Already two centuries ago it was said that from nervousness a person tears his hair from his head. But what if such a reflex accompanies us all the time? When should we be concerned?
Could constant pulling out of one’s hair be a disorder? And if so, where to seek help?
What is trichotillomania?
Trichotillomania is a fairly rare disorder characterized by uncontrollable pulling out of one’s hair. It leads to hair loss or significant thinning of hair.
There are two varieties of trichotillomania. In the first, the sufferer concentrates on the hair pulling itself – doing it very carefully and consciously. In the second, on the other hand, the action is more reflexive. It occurs while doing other activities, such as watching TV, reading a book or making a phone call.
“I need to … pull my hair out,” or how does pulling my hair out relieve tension?
After all, at first glance, trichotillomania doesn’t do any good – or even harm. After all, rather than hair loss, we dream of a healthy and voluminous hairstyle.
However, our habits have a purpose. They aren’t random and don’t appear for no reason; something always triggers them. Just think about how we react when we get an itch from something – we immediately want to scratch and remove the unpleasant feeling of our scalp. And what does such a mechanism have to do with hair pulling? It turns out that it really has a lot.
Let’s look at the activity of pulling out one’s hair as a quick way to relieve tension. The whole thing then becomes much clearer. Let’s imagine the following situation:
We feel more and more tense. We don’t even know where the stress came from, but it’s already here – and it’s getting better.
We want to get rid of the discomfort as quickly as possible. Make a small move that will bring us relief.
Without thinking, we lift our hand toward our head. We pull. We have one hair less, but the tension has gone somewhere.
Calmness appears – or at least until the situation repeats itself…
This is precisely the key to explaining trichotillomania. Pulling hair out of our heads becomes our way of releasing tension. Unfortunately, however, it is a solution that brings only short-term satisfaction. Quickly, another impulse arises, the behavior repeats itself, and a compulsion to perform a certain activity emerges. This mental disorder makes it increasingly difficult to stop the harmful habit.
Why doesn’t everyone tear their hair out?
If pulling one’s hair out brings relief, why doesn’t everyone do it?
First, pulling out one’s hair may have become a learned reaction. We once pulled our hair out in a stressful situation and noticed that it helped us. So we may want to repeat this behavior. The next time we feel uncomfortable, we will use a familiar strategy. And over time, we will find that we already have a hair-pulling reflex that is impossible to control.
Pulling out hair can also be part of a broader ritual to bring relief. So it’s not just about getting rid of the hair, but playing with it, wrapping it around your finger or breaking it into smaller pieces. Only the performance of subsequent activities provides satisfaction and relief from anxiety. Generally in such a case, intrusive thoughts about hair and pulling it out also arise during the day. And this may resemble the mechanism of obsessive-compulsive disorder. Read also: Dermatillomania – what is it and how to stop skin plucking?
Causes of trichotillomania
Let’s collect the causes of trichotillomania below. Both those just mentioned and those that have not yet been mentioned.
Causes:
– genetic predisposition,
– chemical changes in the brain,
– brain damage due to trauma,
– obsessive-compulsive disorder,
– pulling one’s hair out as a strategy for coping with stress.
Trichotillomania – a neurosis
The compulsive urge to pull out one’s hair can be linked to the presence of obsessive neurosis (obsessive-compulsive disorder). By performing a particular activity, one relieves tension and experiences temporary relief.
Neurotic disorders lead to experiencing significant discomfort. They force us to withdraw from contact with loved ones and isolate ourselves from people. They obscure our whole world with unpleasant worries and prevent us from enjoying what has always brought joy before.
Fear, anxiety and insecurity follow us step by step. We agonize, trying to predict when the neurosis will strike again and make us pull our hair out.
Problems of trichotillomania – eyelashes, eyebrows, body hair
Trichotillomania is most often associated with pulling hair out of one’s head (as many as 75% of patients do it). However, this is not the only area of the body that can be affected by the disorder. Often we find that patients indicate more than one affected area.
The most frequently mentioned areas include eyelashes and eyebrows (answers given by nearly 50% of patients). One in five patients pluck hair from their intimate area, and one in ten from their chin.
Symptoms of trichotillomania
Trochotillomania belongs to the group of control and impulse disorders.
