Trichotillomania: Causes, Symptoms & Treatment

What is Trichotillomania Disorder (Hair Pulling)?

Trichotillomania (commonly referred to as “Trich”) is an emotional disorder in which a person feels a compulsive urge or an uncontrollable need to pull hair from their body; Or to be more precise, an inability to resist the urge to deliberately pluck the hair from their body. It is on the spectrum of disorders call Body-Focused Repetitive Behaviors (BFRB).

The impulse is not necessarily associated with a desire for pain, but rather the “thrill” before the plucking, or a feeling of relief or release of tension that accompanies plucking.

Individuals who suffer from this phenomenon can feel an urge to pull hairs from any part of the body, ranging from the head and scalp, to facial hair (e.g. eyelashes, eyebrows or beard), to other areas of the body (e.g. pubic hair or chest hair).

Studies show that between 3-6 million people in the U.S. suffer from this condition, however due to a known issue of underdiagnosis, the true prevalence may be even higher.

 

 

Statistics  show that in most cases Trichotillomania will appear in childhood and in adolescence (between 10-13 on average), and will last for several years. During childhood, there is no gender that tends to suffer more, but in adulthood women tend to suffer more than men from the condition.

Researchers found that 78% of those suffering from compulsive hair pulling also suffered from other mental disorders such as depression, anxiety, post-traumatic stress disorder, depersonalization or derealization. A high correlation was also found between Trichotillomania and alcohol addiction.  

Those who suffer from Trichotillomania are often embarrassed to talk about their issue or are afraid to seek treatment, and may even self-isolate due to feelings of shame, resulting frequently in untreated and persistent cases.

trichotillomania

Development of Trichotillomania

What Causes Trichotillomania?

Trichotillomania is one of the least understood disorders. However, there are several theories that offer an explanation for what causes Trichotillomania.

Psychodynamic theory 

One theory holds that hair pulling appears as compensation for some loss, whether real or imagined by the sufferer.

Another theory sees the phenomenon of Trichotillomania as an expression of sexual urges and aggressive urges. Also, symptoms characteristic of Trichotillomania have been documented in people suffering from trauma or who have suffered in the past.

Neurological theory

This approach treats the disorder as a neuropsychiatric problem. This claim cannot be dismissed, since psychiatric drugs have achieved positive results in treatment of the condition.

trich BFRB

 

 

Cognitive-behavioral theory

Pulling or plucking hairs is a means of releasing emotional tension. Those who pluck hairs may experience a feeling of tension or excitement before the act and relief after plucking hairs.

One explanation for the phenomenon is attributed to the individual’s tendency not to vent or release tension effectively, resulting in pent-up emotions and a need to release the accumulated tension. Another explanation is that individual’s with a tendency to negativistic thinking (judgmental, critical, perfectionistic, demanding, high expectations, etc.) contribute to the build up of tension with this type of thinking.

There are many reasons why people do not vent their feelings: they may not have learned to tolerate and acknowledge their feelings or to actively vent them in a healthy way, such as through artistic expression, mindfulness, or sharing with others.

These problems often develop in childhood, where the parents’ behavior – via modeling or feedback – “teach” the child to be afraid of strong emotions and they learn to become emotionally reserved.

The “Healthy Mindset” Toolkit further explains how unhealthy emotional habits that lead to a build-up of tension can result in the development of Trichotillomania and other emotional problems, and provides therapeutic exercises to improve emotional habits and stop pulling hair. 

If you’d like to learn more, watch the first lesson now.

Common Symptoms of Trichotillomania

What Are Other Symptoms Of Trichotillomania?

Trichotillomania has several characteristics beyond just pulling hairs:

  • The inability to control an urge to pluck is often associated with OCD spectrum disorders, as it is considered a compulsive behavior.
  • A visual consequence of the disorder is conspicuous baldness in areas of the body where the repetitive plucking is carried out.
  • The feeling of tension before pulling a strand of hair and the sensation of relief afterward are also defining characteristics.
  • Often pulling is done without awareness, and may be accompanied by a sense of derealization or depersonalization.
  • Sufferers of Trichotillomania may also engage in other behaviors with their hair that are associated with the disorder – putting the hair in their mouth, chewing or braiding, breaking, swallowing, etc.
  • Concealment and avoidance are also signs of Trichotillomania: frequently those suffering from the disorder are aware of their condition, are ashamed of it and tend to hide their condition by wearing hats or wigs, or by avoiding to appear in public.

