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Understanding trichotillomania and how to deal with it

  • The whats, whys and hows of this psychological hair-pulling disorder, along with expert advice

People suffering from trichotillomania have the constant urge to pull out their hair, either from the scalp, eyebrows or other body parts
People suffering from trichotillomania have the constant urge to pull out their hair, either from the scalp, eyebrows or other body parts (Unsplash/Vladislav Muslakov)

Do you find yourself tugging at your hair while thinking or focusing? Do you often pull at your brows with your nails? If so, you may be suffering from Trichotillomania (TTM), a hair-pulling disorder where a person has the constant urge to pull out one’s hair, either from the scalp, eyebrows or other body parts. About 0.5-2% of people suffer from this condition and it often, unfortunately, goes undiagnosed. The disorder, however, can have lasting effects, both physically and mentally. Read on for a lowdown on this rare condition.

What is Trichotillomania?
Trichotillomania is a compulsive hair-pulling disorder that occurs both consciously and unconsciously, where you feel the urge to pull out hair from the scalp, eyebrows, beard, and other body parts. It can be triggered by boredom, stress, anxiety or some form of trauma. In some cases, people suffering from trichotillomania also go through a condition called trichophagia, which involves chewing, biting, licking, and in some extreme cases, swallowing your own hair, causing problems in the gastrointestinal tract.

Most often, people develop this condition in adolescence, which if not diagnosed and treated in time, can continue well into adulthood.

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Trichotillomania is a body-focused behaviour. Hence, its symptoms are mostly physical. People indulge in repetitive pulling out of hair, which results in hair loss on the scalp, eyebrows, beard and other body parts. Dr. Anjali Chhabria, founder of Mindtemple Institute of Behavioral Sciences, Mumbai, explains, “Trichotillomania falls under the category of Body-Focused Repetitive Behaviours (BFRBs), a group of related conditions that involves self-grooming behaviours such as skin picking and nail biting."

Some people experience behavioural symptoms like a sense of relief and satisfaction after pulling out hair and also feel the need to perform other repetitive actions like counting or twisting hair. In this condition, people also pull hair out from other things such as clothes, pets, dolls, and even blankets.

For many, this hair-pulling action is more focused and intentional as it relieves stress or tension. For others, it is an automatic action done when they are bored, watching television or reading. In fact, a person might indulge in both automatic and focused hair-pulling depending on the situation and mood.

Researchers are still not certain about the exact causes of TTM. Some studies show that the condition could be genetic. Dr. Chhabria explains, “There is evidence to suggest that trichotillomania may have a genetic component. Individuals with a family history of this disorder are more likely to develop it themselves.”

There could also be a link between low vitamin D levels, where such a person is more susceptible to this condition. In fact, studies have shown a direct correlation between low vitamin D levels and many psychiatric illnesses, such as depression and obsessive-compulsive disorder (OCD), as it reduces pivotal chemical functions in the brain. 

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“Some research indicates that imbalances in certain neurotransmitters, such as serotonin, dopamine, and norepinephrine, may play a role in trichotillomania. These chemicals are involved in mood regulation and impulse control,” says Dr. Chhabria. This mental disorder is often related to other conditions like anxiety, depression, autism and attention deficit hyperactivity disorder (ADHD). However, not everyone with these conditions will suffer from TTM. “Pulling out hair may serve as a coping mechanism for individuals experiencing emotional distress,” adds Dr. Chhabria.

According to the National Organisation of Rare Disorders, a person who has been through some form of childhood trauma is more likely to develop trichotillomania. Dr. Chhabria confirms, “Some cases of TTM may be associated with traumatic experiences or childhood adversity, though not all individuals with the disorder have such histories.”

The treatment of trichotillomania would essentially depend on the severity of the symptoms the presence of other mental conditions associated with it. A combination of treatments including therapy and medication has proven to be effective in reducing the symptoms. Dr. Chhabria explains the different therapies used to treat people suffering from this condition.

Comprehensive Behavioural (ComB) Treatment is a cognitive-behavioural therapy developed to address TTM. It encompasses various techniques aimed at helping individuals manage their hair-pulling behaviour effectively. The therapy includes habit reversal training, stimulus control and relaxation training.

Habit Reversal Training (HRT) is a fundamental element of ComB that focuses on identifying triggers and situations that lead to hair-pulling. Individuals are taught to replace hair-pulling behaviour with a competing response, such as clenching their fists or sitting on their hands. The goal is to increase awareness of the hair-pulling behaviour and provide alternative responses when the urge arises.

Stimulus Control is another ComB strategy that involves making changes to the individual’s environment to lessen hair-pulling triggers. This could involve taking down or concealing mirrors, wearing gloves or helmets, or avoiding circumstances that cause hair tugging.

Relaxation Training is a component of ComB that teaches people relaxation techniques like deep breathing or progressive muscle relaxation to help them cope with stress and anxiety, which triggers hair-pulling.

ComB also includes other components such as cognitive restructuring, social support, and self-monitoring to help people manage their hair-pulling behaviour and improve their overall quality of life. 

“Medication plays a crucial role in reducing the symptoms of trichotillomania. Since trichotillomania is considered to be in the OCD spectrum, medications effective in treating OCD may be used. It is important for every person suffering from trichotillomania to receive an evaluation from both a psychiatrist and a psychotherapist. The prescribing psychiatrist will determine the medication based on the patient's medical history and genetic factors, as what works for one individual may not be suitable for another,” Dr. Chhabria explains.

Trichotillomania is a complex condition with multiple causes ranging from genetic and cerebral to environmental and hormonal influences. An effective treatment should include a holistic approach that can address some or all factors. It is advisable to seek the help of an experienced healthcare professional to treat this condition.

Shweta Dravid is a self-confessed explorer who writes on travel, health, wellness, mindfulness and life truths.

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