Diagnosis spotlight: trichotillomania

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We all have nervous habits, like biting nails or chewing on pencils. But when taken to an extreme, such repetitive actions can become a serious problem. One case is trichotillomania, a condition of repeated compulsive hair pulling that results in hair loss. While much more than a nervous habit, it can have similar feelings of instinctive impulsivity and a soothing power. It is also difficult to stop, so much that professional help is often needed.

Hair pulling can occur at numerous different sites on the body. Some of the most common ones include the scalp, eyebrows and eyelashes. With the latter two, they may become removed completely. Trichotillomania of the scalp can lead to visible hair thinning and baldness. To be diagnosed with it, efforts to stop must have failed and there must be significant distress and/or impairment in at least one major area of life. This might include avoiding social situations due to embarrassment or shame. It can be exasperated by stress.

Trichotillomania is more common than you may think. According to the DSM (psychiatric diagnostic manual), it affects 1-2% of the adolescent and adult population in any given year. Women are ten times more likely than men to have trichotillomania. In children, the ratio is more even. 

There can also be accompanying behaviors to trichotillomania. Rituals may be established in how the hair pulling is done. This might include looking for certain types of hairs, trying to pull out hair in a specific way (like leaving the root intact), studying the hair, playing with it and chewing the hair. It is not required diagnostically, but other body-focused symptoms (nail biting, lip chewing, skin picking, etc.) can be present. Trichotillomania also often co-occurs other mental illnesses, notably major depressive disorder. These should be assessed for and addressed as part of treatment.

Seeking help for trichotillomania is important. In addition to the psychosocial consequences of this disorder, there are multiple medical concerns that accompany it. It can lead to permanent damage to hair growth and quality. Less commonly, it can cause skin conditions, carpal tunnel syndrome and musculoskeletal pain. If the hair is eaten, it can cause dental damage and very painful digestive problems.

  

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Treating trichotillomania primarily involves psychotherapy. Cognitive, behavior and acceptance and commitment therapy have been found to be particularly effective. Habit reversal training might be a big part of treatment, teaching you how to redirect and lessen your behaviors. There is no FDA approved drug treatment for trichotillomania, but some drugs might help alleviate symptoms. These include SSRI antidepressants, clomipramine (a tricyclic antidepressant), olazopine (an atypical antipsychotic) and naltrexone (used to treat substance dependence).

Relapse is very common with trichotillomania. One thing to remember is that a slip up does not mean you are actually relapsing. You can engage in your behaviors without returning to them fully. Let those times simply be single instances instead of an excuse to return to full-blown pathology. Stick to any treatment plans you have developed and don’t be afraid to reenter treatment. Trichotillomania is not a character flaw. It’s a mental disorder that very well might be partially due to abnormalities in brain chemicals. That’s not your fault.

It might be difficult to seek help for trichotillomania, seeing as those who have it often find it embarrassing. Remember that it’s a real condition and that you have as much of a right to treatment as someone with bipolar disorder or diabetes. Any competent therapist will not judge you or berate you. They are there to offer support and help you learn how to manage the condition. With treatment, trichotillomania can and does get better. 

Have you experienced trichotillomania or another compulsive, body-focused problem? Share your thoughts and experiences in the comments.