Trichotillomania – The Hair Pulling Disorder

For some men and women, hair loss can be an embarrassing predicament but for others, it can be the self-inflicted result of a bad habit that's laden with guilt and shame.

Trichotilomania (trick-o-til-o-MAY-nee-ah) is a disorder that causes some people pull out hair from their scalp, eyelashes, eyebrows, and other parts of their bodies but those who do it have no idea why.

The hair pulling behaviour, which results in noticeable bald patches, varies greatly in severity. Sometimes, the urge is mild and can be quelled with a bit of extra awareness and concentration, other times it can be so strong that the sufferer can’t think of anything else. People have been known to sit for hours, pulling at their hair until half their head is bare. Others may search until they find and pull that one hair they feel doesn’t belong.

People with trichotillomania are overwhelmed by the urge to pull. It is generally not painful for them, or the pain is mild and they find the pulling gives them great relief, or even comfort. However, these feelings are quickly replaced by regret and shame. Dubbed “trich” for short, it affects roughly three to four million people and seems to be more common in women but the exact prevalence is unknown, since people are often ashamed of their behaviour and are consequently reluctant to discuss it, even with their doctor. Some people are as young as 7 when they start pulling and many will have the condition for life.

Despite what it sounds like, trichotillomania is not a form of self-mutilation, it is not caused by trauma, and because there aren’t always obsessive thought patterns involved, it’s not considered to be an obsessive compulsive disorder. Originally thought to be psychiatric disorder, trichotillomania has been likened to bad habits such as nail biting and skin picking. But for a trich sufferer, hair pulling is much more devastating than that.

Trichotillomania is now understood to be a medical condition, but the genetics and biological components are not yet known. Some have likened it to tourettes syndrome a neurological disorder marked by repetitive, involuntary movements or outbursts. Other researchers believe it’s the result of a grooming gene gone haywire. People with trichotillomania don’t like what they do to themselves but it is a relentless, uncontrollable condition for which there is no cure.

There are methods of treating trichotillomania but nothing has actually been approved or is guaranteed to work. Some doctors think a combination of anti-depressants and behaviour modification techniques could help. However, drug therapy has largely been disappointing and wearing a beanie and gloves at night won’t solve every trich sufferer’s problem. Cognitive Behavioural Therapy (CBT) is thought to be extremely helpful in getting people affected to understand their triggers - what causes them to pull or twist their hair to such extremes - and thus learn to identify and avoid them, lessening the problem and encouraging them to be 'pull-free'.

One of the primary concerns of a trich sufferer is the appearance of their hair. However, using even the clinically proven hair loss treatments wouldn't be much use to a trich sufferer. Pulling to them is like alcohol to an alcoholic and addressing the hair loss would be like pouring water into a hole-punched bucket. Many turn to wigs and hairpieces just to cover up the damage while they seek support.

The effectiveness of support groups is dependent on the individual. Knowing they’re not alone, realising there’s more to life than just hair and remembering that they still have their friends, family, skills and talents can be extremely helpful in accepting themselves the way they are.

The type of hair loss caused by trichotillomania is known as Traction Alopecia. The tugging and twisting causes excessive strain on the follicles and can damage them quite severely. Once the sufferer has dealt with the underlying cause of their urge to pull their hair out and is considered safely 'pull-free', if necessary a bespoke course of traction alopecia treatment for those aged 16 years old and above can help to accelerate the regrowth process. However, in some cases the hair loss is permanent due to the follicles being beyond help. They then scar over leaving patches of scarring alopecia otherwise known as Cicatricial Alopecia, which currently has no cure or viable treatment options.

Useful Sites:
Trichotillomania Learning Center
Trichotillomania Support UK
Daily Strength
TrichStars