Trichotillomania - Causes, Symptoms, Diagnosis, and Treatment

What is Trichotillomania?

Trichotillomania is commonly known as hair-pulling disorder. It is a psychological disorder that comes under the category of obsessive-compulsive disorder. It involves an uncontrollable urge to pluck or pull the hair in the scalp, or hair from the eyebrows, eyelashes, and private parts. Pulling of hair from the scalp might cause patches in the scalp. This condition is usually very mild, but can be moderate to severe in untreated or chronic cases.

What Are the Symptoms?

Trichotillomania has a characteristic obsession in thoughts to do a particular behavior in general. Performing such activities, again and again, will give the patient psychological relief. The patient may or may not be aware of their repetitive behaviors. If the behavior is appropriate according to the environment, then it is known as syntonic. If the behavior is not in alignment with the needs of the self, or to the environment, then it is known as dystonic. Trichotillomania is often known to be dystonic. The patient’s excessive urge to pull hair might be inappropriate in a social set-up. If the patient identifies their repetitive behavior, it might be easy for the doctor to treat the patient. If the patient is totally unaware of his own condition, the treatment might require time. The other notable symptoms are:

• Pulling or plucking the hair from head, eyebrows, private parts, or from anywhere in the body. This behavior might create a re-assurance feeling for the patient. Some patients experience anxiety while pulling their hair.

• Almost all the patients experience hair loss due to the continuous habit of pulling the hair.

• Biting and chewing the hair which the patient has pulled out.

• The patient develops an unusual urge if you try to control their compulsive pulling. There might be anger, frustration, and a sense of guilt.

• The patient might prefer to pull out a specific type of hair patterns. This may result in baldness in a particular area. Baldness occurs only in severe cases.

• Pulling out a few strands from the hair and rubbing it against the face, lips, or hands.

• Experiencing a pointless pleasure when touching and pulling the hair.

• The patients tend to pull hair from dolls and pets too.

• Poor performance in academics.

• Increased levels of stress in personal and professional life.

Whom Does It Affect?

Irrespective of gender, trichotillomania can affect both males and females. Pre-school children and young adults are commonly affected. African women are known to be affected more than other races. Trichotillomania is known to have an association with a borderline personality disorder. Patients who are affected by borderline personality disorder are known to develop trichotillomania as a self-harming behavior. The tendency to hurt oneself will be higher in borderline patients, and the act of pulling hair will be done by these patients as a compensatory deed for emotional trauma. The extensive emotional rides these patients face will make them depend on unhealthy coping habits. When borderline personality disorder coexists with trichotillomania, then such a condition is comorbidity.

What Are the Causes?

The common causes of trichotillomania are:

1. Poor parenting in childhood.

2. Traumatic family relationships.

3. Low self-esteem.

4. Post-traumatic stress disorder.

5. Family history.

6. Genetics.

7. Anxiety and depression.

8. Emotional trauma.

What Are the Types of Trichotillomania?

Based on whether the person is mindful about the behavior or not, trichotillomania can be classified into two categories:

Automatic: In automatic type, the person carelessly runs his fingers over the hair. This may be casually done while reading a book or watching the T.V.

Focused: In this type, the patients do it as a ritual for a prolonged duration. This may be accompanied by biting and chewing the hair.

How Is It Diagnosed?

Trichotillomania is very difficult to diagnose as the patient refuses to agree with their behavior. This might be due to the shy or guilt feeling the patient has. Trichotillomania is often misdiagnosed with other conditions. A biopsy result might be helpful in a few cases as it may detect perifollicular hemorrhage or defective hair patterns. Empty hair follicles can be an indicative sign of Trichotillomania. Diagnosis requires a skilled psychiatrist or psychologist to identify the condition.

What Are the Treatment Options?

The treatment options vary according to the age of the patient. It might be any medication or psychotherapy treatment.

Medication:

The tricyclic antidepressant drug such as Clomipramine is given for trichotillomania patients. This medication is not available over-the-counter and should be taken only after the doctor’s guidance.

Biofeedback: This process helps to gain control over the involuntary muscles. It helps a person to achieve awareness of their own body. It involves both auditory and visual feedback mechanisms. It helps to improve the overall functioning and health of the individual.

Cognitive-Behavioral Therapy: It is a well known psychological and therapeutic method to improve the mental health status of the patients. Self-cbt practices and books are available. However, when it is guided by professional psychotherapists, the improvement will be beneficial. With the help of cbt, thoughts, behaviors, and emotions can be brought to proper alignment.

Habit Reversal Training: Habit reversal training involves engaging the patient to identify the patient’s negative behavior, increasing their awareness about the patient’s performance and urges. This technique helps the patient to cope up with the compulsive thoughts and actions. This training method requires support from parents, teachers, and friends.

Acceptance and Commitment Therapy: This therapy is used to overcome workplace issues and stress. The importance of radical acceptance will be emphasized in this therapy. Certain intellectual thoughts will be educated so that the person does not behave only according to his emotions and urges. Self-observation will be taught, and committed actions that are healthy will be educated.

How Is the Prognosis?

Prognosis is usually good for patients below five years of age. Infants do not need any treatment protocol. The rate of prognosis is poor in patients above five years because trichotillomania in such patients may be a sign of other psychiatric illnesses. This is the best treatment option for substance abuse and chronic pain.

What Is the Differential Diagnosis?

1. Iron deficiency.

2. Hypothyroidism.

3. Thallium poisoning.

Are you suffering from trichotillomania? Call a doctor online.