The most important symptoms are:
- impulsively plucking hair from the head, eyebrows, eyelashes or other areas of the body,
- accompanying plucking with additional activities, such as playing with the hair, breaking it into smaller pieces, moving it around in the mouth, chewing or eating the hair,
- attempts to hide the plucked hair and mask the loss with appropriate hairstyles, wigs, and makeup (occurs especially with high severity of trichotillomania),
- difficulty in reducing or eliminating the need to pull out hair (despite the awareness that this behavior is not conducive),
- feeling relief immediately after pulling one’s hair out,
- dissatisfaction with one’s appearance and feeling unattractive,
- fear that someone close to us will pay attention to our behavior,
- low self-esteem,
- loneliness,
- lowering of mood.
Trichotillomania and trichophagia
Some patients with trichotillomania are also found to have trichophagia – eating fragments (for example, the very ends) or whole hairs. In some cases, not only one’s own hair is eaten, but also those found in the environment. However, such severity of trichophagia is quite rare, and most often affects children and patients with multiple co-occurring disorders.
Rapunzel syndrome
Trichotillomania, accompanied by trichophagia, is a particularly dangerous combination for the digestive system. Ingested hairs can begin to accumulate in the stomach and form into a compact ball shape. The growing formation impedes digestion and contributes to the occurrence of obstruction of the small or large intestine. This condition is referred to as Rapunzel syndrome.
The name itself, inspired by the long-haired character in the Brothers Grimm fairy tale, does not sound dangerous. However, the consequences of Rapunzel syndrome can be very distressing and threaten our lives. With intestinal obstruction, surgical intervention is sometimes necessary to remove the hairball.
Symptoms that alert you that there is hair in the digestive tract are:
– abdominal pain,
– nausea and vomiting,
– weight loss,
– lack of appetite,
– frequent diarrhea or constipation.
Effects of trichotillomania
Hair loss
Pulling one’s hair out leads to hair loss. How much thinning there will be depends primarily on the severity of the disorder. Some people only occasionally pull out their hair and it is virtually impossible to notice hair loss in them. Others, on the other hand, do it on such a large scale that bald spots, which cannot be masked, are already conspicuous from a distance.
Reduction in quality of life
Those afflicted with trichotillomania realize they have a problem. They often try to control it. However, the habit is stronger than they are, and no amount of effort has the desired effect.
They feel helplessness and shame. They also know that most people will not understand what they are up against – so they are completely alone with their trichotillomania.
The mood lowered by the disorder, the feverish attempts to hide the problem from the world and the feeling of helplessness lead to a deterioration in quality of life. It becomes more difficult to perform daily duties and derive satisfaction from work. In addition to professional functioning, contacts with family and friends also suffer – patients often withdraw and prefer to spend their free time alone.
Unpleasant emotions
Although the act of pulling out one’s hair brings relief and satisfaction, this is a short-lived state. They are quickly replaced by feelings of guilt, dissatisfaction with oneself and shame. There is also nervousness and anger – because once again the habit has not been brought under control.
Trichotillomania in children and hair regrowth
The first description of trichotillomania was published more than a century ago – and it was not at all that of an adult patient. At the time, uncontrollable hair pulling was noticed in the pupils of an orphanage. Subsequent years of research and medical interviews also focused on younger patients.
It is estimated that trichotillomania occurs much more frequently in children and adolescents than in adults. It is found as early as in four-year-olds, but as a rule, the diagnosis is not made until the teenage years (usually between 11 and 13).
In general, the earlier the first symptoms occur, the milder the course of the disorder will be. Some researchers even suggest that trichotillomania is more likely to resolve spontaneously in preschool children. However, this does not mean that it should be ignored and pretend that nothing is happening.
Causes of trichotillomania in children:
– abnormal family relationships,
– rejection from peers,
– stress related to school difficulties,
– sudden life changes (such as moving, hospitalization, divorce of parents).
Even if a child’s behavior draws the attention of a teacher or educator, they generally do not take further steps. Educators are often not even aware that there is such a thing as trichotillomania, and consider hair pulling to be a “bizarre” but harmless habit. Disturbing signals are often quicker to arouse the vigilance of parents, who take matters into their own hands and go to a specialist to investigate the problem.
Trichotillomania – how to stop pulling out?
Facing the symptoms of trichotillomania is a nuisance. What’s more, it also proves to be time-consuming. Some patients even spend several hours a day pulling out their hair and the accompanying habits. So it is not worth looking at trichotillomania as an insignificant problem and pushing it to the background.
Every patient knows very well how difficult it is to resist the impulse to pull out one’s hair. For although we are aware that this behavior is not good, we cannot avoid it. All attempts to control ourselves usually fail. This causes frustration, because we see that we are not so strong to take control of the impulse.
