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Monday, May 14, 2018


Trichotillomania – Compulsive Hair Pulling Disorder Explained

Sarah started pulling her hair out at the age of twelve when she could no longer stand the fighting between her mother and father. She hid the bald patches with a specific hairstyle. She was afraid that people could see the bald patches despite her attempts to hide them. It was only when she was 16 that she found the courage to seek help. 

She is just one of the many people who suffer from a disorder called trichotillomania.  She didn’t know why she was pulling out the hair on her scalp, but she just couldn’t seem to stop.      

What is trichotillomania

Trichotillomania is a disorder that results in people tugging out their own hair. They pull it out by the root from their scalp, eyelashes, eyebrows, beards and any other place where there is hair. 

It can begin at any age although it is most common in the teenage years. Some people pull out one strand of hair at a time, and others pull out handfuls. Resisting the urge to tear out the hair is similar to having an itch that you just have to scratch.

The more relief the behavior brings, the more it is likely to be repeated. The longer the behavior persists, the harder it becomes to resist the urge. 

Some people pull their hair out automatically and aren’t aware of their behavior. Others are more conscious of their behavior. Some people have a mixture of both automatic and focused behavior.

They are ashamed of their behavior, so they hide it from others, and it often takes place in a bathroom or a bedroom. Those who pull their hair out automatically may do it while sitting and watching TV or reading. 

The behavior often comes with specific rituals such twirling the hair before pulling it out, pulling out specific hair types or pulling it out in a specific manner. People often fiddle with their hair after pulling it out. They may roll it between their fingers or put it hair in their mouths. Some swallow it which can cause digestive problems because it creates a ball in their intestines. 

The cause of trichotillomania 

A single cause does not appear to exist. No-one knows what causes it although there appear to be many contributing factors such as emotional stress, hormonal changes, a genetic predisposition or a tendency to compulsive behavior.  

It may begin with a traumatic event that causes emotional distress.  There is some evidence that the brain’s chemical signals (neurotransmitters) are not working properly. 

The consequences 

Sufferers often feel frustrated, embarrassed, ashamed or depressed. They worry about what others think and feel that no-one will understand. They hide their behavior from others, even their family members and are self-conscious about how the behavior affects their appearance. They attempt to disguise the thinning hair or bald patches by the clothing they wear or by covering up with caps, wigs or scarves. They do not feel confident in social situations and may avoid dating and other situations where exposure is possible. They blame themselves for the fact that they cannot seem to resist the urge to pull out hair. 

Diagnosis may be delayed because the behavior is hidden and often not even family members know about it. When diagnosis comes at a late stage, the disorder is harder to treat and may have already caused much suffering in the life of the patient. 

Overcoming the problem

People who suffer from this disorder usually require help from psychologists or psychiatrists to stop. Behavioral therapy is often used when treating these patients. 
Patients learn how to identify what triggers the behavior. They learn about urges and how they fade when they do not give in to them and become stronger when they give in. They often have to keep a diary so that they can identify the situations or places when they feel the need to pull. 

They learn how to replace the harmful behavior. This may involve squeezing a stress ball or examining a drawing or handling a textured object. If the right help is given, they manage to overcome their urge to pull out their hair, and it usually grows back once they stop pulling it out.

The problem with this therapy is when the behavior is unconscious – it becomes difficult to identify the trigger. Some devices have been developed that can help to create awareness such as one which monitors hand movements and vibrates when certain critical movements are made. 

Medication may also be prescribed, but results of research seem to indicate that behavioral therapy works better than many of the drugs.  

The support of family and friends is often important in the recovery process. Being able to communicate with others about the disorder is helpful and seems to reduce the hair-pulling behavior.  


Ariel Taylor

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