ArtsAutosBooksBusinessEducationEntertainmentFamilyFashionFoodGamesGenderHealthHolidaysHomeHubPagesPersonal FinancePetsPoliticsReligionSportsTechnologyTravel

I Pull My Hair Out: Trichotillomania Symptoms and Socio-Cultural Perspectives

Updated on February 8, 2019
Charlotte Doyle profile image

Charlotte likes pretty things, and she loves the beach, sushi, coffee and seashells.

Hair Pulling - Trichotillomania
Hair Pulling - Trichotillomania | Source

Making a Differential Diagnosis

What is a differential diagnosis? A healthcare professional uses a process called differential diagnosis to find out what may be ailing the patient. They review the patient's history, the patient's symptoms, and any results that occurred from a physical exam that was administered to the patient. The differential diagnosis ends up being a list of conditions or disease states that the patient could be suffering from. To obtain a differential diagnosis, it's important to ask the patient what their symptoms are, and how long the symptoms have been going on. We need to find out if the symptoms have a trigger, and if there's anything that the patient has done that has either improved or worsened the condition.

Recommending a diagnosis based on the patient’s symptoms, presenting problems, and history:

Trichotillomania is a disorder where a person pulls their hair. It is considered a mental disorder that is part of the family of mental disease called obsessive compulsive disorder. The patient who is currently suffering from this disorder has been pulling her hair out from the scalp area, eyebrows, and eyelashes. The patient is aware of the behavior and is trying to cease the practice. The patient has a history of depression and anxiety that has been caused by her parents and also by significant life events, such as beginning college and having a relationship that started off promising but ended up failing. The hair pulling that the patient has suffered from has left areas that are considered patchy and bald, and this can cause stress for the patient's social life as well. The patient, if the situation continues, may start to go through considerable lengths to cover up the hair loss that s caused by the trichotillomania symptoms. The patient attempted to manage her symptoms by being aware, but the breakup of an intimate relationship reignited the symptoms again. Because she is aware of the situation, she is seeking help.

Assessing the validity of the diagnosis using a sociocultural perspective:

Most people are familiar with obsessive-compulsive disorders, but they are not familiar with trichotillomania. There was a study done to find out how Obsessive Compulsive Disorder and Trichotillomania are related. These findings support previous work demonstrating significant differences between OCD and TTM. The classification of TTM as an impulse control disorder is also problematic, and TTM may have more in common with conditions characterized by stereotypical self-injurious symptoms, such as skin-picking. Differences between OCD and TTM may reflect differences in underlying psychobiology and may necessitate contrasting treatment approaches. (Lochner, 2008) It appeared that patients with obsessive-compulsive disorder seemed to have more disability that lasted for their lifetime, but they patients with trichotillomania felt that they did not respond to treatment as much. Patients with obsessive-compulsive disorder seemed to have higher comorbidity, they were also more susceptible to harm avoidance but did not seek novelty as much. (Leombrune, 2016) What is harm avoidance? Harm avoidance is when a person worries excessively. They are mostly very shy and experience a lot of fear and doubt. They may also become fatigued much more easily than normal. It has been discovered that patients with harm avoidance have less grey matter in their brain, especially in the occipital regions. Temperament is considered the more heritable personality component that is stable throughout life and is responsible for adaptive emotional responses and behavioral reactions to life experiences. It is assessed through four dimensions: Harm avoidance (HA), Novelty seeking (NS), Reward dependence (RD), and Persistence (P). (Leombroni, 2016)

Comparing at least one evidence-based and one non-evidence-based treatment option for the diagnosis:

One evidence-based treatment is habit reversal training. What is habit reversal training? Habit reversal training makes sure that the patient is aware of what's going on. The patient has to go through response training and contingency management. They have to learn techniques on relaxing, and it not only helps with trichotillomania, but it also helps with biting of the nails, sucking one's thumb, issues with a stutter, and disorders of the TMJ area. A study found that Habit Reversal therapy is extremely effective. Compared to control conditions, HRT showed a large effect size pre-treatment to final post-treatment assessment. Moderator analyses revealed significant treatment effects for HRT for most moderator levels, indicating that HRT is efficacious in some variations for a variety of types of maladaptive behaviors, across a wide range of sample characteristics. The findings provide substantial support for the efficacy of HRT for disorders it is commonly used to treat. (Bate, 2011)

A non-evidence based treatment is mindfulness-based cognitive therapy. This treatment appeared to be quite effective. The goal of this treatment is to have the patient accept that the experience they are going through is uncomfortable. The problem is not the discomfort itself. The goal of those who suffer from trichotillomania is to gain the ability to be able to deal with their negative feelings but without the act of pulling out the hair. Mindfulness is a somewhat new trend where individuals face their thoughts and use forms of meditation to become present. When someone is mindful, they are more aware of their present moment in time and in a way that is not judgmental towards themselves. The therapy known as mindfulness based cognitive therapy marries the cognitive therapy concepts with practices that are considered more of the meditation realm. Once the patient is aware of their thoughts, they learn to have a different kind of relationship with these particularly thoughts that trigger their trichotillomania. The patient does homework to begin to train their brain to think differently and uses meditation, breathing exercises and yoga.

