Trichotillomania: Losing hairs

Not Just Hyperbole.
Not Just Hyperbole.

We've all heard the phrase "I feel like pulling out my hair". Some of us have even said it. It's an idiom. No one takes it seriously. As kids turn into teenagers, men are starting to lose their hair. Most assume that's where the joke comes from. The truth is that hair pulling is a real, physiological, condition called "Trichotillomania".

For many, the phrase "pulling out my hair" isn't just hyperbole, it's a condition that first shows up around the age of puberty. Trichotillomania is a disorder which causes the sufferer to have an incontrollable urge to pluck out their hair strand by strand. Crazy? Since hair pulling isn't a well known (literal) problem, many sufferers fear they really are going crazy. After all, they know that pulling out hair is a problem. They dread facing the mirror in the morning. But they are compulsively drawn to repeatedly pluck out eyebrows, body hair, even hair from their own scalp. The results are an unsightly bald patch and a feeling of dread when they realize they can't hide what they've just done from the rest of the world. This stress can then exacerbate the problem.

How Do You Treat Trichotillomania?

Since so much is still unknown about trichotillomania, there are still a variety of treatment options. Since individuals are different, what works well for one may not help another. The best approach seems to be multifaceted.

  • Cognitive Behavioral Therapy enlists the help of a trained therapist. The therapist will work with the individual to help them feel in control of symptoms, rather than controlled by the need to pull hair.
  • Family Therapy can help the individual's family learn how to be most supportive. However, since trichotillomania is not well understood, there aren't a lot of providers who have a firm understanding of what it really is and how best to help. When seeking therapy, look for a therapist who is up to date on current findings and follow your own instincts as to whether the suggested protocols are helpful or hurtful.
  • Treating coexisting conditions such as ADHD, Depression, or Clinical Anxiety will also lessen the impact of trichotillomania, effectively by treating the underlying disorders you will also 'treat trich'.
  • Medication is often considered when a problem doesn't go away quickly. Trichotillomania can be a lifelong struggle. Although some medications have appeared to help, the efficacy seems to fade over time. There is a lot of concern over what side effects may be caused and whether or not the side effects of Selective Seratonin-reuptake Inhibitors (SSRI medication) are worth the potential trade offs.
  • There is also some indication that alternative supplements may be beneficial to people with trichotillomania. Early studies indicate that N Acetyl Cysteine, an amino acid, may help reduce the urge to pluck hair with fewer potential side effects than SSRIs.

Regardless of the treatment chosen, the most important aspect in treating trichotillomania is to acknowledge that it is a valid medical condition. It isn't a family issue, or a parenting issue, or a symptom of deeper psychological problems. Treating it as if it is a behavior problem will do more harm than good.

What Causes Hair Pulling?

Trichotillomania, or hair pulling, was once believed to be purely behavioral. People with Trichotillomania were categorized under OCD or Anxiety or some other similar disorder. It is now considered either an "Impulse Control Disorder" or "Body Focused Repetitive Behavior". Trichotillomania isn't an Obsessive Compulsive Disorder. (OCD is accompanied by 'superstitious' beliefs that certain behaviors or habits can control irrelevant events. The person with OCD might think they are responsible for an earthquake because they didn't touch a doorknob the prescribed number of times before turning it. A person with Trichotillomania doesn't feel responsible for the earthquake. If they pluck more fervently after the earthquake, it's for the same reason the nail-biter is busy attacking their hangnails and the nervous-eater is snacking. Stress triggers nervous habits.)

There was also a point in time when hair plucking was believed to be intentional on some level. People with this disorder were treated as if they wanted to deface their own appearance either consciously or unconsciously. We now know that this simply isn't true.

What we don't know is exactly what causes some individuals to develop Trichotillomania. It is currently believed to be a combination of genetic, hormonal and environmental factors. Current research indicates that there may be a gene that causes certain individuals to have a heightened sense of hygeine, which in turn causes them to play with (and then remove) their hair. Whatever the cause, we do know that it is a medical condition and that the individuals are not necessarily responsible for their actions.

The hair plucker begins plucking out hair because something inside of them says it's important. They feel a need to remove hair strand by strand. And each time they pluck out an offending hair, they feel momentarily relieved, like things are getting better. They may feel that the hair doesn't belong, even if they can rationalize that it's normal to have a full head of hair and they'll look different and unappealing with a bald spot. Once they begin pulling, it becomes a nervous habit, like nail biting. While they can get it consciously under control, any stressful situation can trigger a new hair pulling session. And, of course, when they see the damage done to their appearance, the depression makes it difficult to give up pulling again. It can be a nasty cycle.

Living With Trichotillomania

If you or a loved one are literally pulling out hairs (one by one, strand by strand), it's important to seek treatment. But rather than looking at it as an illness that needs 'curing', look at trichotillomania as a lifelong condition.

People with trichotillomania need to learn how to live with it in order to take control after the trichotillomania gets the best of them. Some feel empowered by the ability to hide the damage they've done. The availability of wigs and hair pieces help them to hide large bald patches. Creative hairstyles and make up application may help others. Trendy hats are great, but often forbidden in classrooms.

For avoiding the temptation to pull in the first place, a small fidget toy can be an effective tactic. It's hard to pull hair when your hands are otherwise occupied. Fidget toys are available in a wide price range, and can be anything as simple as a small party favor or koosh style toy, to a hand sized metal key fob designed for the task. There are also 'spinner rings' that can be purchased and used as fidgets. These rings are actually a double ring, a larger ring fitting inside the groove of a smaller ring. The large ring can be unobtrusively spun and fidgeted with in lectures, classes and doctors offices, and the ring format makes them less likely to get lost.

Support is the most important tool anyone has for success, and people with trichotillomania are no exception. The uncontrollable urge to remove your own hair can be very isolating. It's hard to understand, and makes hair pullers feel like outcasts. Family and friends can provide unconditional love and support to people with trichotillomania. There are also support groups for adults in many cities, and a few for kids, too.

Remember, trichotillomania is an actual medical condition. It affects up to one in fifty individuals at some point in their lives, although many are able to hide or minimize the impact on their lives. It isn't easy to control or overcome. But there are some treatment options, and people with trichotillomania aren't alone.

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