 

 TRICHOTILLOMANIA DIAGNOSIS ACCORDING TO THE DSM-5

Trichotillomania should be diagnosed by a psychologist or psychiatrist. According to the DSM-5, a diagnosis requires that the following conditions be met :

  • Pulling hairs from the root repeatedly causing hair loss.
  • Repeated unsuccessful attempts to reduce or stop hair pulling.
  • Plucking creates emotional distress or significantly harms the individual’s social, marital, or occupational functioning.
  • The hair loss is not due to another medical condition (e.g. Alopecia).
  • The condition is not due to another disorder that provides better justification for pulling out the hair (e.g. Body Dysmorphic Disorder).

What Are The Consequences Of Trichotillomania ?

Have you found yourself pulling hair from your head or other parts of your body? It turns out that there are millions of individuals pull out hairs without really understanding why or without being aware of the consequences if it goes untreated. 

Those dealing with Trichotillomania feel an uncontrollable urge to pull out hair, which eventually leaves them with baldness in the affected areas of their body, leading to feelings of shame and anxiety, at times to the point of preventing them from engaging with others and harming their self-esteem.

Consequences of Hair Pulling include:

  • Baldness or hairless areas
  • Thin hair
  • Skin irritations and infections, itching, tingling and redness in the affected areas
  • Avoidance of social interaction = social anxiety, depression
  • Avoidance of sports and other activities such as swimming
causes of trichotillomania

Can I Check My Own Trichotillomania?

Only a mental health professional can unequivocally diagnose mental health problems.

But if you have a suspicion about your emotional state or have recognized  within yourself some of the common symptoms of anxiety, this questionnaire can enable you to get an idea of the severity of the problem and a possible need for treatment.

What Is The Treatment For Trichotillomania ?

It's Important To Understand That Trichotillomania Can Be Treated! There Are Ways Of Dealing With The Disorder That Significantly Alleviate The Emotional Distress Within A Short Period Of Time.

Although there may be periods of time when the urge to pull hair subsides for a while, the number of cases where hair pulling disappears completely without treatment are rare, and they nonetheless happen after a period of unnecessary suffering. In addition, related disorders such as anxiety, depression, use of addictive substances, and more may develop and persist after the hair pulling has stopped.

Compulsive hair pulling can cause severe emotional distress and deteriorate with time, so it is recommended to seek Trichotillomania treatment quickly. 

Medication –  Trichotillomania today is sometimes treated with anti-depressant and anti-anxiety drugs. Other treatments that have been proven to offer relief are antipsychotic drugs such as lithium, clomipramine and more. Despite the effectiveness of medication, it was found that without corresponding psychotherapeutic treatment, the disorder tends to return again.

CBT therapy – the research-based treatment approach to Trichotillomania treatment is CBT therapy – cognitive behavioral therapy, which works through:

  • Increasing awareness of hair-pulling thoughts.
  • Learning to tolerate feelings of anxiety without resorting to hair plucking.
  • Replacing the act of hair pulling with alternate behaviors.
  • Increasing self-confidence.
  • Developing and practicing healthier emotional habits.

How Does Cognitive Behavioral Therapy (CBT) Work?

Cognitive Behavioral Therapy (CBT), which has been proven in hundreds of research studies to be a highly effective method of therapy, focuses on two major areas of functioning: cognitive and behavioral.

Treatment – How to Stop Hair Pulling:

Cognitive therapy –

By identifying the thoughts, feelings, situations and factors that increase tension (thoughts of personal problems, fear, excitement, boredom, driving, writing, watching TV, speaking on the phone, etc.), we can better understand the preliminary conditions that trigger us emotionally and consequently trigger hair pulling behaviors.

