The first time you notice yourself subconsciously pulling your hair out, you might feel alarmed. Perhaps you write it off as a one-time, out-of-the-ordinary occurrence or bad habit. Many people with trichotillomania, which the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) defines as recurrent pulling of hair, will opt not to tell anyone else because they feel embarrassed. This article will attempt to alleviate some of the mystery and concern about trichotillomania and review its potential causes and possible treatment options.
Why Do I Pick At My Head?
Many people who struggle with hair pulling urges may do so in response to stress, anxiety, or emotional distress. When you are feeling out of control, you might subconsciously pull your hair out.
Pulling hair is similar to the habit of nail-biting, which can become subconscious in response to stress, overthinking, or anxiety, and can be a difficult habit to break. Likewise, it can be hard to stop hair pulling once you have developed the response.
Hair-pulling can also be the result of an impulse control disorder or a general lack of impulse control. If you are familiar with obsessive-compulsive disorder (OCD), you might know that those who experience symptoms of this mental disorder frequently use external methods to meet the needs of OCD or another control-related challenge. For example, the individual might open and close a door a certain number of times or flick a light switch on and off a specific number of times.
When people feel an overwhelming urge to pull out their hair, it might be considered a symptom of an impulse control disorder. While this may feel intimidating, there are solutions you can consider. First, it is important to understand the textbook definition of hair-pulling disorder, also known as trichotillomania.
What Is Trichotillomania?
An individual who is diagnosed with trichotillomania (hair pulling disorder) experiences irresistible urges to pull their hair out, whether it is the hair on the individual's head, eyebrows, real or false eyelashes, arms, or anywhere else. Repeated attempts to stop hair pulling usually fail.
Even when the hair becomes more resistant to pulling, an individual with this diagnosis often cannot resist the urge without assistance. The person who pulls out their hair may feel significant distress, which can prompt the urge to pull. The act of pulling out their hair usually produces positive feelings of relief from the distress.
In more severe cases of trichotillomania, pulling hair out causes skin and hair damage that may result in preventing hair growth and even permanent hair loss. People with trichotillomania might pull out all their eyebrow hairs or eyelashes. Eating hair is also sometimes a symptom of this mental illness.
It’s important to recognize that trichotillomania is a separate condition from other mental health disorders that may result in hair pulling, such as body dysmorphic disorder, in which an individual may pull out their hair due to a perceived defect with their appearance.
How Can I Help My Child Stop Picking?
Recent research on trichotillomania found that the average age of onset was 17.7 years, with significant differences by gender. If you are a parent with a child who struggles with hair-pulling and may be developing trichotillomania, there are a few things you can do to help. For example:
- Look For Triggers: What sets the child off? Is there a specific circumstance or scenario in which they initiate hair-pulling? Identify situations that may accompany hair-pulling in young adults.
- Try Distractions: Once you know the trigger, you can start to practice stopping trichotillomania in its tracks. Try to develop a method to refocus energy toward something more productive or meditative.
- Meditation: If your child struggles with stress and anxiety, try to initiate a meditation and deep breathing practice to help prevent hair pulling.
- Up-Dos: When possible, keep hair off the face. Braids, a ponytail, or a bun can all become a roadblock to pulling hair.
- Physical Stress Reliever: A stress ball, fidget spinner, or any other stress-related toy can be a helpful distraction for self-inflicting or harmful behaviors such as pulling one’s hair.
As a parent, try to be supportive. Your child is already likely stressed about the hair-pulling and might be embarrassed or upset by the response. If you can help them feel loved and supported, you might have an easier time redirecting their anxious and stressed energy and thereby treating trichotillomania.
In addition, you can reach out and ask for help. You do not need to have all the answers by yourself; it’s okay to depend on other people. Trichotillomania is a mental health condition that can develop from genetics or as a result of traumatic experiences. There are professionals who can diagnose trichotillomania and help your child receive treatment.
What Are The Risks Of Trichotillomania?
People with trichotillomania often experience gastrointestinal issues from accidentally swallowing some of the hair they have pulled out. Swallowed hair can eventually create a hairball in the individual’s digestive tract. If you have trichotillomania and experience sudden weight loss or other complications, call a doctor about a potential blockage in your digestive tract.
Additionally, a person who has trichotillomania might feel extreme discomfort in social settings. They might feel self-conscious about the areas on their head where they have noticeable hair loss in a potentially unusual shape, or they could be nervous about their behavioral response occurring in public or in their social life.
These risks can cause low self-esteem and impact an individual’s ability to feel comfortable in public.
Unaddressed social anxieties, especially with children, can result in more serious issues down the line. For example, a child with social anxiety might struggle with self-consciousness, which can manifest in different self-destructive or self-sabotaging behaviors. With professional assistance and personal determination, it’s possible to work toward addressing anxiety and its sources.
How To Get Help For Hair-Pulling
Getting help from a therapist can be an effective way to start learning how to control symptoms of trichotillomania and stop them before they become lifelong problems. Whether you go to online or in-person therapy, a licensed professional can help you confront your hair-pulling and set you on a path to success.