So what to do? Give up? Of course not! In the first place, it is necessary to admit that the problem is beyond us. We can’t cope on our own – we’ve convinced ourselves of this by trying many different ways. It’s time to go to a specialist and let him act.
How to diagnose trichotillomania?
Proper diagnosis of trichotillomania requires a thorough medical history. However, you don’t have to be afraid of it – it’s a conversation in which we will be questioned about our ailments and how they affect our daily functioning.
The diagnosis of trichotillomania should take into account the severity of the symptoms and their duration. Last but not least, how severely the difficulties experienced interfere with our ability to work, perform household duties and maintain social relationships.
In the course of diagnosis, we can reach much deeper than we initially assumed. A skilled specialist’s eye can piece together multiple symptoms and describe what’s wrong with us. And it may be more than trichotillomania alone.
After all, simultaneous trichotillomania can occur:
– anxiety disorders,
– depressive disorders,
– mood disorders,
– eating disorders,
– behavioral addictions,
– abuse of psychoactive drugs,
– attention deficit hyperactivity disorder (ADHD).
Why is a diagnosis necessary?
None of us likes to be bothered by something and have it “not pass on its own.” Nor will any of us be happy to learn that we have a disorder. But getting a diagnosis is essential for effective treatment.
We can’t fight the symptoms of a disease we have no idea about. The same is true for treating disorders related to the human psyche. To tailor the appropriate action, we simply need to make a diagnosis. It is she who will indicate what direction to take and bring us closer to our goal – that is, to get rid of unpleasant symptoms.
Trichotillomania disorder – how to treat it?
Treatment of trichotillomania is tailored individually to the needs of the patient. This means that there is no one-size-fits-all method or medication to reach for.
The measures taken take into account age, intensity of symptoms and concurrent disorders. Sometimes antidepressants and anti-anxiety medications need to be prescribed. In many cases, however, drug treatment is not reached. Instead, psychotherapy in the cognitive-behavioral stream is implemented. Habit change training, which focuses on careful self-observation, impulse control and the use of relaxation techniques, is also highly effective.
Trichotillomania – cognitive-behavioral therapy
Cognitive-behavioral therapy (CBT) is one of the most widely used therapeutic approaches for treating trichotillomania. CBT focuses on identifying and modifying thoughts and behaviors that contribute to the problem. In the case of trichotillomania, this therapy can include several key components:
- Awareness of one’s own habits. The first step in CBT therapy for trichotillomania is understanding and being aware of one’s own hair-pulling habits. The patient and therapist work together to identify situations in which hair pulling occurs and the thoughts and feelings associated with it.
- Conscious Impulse Control Techniques. CBT therapy helps develop skills in conscious impulse control. The patient is taught to recognize moments when the urge to pull out hair occurs, and to replace this behavior with alternative responses that do not cause hair loss.
- Developing strategies for coping with stress. Because stress can be one of the factors contributing to trichotillomania, CBT therapy focuses on developing effective coping strategies to deal with stress. This may include learning relaxation techniques, meditation or emotion management skills.
- Modifying thoughts and beliefs. CBT helps the patient identify and modify thoughts and beliefs that may be contributing to trichotillomania. The therapist and patient work to change negative thoughts into more positive and constructive ways of thinking.
- Supporting self-esteem. Boosting positive self-esteem and building self-esteem are important components of CBT therapy for trichotillomania. This can help the patient cope with negative emotions that may be associated with the disorder.
How will psychotherapy help you?
– in understanding your own reactions and behavior,
– in discovering your needs and understanding yourself,
– in learning about the disorder and its characteristic mechanisms,
– in changing some of your internal beliefs to ones that will better serve you,
– in mastering effective ways to cope with daily stress and difficulties.
Don’t be ashamed to seek help for your trichotillomania problem, you deserve support and appropriate interactions!
Bibliography:
Gawlowska-Sawosz, M., Wolski, M., Kaminski, A., Albrecht, P., Wolańczyk, T. (2016). Trichotillomania and trichophagia – diagnosis, treatment, prevention. An attempt to establish treatment standards in Poland, Psychiatry Poland, 50(1), pp. 127-143.
Makowska, I. (2020). Trichotillomania in children and adolescents. Dermatology after graduation, 20(2), pp. 43-46.
Szepietowski, J., Solomon, J. (2009). Trichotillomania – clinical picture and management. Dermatological Review, 96, pp. 104-106.