Historical perspectives and theoretical orientations that are inappropriate alternates for the conceptualizations in this case:

Individuals have been pulling their hair t for several centuries. At some point, hair pulling was considered an act that was encouraged among the ancient Egyptians. The term for trichotillomania is when a person pulls their hair as part of an aberrant act. It's when a person feels a strong urge to pull their hair out due to some anxiety or stress trigger. It is considered a new disease that is not fully understood. At this time, about one to two percent of the general population have the condition trichotillomania. People who are affected try to avoid group activities due to their appearance, as sometimes they have bald spots or areas without hair. It can lead a person to have a lower quality of life, and it is correlated with anxiety. One of the behavioral treatments for trichotillomania is to offer group treatment, but this may be considered an inappropriate alternative. While group therapy may be beneficial to some, the thought of joining a social group to talk about what is considered an embarrassing habit may cause an individual to feel more ashamed.


Bate, K. (2011) the efficacy of habit reversal therapy for tics, habit disorders, and stuttering: a meta-analytic review. Clin Psychol Rev. 2011 Jul;31(5):865-71. doi: 10.1016/j.cpr.2011.03.013. Epub 2011 Apr 5.

Leombruni, P., Zizzi, F., Miniotti, M., Colonna, F., Castelli, L., Fusaro, E., & Torta, R. (2016). Harm Avoidance and Self-Directedness Characterize Fibromyalgic Patients and the Symptom Severity. Frontiers in Psychology, 7, 579.

Lochner, C. (2008) Obsessive-compulsive disorder and trichotillomania: a phenomenological comparison. BM Psychiatry20055:2

© 2018 Charlotte Doyle


    0 of 8192 characters used
    Post Comment

    No comments yet.


    This website uses cookies

    As a user in the EEA, your approval is needed on a few things. To provide a better website experience, uses cookies (and other similar technologies) and may collect, process, and share personal data. Please choose which areas of our service you consent to our doing so.

    For more information on managing or withdrawing consents and how we handle data, visit our Privacy Policy at:

    Show Details
    HubPages Device IDThis is used to identify particular browsers or devices when the access the service, and is used for security reasons.
    LoginThis is necessary to sign in to the HubPages Service.
    Google RecaptchaThis is used to prevent bots and spam. (Privacy Policy)
    AkismetThis is used to detect comment spam. (Privacy Policy)
    HubPages Google AnalyticsThis is used to provide data on traffic to our website, all personally identifyable data is anonymized. (Privacy Policy)
    HubPages Traffic PixelThis is used to collect data on traffic to articles and other pages on our site. Unless you are signed in to a HubPages account, all personally identifiable information is anonymized.
    Amazon Web ServicesThis is a cloud services platform that we used to host our service. (Privacy Policy)
    CloudflareThis is a cloud CDN service that we use to efficiently deliver files required for our service to operate such as javascript, cascading style sheets, images, and videos. (Privacy Policy)
    Google Hosted LibrariesJavascript software libraries such as jQuery are loaded at endpoints on the or domains, for performance and efficiency reasons. (Privacy Policy)
    Google Custom SearchThis is feature allows you to search the site. (Privacy Policy)
    Google MapsSome articles have Google Maps embedded in them. (Privacy Policy)
    Google ChartsThis is used to display charts and graphs on articles and the author center. (Privacy Policy)
    Google AdSense Host APIThis service allows you to sign up for or associate a Google AdSense account with HubPages, so that you can earn money from ads on your articles. No data is shared unless you engage with this feature. (Privacy Policy)
    Google YouTubeSome articles have YouTube videos embedded in them. (Privacy Policy)
    VimeoSome articles have Vimeo videos embedded in them. (Privacy Policy)
    PaypalThis is used for a registered author who enrolls in the HubPages Earnings program and requests to be paid via PayPal. No data is shared with Paypal unless you engage with this feature. (Privacy Policy)
    Facebook LoginYou can use this to streamline signing up for, or signing in to your Hubpages account. No data is shared with Facebook unless you engage with this feature. (Privacy Policy)
    MavenThis supports the Maven widget and search functionality. (Privacy Policy)
    Google AdSenseThis is an ad network. (Privacy Policy)
    Google DoubleClickGoogle provides ad serving technology and runs an ad network. (Privacy Policy)
    Index ExchangeThis is an ad network. (Privacy Policy)
    SovrnThis is an ad network. (Privacy Policy)
    Facebook AdsThis is an ad network. (Privacy Policy)
    Amazon Unified Ad MarketplaceThis is an ad network. (Privacy Policy)
    AppNexusThis is an ad network. (Privacy Policy)
    OpenxThis is an ad network. (Privacy Policy)
    Rubicon ProjectThis is an ad network. (Privacy Policy)
    TripleLiftThis is an ad network. (Privacy Policy)
    Say MediaWe partner with Say Media to deliver ad campaigns on our sites. (Privacy Policy)
    Remarketing PixelsWe may use remarketing pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to advertise the HubPages Service to people that have visited our sites.
    Conversion Tracking PixelsWe may use conversion tracking pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to identify when an advertisement has successfully resulted in the desired action, such as signing up for the HubPages Service or publishing an article on the HubPages Service.
    Author Google AnalyticsThis is used to provide traffic data and reports to the authors of articles on the HubPages Service. (Privacy Policy)
    ComscoreComScore is a media measurement and analytics company providing marketing data and analytics to enterprises, media and advertising agencies, and publishers. Non-consent will result in ComScore only processing obfuscated personal data. (Privacy Policy)
    Amazon Tracking PixelSome articles display amazon products as part of the Amazon Affiliate program, this pixel provides traffic statistics for those products (Privacy Policy)
    ClickscoThis is a data management platform studying reader behavior (Privacy Policy)