Trichotillomania: İnability to Stop Pulling Hair

You are about to take your biggest exam of the year. You have sweats coming out of your hand, you can feel your heart beating too fast. Suddenly you start to realize your leg is bouncing, on its own. You are not the one who’s doing it, yet it’s your body. Bouncing your leg made you feel calm somehow. You are still worried but you feel a bit eased down. You take a huge deep breath and it’s all okay.

Well, this could be the simplest and the best non-scientific definition of a coping mechanism that I could give. To deal with emotions that are hard to handle, coping mechanisms are often used by most people1. Coping appears when the status of your life adjusts to a new one that is stressful. Even though stress is mostly associated with negative life changes, this could go both ways, even something positive as getting accepted to college can be pretty stressful2.

There are two dominant types of coping mechanisms: healthy and unhealthy.

Healthy coping mechanisms are more positive toward the problem being handled. Talking about the problem, meditating, and exercising can be some examples of healthy coping.

Unhealthy coping mechanisms can reduce the amount of stress that the problem is causing but might be harmful to the person in the long term. Self-harm, procrastinating, binge eating, and isolating one’s self can be given as some examples of unhealthy coping.

Hair-pulling is one of the most used coping mechanisms that people use as a self-soothing behavior for negative feelings such as anxiety3. But in some cases, this could go too far, to a point where one cannot control the urge to pull out their hair or body hair. This condition is called trichotillomania.

Trichotillomania is a chronic, mental disease of impulse control, characterized by repetitive, compulsive, and self-induced hair pulling. The term “trichotillomania” was first used by Hallopeau in 1889. It originates from the Greek words “thrix” (hair), “tillein” (to pull), and “mania” (madness)4. It is stated that 0.5 to 2% of people have trichotillomania5. There is no fixed age for trichotillomania, anyone can develop it at any age; it has been reported among infants as young as 1 but is also known to emerge later as late as age 70 and above6. In children, it happens equally between men and women. Women outnumber men with this condition in adults by as much as 9 to 17.

In trichotillomania, pulling can be undertaken at any bodily region with hair, but the scalp is the most common site (72.8% of patients) followed by eyebrows (56.4%), and the pubic region (50.7%)5.

Figure: A person with trichotillomania experiencing hair loss.

In simple terms, a person who has trichotillomania is not aware that they are pulling most of the time, even when they do, it just creates a cycle effect. The person starts to pull because they are anxious, they get a sense of relief from the pulling but then realize they have pulled their hair out and the guilt comes after and makes them even more anxious, which causes even more pulling. This is one of the reasons why it’s a hard habit to break.

What causes trichotillomania?

The answer to the question differs from one to another. In some people, it might be OCD related, whereas in others it can be caused by anxiety. But the scientists aren’t certain about what causes trichotillomania, although that doesn’t mean that they don’t have any clue about what’s going on. Some of the predicted causes of trichotillomania are

  • Genetics
  • Changes in brain structure or chemistry
  • Coping mechanism7

Treatment

As dark as it seems, there is hope for people suffering from trichotillomania. It is a hard and long recovery. It involves medication or therapy, most of the time both of them.

Therapies
  • One of the most successful treatment options for trichotillomania is habit reversal therapy. By this method, the patient learns more about themselves such as: why they do it, when they do it, and how to break the habit.
  • Group therapy and peer support7.

On top of these, people with trichotillomania can consult a dermatologist for scalp treatment and such.

Conclusion

Trichotillomania is more of a more complicated disease than we think. People who struggle with it usually have comorbid mental illnesses. 79% of people with trichotillomania have one or more mental health comorbidities; the most common being anxiety/depressive disorders, OCD, PTSD, and ADHD8. So resisting the urge of pulling their hair is not the only fight that they are in. There is a need for broader research about it.  Because so many people who suffer from trichotillomania do not reach out for help and don’t view themselves as sick, it is why hard to collect statistical data on the frequency of the disorder9. There is also more need for awareness about the disease. People with trichotillomania feel ashamed of themselves, their bald patches on their heads, rare eyebrows, and mostly public backlash. Next time you see a person that seems to suffer from trichotillomania, do not invade their feelings and directly ask them about it, do not tell them to “stop doing it” and overall do not make them feel alienated.

References:

  1. https://www.goodtherapy.org/blog/psychpedia/coping-mechanisms
  2. https://my.clevelandclinic.org/health/articles/6392-stress-coping-with-lifes-stressors#:~:text=Take%20brief%20rest%20periods%20during,meditation%20or%20progressive%20muscle%20relaxation
  3. https://www.trichstop.com/info/causes/anxiety#:~:text=Many%20people%20use%20the%20hair,performing%20the%20self%2Dsoothing%20behavior.
  4. Cisoń, Hanna, Aleksandra Kuś, Ewa Popowicz, Marta Szyca, and Adam Reich. 2018. “Trichotillomania and Trichophagia: Modern Diagnostic and Therapeutic Methods.” Dermatology and Therapy 8(3):389–98. doi: 10.1007/S13555-018-0256-Z/TABLES/1.
  5. Grant JE, Chamberlain SR. Trichotillomania. Am J Psychiatry. 2016 Sep 1;173(9):868-74. doi: 10.1176/appi.ajp.2016.15111432. PMID: 27581696; PMCID: PMC5328413.
  6. https://www.trichstop.com/trichotillomania-onset-and-symptoms#:~:text=Age%20of%20Onset&text=It%20is%20most%20likely%20to,as%20age%2070%20and%20above.
  7. https://my.clevelandclinic.org/health/diseases/9880-trichotillomania
  8. Grant JE, Dougherty DD, Chamberlain SR. Prevalence, gender correlates, and co-morbidity of trichotillomania. Psychiatry Res. 2020 Jun;288:112948. doi: 10.1016/j.psychres.2020.112948. Epub 2020 Apr 18. PMID: 32334275; PMCID: PMC7212053.
  9. https://www.trichstop.com/info/general/trich-statistics

Figure Reference: https://www.stylecraze.com/articles/trichotillomania-hair-regrowth/

Inspector: Beril GÜREL

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