One such therapy is called habit reversal training (HRT). This type of therapy helps you identify the trigger and replace the urge to pull at your hair with an action that directly inhibits your ability to pull at your hair (e.g., something that uses both of your hands).
Some psychiatrists might also prescribe selective serotonin reuptake inhibitors (SSRIs), so talk to your doctor about your options.
Recent research suggests that trichotillomania affects around 0.5% to 2.0% of the population, The American Psychological Association estimates that trichotillomania affects roughly 4% of the U.S. population, so if you are experiencing this disorder, you are far from alone. Support groups where you can connect with peers who are experiencing trichotillomania can be another source of healing and community.
Participating in online therapy can be beneficial for those struggling with trichotillomania and other kinds of mental health disorders. BetterHelp is an online counseling platform for adults, while TeenCounseling provides similar services, but for teenagers (and parents of teens). Each is designed to help you receive assistance from the comfort of your home. Since those struggling with impulse control disorders often have high levels of anxiety, making it to in-person therapy sessions might be difficult. Online therapy makes it possible to still receive care that is both convenient and comfortable.
Recent studies also continue to prove the efficacy of online-based interventions. For instance, one such study demonstrated that an online self-help intervention was effective in reducing symptoms of trichotillomania.
If you are still apprehensive about online therapy, check out verified user testimonials, such as this one:
“Stephanie is a blessing for the whole family. To know that my daughter has someone that she can reach out to whenever she needs is a great resource in those difficult times. I know my daughter is in good hands and I am always happy about Stephanie’s feedback and so is my daughter. I can see that the regular sessions give her stability, and the app makes it easy for her as well. The different time zones (we live across the Atlantic) are also in our favor since our daughter can reach out at night when she is thinking about her problems and get a response right away. - I can highly recommend her.” - Review written by TeenCounseling user M.A. after counseling with Stephanie Young for 5 months
Is it damaging to pull out hair?
When you pull hair from your face, scalp, or body, it can sometimes have damaging consequences. The process can lead to skin and tissue damage, which can sometimes lead to bleeding. This may leave your skin vulnerable to infections. It can also result in ingrown hairs, which can become inflamed and cause itching or pain.
Over time, repeatedly pulling out hair from the same spot may damage follicles, slowing or preventing hair regrowth. This can leave bald patches on the scalp, eyebrows, or body, or sections of eyelids where lashes won’t grow. These areas may also show signs of scarring.
Trichotillomania-related changes in appearance may also cause stress, low self-esteem, and a sense of isolation. An individual with visible signs of hair-pulling may feel marked as “different” from their peers, or worry that people will assume they have a contagious disease. This mental strain may have negative effects on their mental health.
Some people with trichotillomania may also swallow the hair they pull out, sometimes without realizing it. This can lead to gastrointestinal problems when hair clumps inside the digestive tract.
Is trichotillomania a type of OCD or anxiety disorder?
Since trichotillomania was first recognized as a mental health disorder, there’s been a fair amount of debate within the research community about how to classify it. The psychological function of trichotillomania hair pulling may differ between individuals, making it difficult to characterize definitively.
The American Psychiatric Association currently groups trichotillomania under the heading of “Obsessive-Compulsive and Related Disorders” rather than “Anxiety Disorders.” The tendency to pull hair may be an attempt to regain a sense of control in the face of distressing thoughts and negative emotions.
Clinical research suggests that it’s common for people with this medical condition to have co-occurring anxiety disorders, though trichotillomania itself is not considered a type of anxiety disorder. Researchers have found that stronger feelings of anxiety tend to correlate with more severe hair-pulling. Other mental health conditions that may co-occur with trichotillomania include:
Alcohol use disorder
Post-traumatic stress disorder
What triggers trichotillomania?
Researchers studying trichotillomania believe that it’s often triggered by stressful events. In a large percentage of cases, children with this disorder first started to pull hair shortly after beginning school. Others began exhibiting this behavior in response to bullying, conflict with their parents, or poor academic performance.
Traumatic events may also trigger trichotillomania. Adults with this condition are more likely to have a medical history, including things like post-traumatic stress disorder. This suggests that trichotillomania can begin as a response to stress.
Some people with trichotillomania may feel specific triggers immediately before individual incidents of hair pulling. These can include sensations, such as hairs feeling irritating or out of place. Negative emotions, including frustration, boredom, anxiety, or anger, can also be triggers. Certain thoughts might also prompt trichotillomania — for example, repetitive thoughts focused on hair or an individual’s appearance.
Not all cases have obvious causes, though. Even in patients with apparently stress-induced trichotillomania, hair pulling may occur during times of relaxation and absent-mindedness rather than during the periods of greatest stress. Though the behavior may begin as a response to emotional tension, it can turn into a habit that may be carried out automatically or unconsciously.
What causes people to pull their hair out?
Researchers are still working to clarify the precise causes of trichotillomania hair pulling. Currently, experts believe that it may be due to a combination of genetic and environmental factors, including social influences and psychological stressors.
