Trichotillomania - Causes, Symptoms, Diagnosis, and Treatment

What is Trichotillomania?

Trichotillomania is commonly known as a 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 is 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 the head, eyebrows, private parts, or from anywhere in the body. This behavior might create a reassurance 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 pattern. 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.

Why Does One Pull Hair Out Strand by Strand?

One pulls hair out strand by strand because of several reasons. Some of them include-

• Tactile Sensation: The sensation of pulling out hair can to some the pleasure or comfort that other people feel when being touched. It could be the case that the act of pulling each strand will work as a self-calming or tension-reliever mechanism.

• Sense of Control: Trichotillomania tends to start as a coping mechanism, particularly among people who are too overwhelmed or stressed in their lives and are trying to regain their sense of control. The constant effort of pulling hair strand by strand may help them regain the perception that they have power over their bodies and the environment where they live, at least for a short period of time.

• Emotional Regulation: Many will do that to keep their emotions under control. They may pull their hair out when they are bored or stressed. The behavior of yanking out hair might cause the individual to not feel too bad for a bit. In doing so, worries such as anxiety, tension, boredom, or anger also relieve themselves.

• Sensory Stimulation: Teasing out hair strand by strand, just like all the other repetitive phenomena, such as nail-biting, and skin tagging, can give a sensation. These pickles are, therefore, strengthening and eventually become ingrained, and results in a vicious circle of pulling hairs.

• Trichotillomania Subtypes: The face presents it differently for different individuals suffering from trichotillomania. Hair loss can be an agonizing experience for some leading to tunk-tunk plucking while for others, it may be clumps or patches of hair that they rip out. The particular conduct, however, might be different as per the personal inclinations of the individual and their triggers.

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 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:

• Poor parenting in childhood.

• Traumatic family relationships.

• Low self-esteem.

• Post-traumatic stress disorder.

• Family history.

• Genetics.

• Anxiety and depression.

• Emotional trauma.

What Are the Types of Trichotillomania?

Based on whether the person is mindful of 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 TV.

• 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 shyness or guilt feeling of the patient. 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 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 to Stop Pulling Out Hair?

Trying to prevent an individual from hair pulling or trichotillomania can be difficult, but it is out there for someone who approaches it correctly and has support from people around. Here are some strategies that may help. Here are some strategies that may help:

• Seek Professional Help: Read a website on trichotillomania or speak to a psychologist or psychiatrist who is proficient in the field of trichotillomania treatment. This is where they can achieve personalized treatment plans and individualized approaches appropriate to your specific requirements.

• Habit Reversal Training (HRT): HRT is a behavior therapy that is specific for hair pulling, teaches people to identify triggers, and develops alternative actions, for example clenching fitting hands, and engaging in relaxation techniques.

• Mindfulness and Relaxation Techniques: Using mindfulness meditation, deep breathing exercises, or progressive muscle relaxation techniques acts as effective hair-pulling triggers for relief from anxiety and stress which often lead to the condition.

• Identify Triggers: Keep a record of the times and places that make you feel a need to pluck out your hair. Here are some extrapolations that explore the influence and implications of automation on different aspects of society. One of the most significant effects of automation on the workforce is job displacement. With the rise of automated systems and the increasing use of machines to perform tasks that were previously carried out by humans, there is determining activators will enable you to predict and avert scenes that are likely to lead to picking repetitions.

• Modify Environment: Alteration of the environment will help you prevent hair pulling or aid to do so. Say, occupy your hands with fidget tools like rubber bands or wear mitts that make access to your hair difficult.

• Social Support: Look for support from friends, family, or groups specifically designed to support the individuals with trichotillomania with you. Sharing experiences and getting moral support from recovering people are outstanding features that play a huge role in the transition phase.

• Healthy Lifestyle: Practicing a healthy lifestyle having plenty of physical activity, good nutrition, and enough rest is a must. Of equal importance is your overall well-being, which can help you to suppress the hair-pulling behavior and it can boost the mood.

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?

• Iron deficiency.

• Hypothyroidism.

• Thallium poisoning.

Conclusion

Trichotillomania is a challenging condition that can significantly impair individuals' quality of life. However, with proper diagnosis and treatment, many people can learn to manage their symptoms and lead fulfilling lives. It's essential for those affected by trichotillomania to seek support from mental health professionals and loved ones to navigate their journey towards recovery.