Trichotillomania - Compulsive Hair Pulling

Trich, trichotillomania or compulsive hair pulling
Compulsive hair pulling - Photo: Getty Images via Canva
There is a very secretive disorder playing itself out in bedrooms and bathrooms across the world. It is done in private and is often times denied by the sufferer and hidden from others, including loved ones.
 
This disorder is often times so shameful that the afflicted person will turn to substance abuse to help calm the feelings of shame and guilt, many times to no avail. So what is this disorder you ask? Trichotillomania, or TTM, is defined as the recurrent, compulsive pulling of one's own hair, resulting in observable hair loss.
 
Hair can be pulled from any part of the body that has hair. The most common areas, though, are the face, scalp, eyebrows, and eyelashes. Other areas that may sometimes be affected are the armpits, pubic area, and perirectal region. Tweezers, pins, or fingernails are typically used to remove the targeted hair. Individuals with Trichotillomania often start with self-stroking or "grooming" responses such as hair twirling and eyebrow caressing. These actions are used to find the perfect clump of hair that will be pulled in the future. A hair-pulling episode is usually preceded by an increase in tension and a strong urge to pull. Following the pull, there is usually a sensation of relief or pleasure.
 
A number of people with Trichotillomania do not actually pull the hair but engage inelaborate hair cutting episodes that are intended to bring about perfect symmetry. These episodes of cutting or pulling can occur over a several-hour period with the individual entering a trance-like state where it seems as though only a few minutes have passed. Generally this will happen when the person is alone while watching TV, reading, talking on the phone, driving, or getting ready in the morning.
 
There is no absolute cause for obsessive hair pulling. Through much research there is some evidence that brain function and structure may be involved in some people with this disorder. CT scans of compulsive hair pulling patients are significantly different than the general population and resemble the brains of those with other psychiatric disorders like Tourette, which leads doctors to look closer at brain anatomy and physiology. There is also some evidence that strep infections may be involved in early onset, that is onset of Trichotillomania early in childhood.
 
Generally the onset does occur in childhood or adolescence. However there are some cases where hair pulling compulsion is undiagnosed until adulthood. At one time, it was thought to exist in only 0.03-0.2% of the population, but now it is believed to be present in 2-3% of the population, and it is an equal-opportunity destroyer in childhood, where the male-to female ratio is 1:1. As adulthood draws near, though, there is a shift in the ratio weighing more heavily on the female side.
 
Pulling hair out with tweezers
Pulling hair with tweezers - Photo: Getty Images via Canva
There are several different treatment modalities available, though each case needs to be examined on an individual basis. Habit reversal training is an effective treatment that involves first becoming more consciously aware of situations and events that trigger hair pulling, then learning to utilize alternative behaviors in response to these situations. Another common cure is the stimulus control technique which utilizes specific physical items as "habit blockers" to restrict the ability to pull out hair.
 
There are many complications resulting from Trichotillomania including alopecia (baldness), slowed or halted hair growth, and changes in hair texture or color. There is also a risk of infection or scarring from the compulsive pulling and digging to get the targeted hair and follicle out of the skin. A number of people actually eat the hair that has been pulled out. These people run the risk of stomach pain, gastrointestinal obstruction, peritonitis, and in rare cases, death. There is also a risk of carpal tunnel syndrome or other neuromuscular problems from the repetitive motion of pulling the hair.
 
It is very important to remember that compulsive hair pulling is not a solitary disorder; it usually coexists with other psychiatric disorders such as anxiety disorders, depression, eating disorders, ADHD, Tourette's disorder, and body dysmorphic disorder. People with trichotillomania usually also suffer from anxiety and substance abuse. However, in many cases, the shame associated with TTM is the greatest debilitating effect, which can drive the person to deny any problems. They may also try camouflaging the hair loss by wearing hats, scarves, false eyelashes, and tattooed eyebrows.
 
Trichotillomania can be a life-changing, and sometimes a life-ending disorder. It needs to be treated by a professional trained in the diagnosis and treatment of obsessive-compulsive disorders. It is not something that can be changed with willpower. Many of the people affected by obsessive hair pulling tend to have a perfectionist personality and believe they can fix themselves, to no avail.
 
So if you have an up-close and personal relationship with your magnifying mirror and your tweezers to the point that you spend more time with them than with your loved ones, you may have a problem that needs to be addressed.
 
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