What is Trichotillomania and How do you Treat it?

When I was a child I had a friend who had bald patches on her head. I didn’t know it at the time but she had trichotillomania or hair pulling disorder. What is trichotillomania? It’s a disorder that compels people to pull their hair, usually on their scalp, eyebrows and lashes but anywhere hair grows can work. Often before they pull their hair there is tension and the tension is relieved once the hair has been pulled. Shame usually follows the relief and the whole process starts again.

Trichotillomania (hair pulling disorder) is currently categorized in the Diagnostic and Statistical Manual (DSM5) under Obsessive-Compulsive and Related Disorders.. Trichotillomania (sometimes referred to as trich) usually begins in early adolescence and many kids who have this impulse control disorder may bite their nails and pick at their skin. There is a theory that this kind of body focus disorder is caused by a grooming gene that is out of whack.   While there is no cure for trich it is not considered self-mutilation and it is not caused by trauma. It is however considered chronic.

Trichotillomania has been treated with antidepressants and anti anxiety meds along with behavior modification. Sometimes it works but often times it does not and the effects can be profound on those who suffer from the uncontrollable urge to pull out their hair. Some people hide their bald patches while others isolate themselves. People who have trichotillomania may also have anxiety, depression, and other types of obsessive compulsive behaviors.

Risk factors of trichotillomania include:

Age – onset usually occurs in early adolescence, around 11-13.

Family History – though not necessarily genetic it is common for someone who trichotillomania to have a close relative with the disorder too. This could be genetic but could also be learned behavior.

Stress – People with trichotillomania are often trying to deal with negative emotions. Pulling ones hair is a way of relieving stress caused by uncomfortable feelings, the irritation and relief caused by the hair pulling can be a distraction from the uncomfortable feelings, an avoidance possibly.

So how do you cure or treat trichotillomania? Sadly there is no known cure or sure fire treatment for trichotillomania. Behavior modification shows promise but isn’t a sure thing. Medications in conjunction with behavior modification show some promise but again, there is no absolute cure for this disorder. The sooner it is identified and acknowledged the more likely treatment will be successful. Treatment can include habit reversal training which means replacing a bad habit with something else that’s not harmful. Teaching stress management skills can also be helpful by helping the person identify when they are feeling stressed so they can redirect their attention instead of pulling their hair.

If you know someone who suffers from trichotillomania or feel you might have this disorder please talk to someone about getting treatment. Talk to your pediatrician or primary care physician for a referral.