One theory is that people with trichotillomania may pull out their own hair as a way to counteract mental and emotional stress. This may be an attempt to use physical irritation to “distract” the mind from other persistent sources of distress.
This theory is reinforced by the common occurrence of other disorders with trichotillomania, including anxiety disorders, post-traumatic stress disorder, depression, substance use disorders, and eating disorders. Many of these conditions can also arise in response to severe stress, suggesting they may often have a common origin.
Trichotillomania may also be accompanied by skin picking disorder, also called dermatillomania. This condition can involve a similar habit of repetitive behavior (picking or digging at one’s own skin) that can cause irritation and damage. Trichotillomania and skin picking may be two manifestations of the same impulse.
Can trichotillomania be cured?
Trichotillomania can be difficult to treat. While a few medications that may help have been identified, they often have unwanted and unpleasant side effects that can make patients (or parents of children with trichotillomania) reluctant to continue the treatment.
Psychological treatments may be more successful and have fewer unpleasant side effects. Behavior modification therapy can often help an individual stop pulling their hair out, or at least substantially reduce the frequency of hair pulling. Psychotherapy may also help to address underlying stress, trauma, and anxiety, potentially reducing the precursors that lead to hair pulling.
While these treatments may help, they’re not considered complete cures for trichotillomania. A person with this condition may still experience the urge to pull hair. If you’ve been treated for trichotillomania, watching out for stressors and monitoring your behavior could be important for making sure that hair-pulling doesn’t resume.
Is trichotillomania a form of depression?
Psychologists currently view trichotillomania as more closely related to obsessive-compulsive disorder rather than as a mood disorder like depression. But these mental health disorders may frequently appear together. The presence of major depressive disorder appears to be associated with significantly worse trichotillomania symptoms.
It’s also common for people with trichotillomania to feel shame and stress related to their behavior and the resulting changes in their appearance. This emotional distress might put them at greater risk for depression even if they’re not already experiencing it.
What vitamin deficiency causes trichotillomania?
There have been a few cases of people whose trichotillomania appears to have been brought on by a Vitamin D deficiency. Treatment with vitamin supplementation substantially reduced hair loss, and the patients reported reductions in their urges to pull their hair out.
The possible connection between vitamin deficiency and trichotillomania has not yet been studied in depth, so it’s hard to say how prevalent this association may be. It’s also not clear how a lack of this nutrient might cause or worsen hair pulling, though some researchers suggest it may play a role in defending against neurological damage. Some other disorders, such as Parkinson’s disease and depression, appear to show links with vitamin D deficiency.
What is the best treatment for trichotillomania?
Current research suggests that the best trichotillomania treatment is an approach called behavioral therapy with habit-reversal training components (BT-HRT). This method is derived from cognitive-behavioral therapy, a type of psychotherapy that has shown effectiveness in treating a wide range of mental health disorders.
In BT-HRT, a therapist interviews an individual with trichotillomania to understand their unique patterns of hair-pulling and get a sense of their causes. The client then receives coaching in strategies for monitoring their thoughts, feelings, and behavior to help them stop pulling hair and redirect their thoughts when the urge arises. This may involve helping them find more constructive options for releasing stress.
Some other treatments for trichotillomania have shown effectiveness in randomized trials, but there’s not yet a substantial evidence base for these options. They include medications such as clomipramine, olanzapine, and N-acetylcysteine. Some kinds of antidepressants may also offer relief, though again, the research on this isn’t clear.
How do I stop trichotillomania?
If you’re living with trichotillomania and hoping to stop pulling your hair, one helpful first step may be to work on increasing your awareness of your own behavior. Some people find it useful to keep a diary, taking note of how they feel each day, what they’re thinking about, and how much or little they engage in hair-pulling. Journaling might help you identify possible causes and make it easier for you to notice when the urge is rising.
Taking up healthy lifestyle habits, such as eating a nutritious diet and making sure to get enough sleep, may reduce mental and emotional strain, helping to ease the impulses to pull at your hair. At the same time, you might also want to adopt some healthy strategies for stress management. Possible options include:
Spending time socializing with friends
Mind-body exercises such as yoga
Talking with an experienced mental health professional can also be an important step in treatment. While the beneficial habits described above may alleviate your psychological distress, therapy is the only strongly evidence-backed treatment for trichotillomania.
Who suffers from trichotillomania?
Research estimates indicate that between 0.5% and 2% of the general population experience trichotillomania. The specific types of hair-pulling behavior may vary from person to person. The most common manifestation is picking hair from the scalp, though many people with this condition also pull eyebrow and pubic hair. Incidences of hair-pulling sometimes follow challenging emotions or negative thoughts, but in other cases, the behavior is mostly unconscious.
Though trichotillomania was once thought to be more common in women and girls than in men and boys, more recent studies have found no substantial gender differences. Women may be more likely to seek treatment for this mental health disorder when it causes substantial hair loss.
Trichotillomania may be most likely to begin in early adolescence, between the ages of 10 and 13. Possible risk factors include:
Significant stress or anxiety
Other disorders such as post-traumatic stress disorder, anxiety disorder, or obsessive-compulsive disorder
A family history of trichotillomania
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