
well on a project or test, and partly because she tended to pull more when she sat in one place for long periods of time.
Daria and her therapist talked about ways to deal with homework stress. She discovered
that being a perfectionist was adding to her tension. Her therapist helped her to see that she could still do good work
without it having to be perfect.
As she began to feel more relaxed —
and still do excellent work — Daria's confidence grew. She also found it helpful to take breaks during her homework
sessions. Getting up and moving around for a few minutes seemed to help.
If
you're worried about hair pulling, talk to a parent, school counselor, or someone you trust about getting help overcoming
the problem.
What is Trichotillomania?
It is officially classified as an impulse control disorder, along the lines of pyromania, kleptomania,
and pathologic gambling.
What are the Symptoms of Trichotillomania?
Recurrent pulling out of one’s hair resulting in noticeable hair
loss
An increasing sense of tension immediately
before pulling out the hair or when resisting the behavior
Pleasure, gratification, or relief when pulling out the hair
The disturbance is not accounted for by another mental disorder and is not due to a general medical condition (i.e.,
dermatological condition)
The disturbance
causes significant distress or impairment in social, occupational, or other important areas of functioning
How and when does it start?
People
often start compulsive hair-pulling around the ages of 12-13; although it is not uncommon for it to start at a much younger
or older age. Frequently, a stressful event can be associated with the onset, such as: change of schools, abuse, family
conflict, or the death of a parent. The symptoms also may be triggered by pubertal hormonal changes.
Does Trichotillomania Lead to Other Problems?
During adolescence, which is an especially crucial time for developing self-esteem, body image, comfort with sexuality,
and relationships with peers of both sexes, teens may endure ridicule from family, friends, or classmates, in addition to
feeling shame over their inability to control the habit. Therefore, even a small bald patch can cause devastating
problems with development that can last life-long. Although many people with trichotillomania get married and carry
on with their lives in a normal fashion; there are those who have avoided intimate relationships for fear of having their
shameful secret exposed.
What Is the Cause?
There is no certain cause of trichotillomania, but the current way of looking at trichotillomania
is as a medical illness. One theory on a biological level is that there is some disruption in the system involving
one of the chemical messengers between the nerve cells in parts of the brain. There may be also a combination of factors
such as a genetic predisposition and an aggravating stress or circumstance; as with many other illnesses. Further,
trichotillomania could be a symptom caused by different factors in different individuals just as a cough can be produced
by a multitude of different medical problems. Finding the cause(s) will take more research.
What Is the Relation to Other Illnesses?
For
many people with trichotillomania, there are symptoms of obsessive-compulsive disorder (OCD) such as compulsive counting,
checking, or washing as well. There are so many similarities between hair pulling and other compulsive symptoms that
some consider it a subtype or variant of OCD. This idea is supported by the tendency for the two problems to run in
the same families and the fact that OCD medications can be helpful in treating trichotillomania.
Depression also frequently occurs in individuals with this illness. There may be a
direct neuro-biochemical relationship and/or be secondary to the chronic demoralization and low self esteem hair-pulling
can bring.
Other associated behaviors may include nail
biting, thumb sucking, head banging, or compulsive scratching. Frequently, hair pullers also find they compulsively
pick at their skin, which may also cause physical and emotional scarring.
What
Treatments Are Available?
The two methods of treatment
that have been scientifically researched and found to be effective are behavioral therapy and medications.
- Therapy. In behavioral therapy, people learn a structured method of keeping
track of the symptoms and associated behaviors, increasing awareness of pulling, substituting incompatible behaviors and
several other techniques aimed at reversing the “habit” of pulling.
- Medications. Although medications clearly help some people temporarily, symptoms are likely to
return when the medication is stopped unless behavioral therapy is incorporated into treatment. Medications may help
to reduce the depression and any obsessive-compulsive symptoms the person may be experiencing.
Commonly used medications are:
Other Resources
Trichotillomania Learning Center, Inc.
303 Potrero
#51
Santa Cruz, CA 95060
Phone: begin_of_the_skype_highlighting 831-457-1004 end_of_the_skype_highlighting
www.trich.org831-457-1004
Obsessive-Compulsive
Foundation
676 State Street
New Haven, CT 06511
Phone Number: begin_of_the_skype_highlighting (203) 401-2070 end_of_the_skype_highlighting
Fax Number: (203) 401-2076
Email Address: info@ocfoundation.org
Website URL: www.ocfoundation.org(203) 401-2070