  1. Negative Thinking – Treatment focuses on learning to identify thinking habits that contribute to a build up of tension, including being judgmental, critical, demanding, over-controlling, catastrophic, ruminating, and other habits that bely an underlying low self-esteem.
  2. Identifying Triggers – Once we’ve learned to identify triggers, therapy can help to increase awareness of those triggers in real time as they happen, that is, to identify signs that precede the urge to pull hair; These can be different emotions and feelings of the sufferer of the problem, such as mental stress or fatigue, but these can also be external factors that trigger hair pulling.
  3. Awareness – Often hair pulling is done unconsciously. Treatment includes increasing awareness of pulling behaviors. This can include recording and documenting each case and even collecting plucked hairs.
  4. Self-monitoring – Documenting all relevant aspects – feelings, emotions, thoughts, habits, etc., and self-awareness training help to identify and replace unhealthy emotional habits.

Behavioral therapy –

This part of therapy combines behavioral techniques and increases the patient’s ability to control situations that trigger the act of pulling hairs. The patient also acquires techniques for developing appropriate and adaptive behavioral habits, which replace the hair-pulling compulsion.

  1. Emotional Tolerance – Poor tolerance of emotion can lead to additional distress (e.g. a fear-of-fear response) when stress cannot be avoided at times. Learning to tolerate the physical manifestations and behavioral impulses of emotions can prevent the build of up “secondary distress”.
  2. Emotional release – Hair pulling is, in most cases, a substitute for healthier forms of tension release. As part of the treatment for Trichotillomania, other techniques for emotional release must be learned. In fact, there is a need here to identify the existing tendencies to restrain emotion that lead to an emotional build-up that ultimately translates into pulling out hairs; The patient must learn how to tolerate the emotion and cope with it in a healthier fashion rather than holding back or avoiding emotional expression.
  3. Habit Reversal Training – Replacing the pulling action with an alternative action – one of the important tools for those who want to stop pulling hair is to replace the pulling behavior with an alternative and harmless action. This is possible only after raising awareness and identifying the triggers and feelings that lead to hair pulling.
  4. Other Avoidance Behaviors – Even incidents of self-criticism, avoidance, and extreme perfectionism/over-controlling behavior (“control freak”) are a form of avoidance of unpleasant emotions and/or situations. The treatment of Trichotillomania makes it possible to treat these habits as well.

CBT is generally short (10-20 sessions on average), effective, focused and goal-oriented. Dr. Ohad has developed a self-help course based on the CBT method to teach individuals how to treat Trichotillomania on their own. Experience the first session now >

What do Dr. Ohad's patients with Trichotillomania have to say?

I Stopped Plucking Hairs And Learned Exercises That Help Me Cope Whenever I Feel An Urge To Pluck

During the CBT treatment, I stopped plucking hairs and learned exercises that help me cope whenever I feel an urge to pluck. Now I can deal better with problems that were difficult for me to cope with before. 

In addition, I worked on raising my self-confidence. I started the treatment with really low self-confidence and a lot of anxiety about working on personal issues, but after just one session I started to feel more comfortable.

Today I feel much more comfortable and confident.

Tali

I Stopped Pulling Out My Hair Halfway Through!

First of all, I want to emphasize that the treatment definitely helped me a lot.

I learned some good techniques on how to control my hair pulling in times of stress or frustration (trichotillomania) and now I use these tools daily.

I am now in control of my urges to pluck and I stopped pulling out my hair halfway through therapy!

Thank you very much for the support and the exercises, the treatment is excellent and I know where to turn to if I experience any trouble again. 

I wish you all success in the future, and again thank you very much for the support and I will keep in touch.

Shira

Additional Body-Focused Repetitive Behavior (BFRB) Disorders

Skin Picking (Dermatillomania/Excoriation)

Nail Biting
(Onychophagia)

Compulsive Skin Biting (Dermatophagia)

Compulsive Nose Picking (Rhinotillexomania)

Compulsive Urge to Eat Own Hair (Trichophagia)

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