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Trichotillomania: Potentially Debilitating yet Often Unnoticed

     

Trichotillomania, or compulsive hair-pulling disorder, involves repetitively pulling one’s hair out to the point of causing bald patches. Many people twist and play with their hair, but that is not the same as trichotillomania. The symptoms of trichotillomania include

  • repeatedly pulling out one’s hair, resulting in hair loss
  • repeated attempts to decrease or stop hair pulling
  • the hair pulling causes significant distress or problems at work, in social situations or other areas of functioning.

(Diagnostic and Statistical Manual of Mental Disorders, DSM-5)

Trichotillomania is one of several conditions called body-focused repetitive behaviors. Others include skin-picking and nail-biting.

hair pulling.jpgThe hair-pulling may involve hair from the scalp, eyebrows or eyelashes or beard and people may try to cover up with hairstyles, scarves, wigs or makeup. It can range from a mild condition that a person is able to manage and cope with to very severe and debilitating. People with hair-pulling disorder may experience significant distress, including shame or embarrassment, or problems with functioning, including avoiding public situations because of hair loss.

It usually first occurs in adolescence, but it may first occur in children or in adults. It can last for many years or only for a few months, and the symptoms may come and go over time. It affects an estimated 1 to 2 percent of the adults, and women appear to be more likely affected than men. However, researchers note, this may be partly because women are more likely to seek treatment and hair loss is more accepted in men. Among children, males and females are affected equally.

Consequences/Impact

While hair-pulling may not seem a big deal, the impacts of trichotillomania can be serious. A recent review of research notes that studies over the past decade have found that trichotillomania “is far from trivial in terms of its impact. Adults with trichotillomania report problems at school, work and social activities, lowered career aspirations and missed works days.” Adults also report spending a considerable amount to hide the hair loss and on treatments. The review also notes that hair-pulling disorder can also affect families, contributing to arguments and secrecy. (2)

“The shame with this is excruciating,” Mary, a woman in her 50s, recently told NPR. Mary explained that for her, it almost feels “like there is some kind of electrical buzz in me that it helps discharge. And living with that buzz is intolerable.” (1)

Treatment

The most common treatment is cognitive behavior therapy, focusing on thoughts, feelings and behaviors. Behavioral treatments generally include three core elements: awareness training, becoming more aware of the act of pulling and the urges that lead to it; stimulus control, creating barriers to the behavior, such as wearing gloves or hats; and habit reversal, engaging in alternate behavior until the urge subsides. Relaxation training is also helpful for some. (2) Treatment may also involve a combination of medication and therapy.

Find more information, referrals, events, support groups and more see the TLC Foundation for Body-Focused Repetitive Behaviors www.brfb.org. BY APA Staff

References

1. Galazka, K. For Compulsive Hair Pullers and Skin Pickers, There is Need For More Help. NPR Your Health. March 17, 2018.
2. Franklin ME, Zagrabbe K, Benavides KL. Trichotillomania and its treatment: a review and recommendations. Expert Rev Neurother. 2011, 11(8):1165-1174.
3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, fifth edition. (DSM-5) American Psychiatric Association Publishing. 2013.

     

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