Trichotillomania
Trichotillomania, also called trich or hair pulling disorder, is a mental disorder involving the irresistible urge to pull one’s hair out. This can be hair from one’s scalp, eyebrows, eyelashes, or other areas of the body.
What is Trichotillomania?
For those who have Trichotillomania, the urge to pull out your hair is recurrent and impossible to resist. Those who suffer from this disorder will often try to stop the damaging behavior but ultimately can’t control the impulse. This can cause noticeable hair loss and lead to the development of bald patches, which then causes extreme distress and self-consciousness.
This distress can hinder one’s daily functioning, bringing a great deal of anxiety to social plans or work. People with hair pulling disorder may try very hard to conceal their hair loss or bald patches, wearing wigs or hats to keep their condition undetectable.
Trichotillomania looks different depending on the person, and it can range from manageable to debilitating. Some people with this disorder can manage it for the most part and live a normal life, while others may feel that their lives are completely overtaken by it. Trich is considered to be a life-long disorder.
Who is Affected by Trichotillomania?
Although trich can affect people in any age range, it’s most common in teenagers and young adults. The most common age of onset is between 10 and 13 years old. Before puberty, it affects equal numbers of females and males. Studies show that 1 in 50 people will suffer from hair pulling disorder throughout their lifetime.
However, after puberty, there are higher rates in women than in men, with women being four times more likely to be diagnosed than men. However, women are more likely to seek help for mental disorders than men, so scientists are unsure what the true difference is.
Symptoms of Trichotillomania
The primary symptom of trichotillomania is pulling one’s hair out, but this is often accompanied by feelings or other related behaviors. Some common signs of trich include:
● Pulling your hair out repeatedly, from your scalp, eyelashes, eyebrows, or other body areas
● A feeling of tension or stress that builds if you resist the urge to pull and is alleviated after hair is pulled
● Hair loss, like bald patches on the scalp or missing eyelashes
● Patterns of hair pulling, or rituals that accompany the action
● Chewing or eating hair that’s been pulled out
● Touching or playing with pulled-out hair
● Attempting without success to stop pulling your hair out
● Issues with daily functioning, such as work, school or social life, due to pulling your hair out
● Low self-esteem or shame because of hair pulling
Trichotillomania often goes hand in hand with other habits like biting your nails, picking your skin or chewing your lips. Some cope with their urge to pull their hair out by pulling hair or thread from objects like blankets, pets or dolls. It's common for people with trichotillomania to attempt to keep the disorder hidden, pulling hair out in private and attempting to conceal the urge in public.
Different Presentations of Trich
Trichotillomania can manifest in a number of different ways, and it looks different depending on the person. Some people with trich pull their hair out intentionally to alleviate the tension they feel. Others engage in the behavior distractedly while in the middle of an activity, without even realizing they’re doing it. Some may do a combination, pulling their hair out intentionally at times and automatically at other times.
Some with trich develop elaborate rituals, like selecting the perfect hair to pull out or rubbing pulled-out hair on their face. Trich can also be related to emotions. For instance, some use the activity to cope with negative feelings like stress, boredom, fatigue or frustration. Others pull out their hair because it feels satisfying and comes with a sensation of relief. For some, trich can become an addiction, and the more someone pulls their hair out, the more they want to do it.
This chronic disorder can change over time, getting worse during various moments of one’s life. Since some engage in hair-pulling due to stress, the disorder can worsen during difficult times such as a divorce or lay-off. Symptoms can be present or dormant for weeks, months or even years at a time. A small subset of people will have trich for just a few years of their life.
Causes of Trichotillomania
Researchers haven’t discovered the exact cause of trichotillomania, but there are a number of theories. Some potential causes include:
● Stress or difficult life events
● Chemical imbalance in the brain
● Change in hormones during puberty
Risk Factors of Trichotillomania
Although the causes of trich are unknown, scientists have discovered risk factors that make it more likely to develop. Some factors that make a person susceptible to trichotillomania are:
● Genetics- those who have a close relative with the disorder are more likely to develop it themself.
● Age- the most common age to develop trich is between 10 and 13 years old
● Other mental health disorders- there are a few mental health disorders that make it more likely that you’ll develop trich. Those with OCD, major depressive disorder, anxiety disorders and substance use disorders have a higher chance of developing trich
● Stress- extreme stress or difficult life events can trigger hair pulling disorder
How Trichotillomania Affects Your Life
Trichotillomania can be a minor, manageable condition for some, while it greatly affects the daily functioning of others. Some ways that hair pulling disorder can impact your life include:
● Distress- it’s common for those with trich to feel shame and embarrassment about their hair-pulling habit. This can lead to low self-esteem, depression, drug use and anxiety.
● Difficulty functioning in daily life- trich can greatly affect one’s ability to function in day-to-day life. The embarrassment and shame can cause people to avoid social situations or in-person jobs, leading to isolation and a lack of intimacy. Many will go to great lengths to keep their condition from being discovered.
● Damage to skin and hair- chronic hair pulling can damage one’s skin or hair, leading to infections, scarring, or decreased hair growth.
● Hairballs- those with trichotillomania who eat their hair can damage their digestive tract. Habitually eating your hair can cause a large hairball to form. In serious cases, this can cause health issues like weight loss, obstruction of your intestines and death.
Treatment for Trichotillomania
Trichotillomania is a chronic disorder in most cases, but with the right treatment it can be a manageable disorder that doesn’t greatly affect one’s daily life. Medications are typically not used to treat this chronic disorder. One of the most common treatment options is cognitive behavior therapy (CBT). This type of therapy involves changing thought patterns to then alter your behaviors. CBT can be used to determine the dysfunctional beliefs you have related to hair pulling, along with helping you to accept your impulse to pull your hair without acting on it.
Habit Reversal Training
The type of CBT most commonly used for trich is called habit reversal training. This is focused on changing a specific damaging habit, replacing it with a less harmful behavior. Habit reversal training often includes:
● Identifying the triggers of your hair pulling and figuring out how to avoid them if possible
● Recording your hair pulling activity in a diary
● Engaging in another behavior when you feel like pulling your hair, such as playing with a fidget toy
It can also be helpful to tell loved ones about your condition, as having support from others can make people with trichotillomania feel less alone in their struggle.
Tips for Coping with Trich
If you suffer from trichotillomania, it’s highly recommended to see a mental health professional and pursue treatment. However, there are a number of things one can do on their own to combat the urges and negative impacts inherent in trich. Some ways to cope with trich include:
● Finding a replacement behavior for pulling hair, like squeezing a stress ball, using a fidget toy, or squeezing your hand into a fist
● Wearing a bandana or tight hat to make hair less accessible
● Cutting your hair short
● Putting band aids on your fingertips
● Repeating a mantra or saying instead of following the urge to pull your hair out
● Using breathing techniques to fight the urge to pull your hair
● Coping with stress by exercising, taking a bath or doing self-care
As helpful as these techniques can be, the support of a therapist can be key in combating the urge to pull your hair out.
If you’re currently experiencing symptoms of trichotillomania, reach out now. We can help.