What is Trichotillomania & How Is It Managed?

Trichotillomania, also known as a hair-pulling disorder is an irresistible desire to pull out one’s own hair, which results in noticeable hair loss. Let us understand what is trichotillomania and how is it managed.

What Is Trichotillomania?

Trichotillomania is an impulse control disorder in which a person is unable to resist the desire to pull the hair and is commonly associated with functional impairment. Hair can be pulled out from the scalp, eyebrows, eyelashes, and other parts of the body.1 The hair pulling might be involved in various degrees.

  • Focused Hair Pulling: Hair pulling is done with the intention of tension relief from pulling. It can involve pulling a certain type of hair.
  • Automatic Hair Pulling: Pulling of hair while being engaged in other activities such as watching TV or doing other mindless activity.
  • Mixed Hair Pulling: It involves a mixture of both types of hair pulling i.e. focused hair pulling and automatic hair pulling.

Trichotillomania is a type of impulse control disorder. The person knows they can cause damage but are unable to stop themselves. This hair pulling can lead to partial or complete removal of hair from the eyebrows or eyelashes and also patchy hair loss on the scalp. People suffering from trichotillomania might also have depression or anxiety.

The precise cause of this problem is unknown, but it can be related to the abnormalities in the brain pathways which are linked with the emotion regulation, movement, impulse control, and habit formation. It is more likely to occur if it runs in the family, as some studies have reported high chances of trichotillomania in first degree relatives.2

Symptoms of Trichotillomania

Apart from hair pulling which is a main feature of Trichotillomania the associated symptoms are:

  • A feeling of tension while pulling the hair or while resisting the urge to pull the hair.
  • A satisfied, relaxed, and pleased feeling after pulling hair
  • A compulsive habit of playing with hair that are pulled out.
  • Problems in social life due to the habit of hair puling
  • The scalp shows patches of hair loss
  • Behavior such as inspecting the hair, twirling hair, chewing or eating hair, and pulling the hair between the teeth.
  • People with this condition tend to hide their hair loss by wearing scarves, hats, and false eyebrow and eyelashes.

How is Trichotillomania Managed?

Trichotillomania is diagnosed with the presence of signs and symptoms. There is no particular test to identify it, but the doctors follow a specific diagnostic criteria to confirm the condition.

There are various complications associated with the condition such as infection, skin damage, and permanent hair loss. These complications can further lead to low self-esteem and body image. Early treatment and management are therefore very important. So, how is trichotillomania managed?

Trichotillomania can be managed by habit reversal training (HRT), which is a type of behavior therapy. In this therapy, the bad habit of the patient is replaced with other less harmful habits. The patient is asked to identify when and what urges them to pull hair and how to relax and divert their attention to something else. It mainly includes awareness training, competing response training and social support.3

An activity known as competing response, in which the patient is advised to make a fist when an urge to pull hair occurs. Cognitive therapy addresses to anything with triggers the behavior such as stress. Stress management is a good option as it is the main trigger of hair-pulling behavior.

Antidepressant medications are also a part of the Trichotillomania treatment program. Atypical antipsychotics such as olanzapine and aripiprazole are also used along with the antidepressants. There is no proven treatment to prevent trichotillomania, but getting treated or leaning the management techniques as soon as possible can prove to be of big help.

Knowing what is trichotillomania helps to provide the much needed support. The most effective way how it can be managed is best decided by the treating physician.

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