Trichotillomania
Trichotillomania, also known as compulsive hair pulling, is an impulse control disorder where individuals feel a strong compulsion to pull out their hair. This condition is considered a complex neurological-behavioral disorder, often manifesting in response to stress, anxiety, or depression. While the exact causes remain unclear, it is believed to arise from a combination of environmental and biological factors, including possible neurotransmitter imbalances.
Typically beginning in adolescence, trichotillomania affects women at a rate four times higher than men and can lead to noticeable bald patches or uneven hair growth, as well as potential physical complications if hair is ingested. Diagnosis involves ruling out other causes of hair loss and assessing for regular hair-pulling behavior. Treatment options generally focus on managing stress and anxiety and may include cognitive behavioral therapy (CBT), particularly habit reversal techniques, as well as pharmacological approaches like selective serotonin reuptake inhibitors. Early intervention in treating underlying emotional conditions may also aid in prevention.
Trichotillomania
- ALSO KNOWN AS: Compulsive hair pulling
DEFINITION: Trichotillomania is an impulse control disorder characterized by a compulsion to pull one’s hair. It is thought to be a complex neurological-behavioral disorder.
Causes
The cause of trichotillomania is unclear, but likely involves both environmental (learned) and biological factors. One possibility is that hair pulling is a learned response to increasing stress and that the act relieves that stress. Biological explanations focus mainly on an imbalance of neurotransmitters.
Risk Factors
Some indication exists that there may be a family history of trichotillomania. The disorder most commonly begins by the age of seventeen, and is four times more likely to affect women than men. It typically appears in persons who are depressed, anxious, or stressed.
Symptoms
Persons with trichotillomania generally show signs of depression, anxiety, or increasing stress. The obvious symptoms of trichotillomania involve pulling hair from the head, eyelashes, eyebrows, beard, or other area of the body.
The disorder is characterized by areas of baldness or by patches of hair just starting to grow. Persons with trichotillomania may play with their pulled hair or even eat it. In cases where enough hair is ingested, an intestinal obstruction may develop.
Screening and Diagnosis
A person with trichotillomania presents with hair loss. Differential diagnosis involves ruling out other causes of hair loss, including both congenital and acquired causes. When hair loss cannot be attributed to any other medical condition in a person who exhibits high levels of stress or anxiety, that person is evaluated to determine if they exhibit hair-pulling behavior regularly. Such an individual is likely to be diagnosed with trichotillomania.
Treatment and Therapy
Because the causes of trichotillomania are not clearly understood, treatment can often be complicated and . All treatments generally involve attempts at decreasing or managing stress, anxiety, and depression, which can affect trichotillomania. Specific treatments for trichotillomania can be either psychological or pharmacological.
Psychological treatment with cognitive behavior therapy (CBT) seems to be most effective, although hypnosis and biofeedback have also been used. The most common type of CBT used is habit reversal, in which the person learns to attend to hair-pulling desires and to engage in a behavior that prevents the hair pulling.
Experts vary in opinion over treating trichotillomania with medication. Selective serotonin reuptake inhibitors and naltrexone have been investigated as effective treatment modalities. These potential pharmacological treatments deal with neurotransmitter regulation.
Prevention
The only real means of prevention involves diagnosing anxiety, stress, or depression before hair-pulling behavior begins. Treating the underlying condition may prevent this physical manifestation.
Bibliography
Grant, Jon E, and Samuel R Chamberlain. “Natural Recovery in Trichotillomania.” The Australian and New Zealand Journal of Psychiatry, vol. 56, no. 10, 2022, pp. 1357-1362, doi.org/10.1177/00048674211066004. Accessed 19 Dec. 2024.
Keuthen, Nancy J., Dan J. Stein, and Gary A. Christenson. Help for Hair Pullers: Understanding and Coping with Trichotillomania. New Harbinger, 2001.
Penzel, Fred. The Hair-Pulling Problem: A Complete Guide to Trichotillomania. Oxford UP, 2003.
“Trichotillomania (Hair-Pulling Disorder).” Mayo Clinic, 22 Nov. 2023, www.mayoclinic.org/diseases-conditions/trichotillomania/symptoms-causes/syc-20355188. Accessed 19 Dec. 2024.
"Trichotillomania (Hair Pulling)." Reviewed by D'Arcy Lyness, Nemours TeensHealth, Nemours Foundation, Nov. 2022, kidshealth.org/en/teens/trichotillomania.html. Accessed 19 Dec. 2024.
"Trichotillomania." Updated by Fred K. Berger. Reviewed by David C. Dugdale, Brenda Conaway, and ADAM Editorial Team. MedlinePlus, NIH National Library of Medicine, 4 May 2024, medlineplus.gov/ency/article/001517.htm. Accessed 19 Dec. 2024.
Walther, Michael R., et al. “Recent Advances in the Understanding and Treatment of Trichotillomania.” Journal of Cognitive Psychotherapy, vol. 24, no. 1, 2010, pp. 46–64.