What is Hair Pulling Disease (Tricotillomania)? Causes and Treatment
Hair pulling disease is a condition in which a person experiences an irresistible urge to pull out hair.
What is Hair Pulling Disease (Trichotillomania)?
Hair pulling disease, also known as trichotillomania, is a mental disorder that causes an irresistible desire to pull hair in recurring episodes. Even though trichotillomania patients try to suppress their desire to pluck hair, they cannot succeed and pluck hair, eyelashes or other body hair. Hair plucking disease may cause bald areas on the scalp. This situation may cause patients to experience problems in both social and business life. Trichotillomania patients may grow their hair or resort to different solutions to hide these bald areas on the scalp. For some patients, hair pulling disease is a controllable condition. In some patients, the urge to pull out hair can be quite strong and can challenge the patient. Various treatment methods can be tried to reduce or completely eliminate the frequent hair plucking behavior of patients.
Trichotillomania causes many different symptoms in people. The symptoms seen in hair pulling disease are as follows:
- Repetitive pulling of hairs on hair, eyebrows and eyelashes (sometimes hairs in other parts of the body may also be pulled and the part where the hair is pulled may change over time)
- Increased tension before trying to pull hair out or when resisting the urge to pull it out
- Feeling of relief and pleasure after hair pulling behavior
- Lightened, bald areas on the scalp or shortening of certain parts of the hair
- Thinning and empty areas in eyebrows and eyelashes
- Preferring a specific hair type
- Turning hair pulling into a ritual
- Biting, chewing or eating plucked hair
- Playing with the plucked hair or rubbing the plucked hair on the lips or face
- Repeatedly trying to stop pulling hair
- When you cannot stop the urge to pluck your hair, try to at least pluck it less frequently.
- Being under serious stress in school, work or social life due to hair pulling behavior
Many patients with hair-playing disease also exhibit behaviors such as skin picking, nail biting, or lip biting. The behavior of plucking hair or feathers from dolls, pets, blankets, or clothes may also be a symptom of trichotillomania. Trichotillomania patients usually do hair pulling behavior when they are alone and try to hide this behavior from other people.
Hair pulling behavior may be focused or automatic in patients. In focused behavior, the patient consciously plucks his hair. The patient has an irresistible urge to tear off his hair, and he provides relief by tearing his hair. Some patients make hair plucking more meticulous and ritualistic. For example, they try to determine the right hair to pluck or bite the plucked hair. In automatic behavior, the patient may not even be aware that he is tearing his hair. These patients may pluck their hair while watching television, reading a book, or when they are bored. Both focused and automatic hair plucking behavior can be seen in the same patient. The person’s current state and mood are effective in how he/she behaves. Some situations may trigger hair pulling behavior in a person. Combing hair can be given as an example of these situations.
Trichotillomania may also be related to emotions:
Negative Emotions: Hair pulling behavior in most patients with trichotillomania; It is done to cope with negative emotions such as anxiety , stress, boredom, tension, disappointment and loneliness.
Positive Emotions: In patients with trichotillomania, hair pulling behavior leads to a feeling of satisfaction and relief. Therefore, patients repeat the hair pulling behavior to continue feeling these emotions.
Hair pulling disease is a chronic, that is, long-term disorder. The disease may worsen or ease from time to time if left untreated. For example, in women, hormonal changes during menstruation can cause disease symptoms to aggravate. In some patients; Untreated trichotillomania symptoms occasionally disappear and then reappear.
What are the Causes of Hair Pulling Disease (Trichotillomania)?
The causes of hair pulling disease have not yet been fully elucidated. However, both genetic and environmental factors are thought to be effective in the development of hair pulling disease.
Although the causes of trichotillomania are not fully known, the risk of this disease is increased in those who have a family history of hair pulling disease.
Hair pulling disease usually occurs during adolescence. The first symptoms seen in patients are hair pulling, and patients state that this behavior reduces the feeling of anxiety and stress. At the beginning of trichotillomania, patients may not be aware that they are tearing out their hair. When the patient realizes this situation, he becomes embarrassed and his anxiety begins to increase. Increasing anxiety causes hair to be pulled out again. Therefore, the patient experiences a cycle such as anxiety-hair pulling-temporary relief-embarrassment-again anxiety-hair pulling.
Hair pulling disorder is a mental disorder and may be associated with some other mental conditions. These situations:
- Obsessive Compulsive Disorder (OCD)
- Anxiety
- Depression
- Autism
- Attention Deficit Hyperactivity Disorder (ADHD)
What are the Ways to Get Rid of Hair Pulling Disease?
In order to get rid of hair pulling disease, it is necessary to first get professional help from an expert. Some practices performed by the individual during the treatment process may also help reduce hair pulling behavior. These applications aim to draw the patient’s attention to another point when the patient has the urge to tear his hair. The patient wants to cut his hair;
- squeezing stress ball-like objects
- Exercise your arm muscles by making fists
- Using fidget type toys
- Wearing accessories such as bandanas or berets that cover the hair
- Repeating a set of words out loud until the urge to pull passes
- Taking a relaxing shower to reduce stress and anxiety
- Deep breathing until the urge to pull out hair goes away
- To exercise
- cut hair short
- He/she may perform applications such as covering the fingertips with adhesive objects such as patches or tape.
How is Hair Pulling Disease (Trichotillomania) Treated?
Behavioral therapy and medication can be applied to treat hair pulling.
A method called ‘Habit reversal therapy’ can be used in behavior therapy. This method
- Increases the patient’s knowledge of trichotillomania symptoms and triggers.
- It helps the patient replace the hair pulling behavior with another behavior.
- Finds ways to stay motivated to stop hair pulling behavior.
- It helps to use newly learned skills in different situations.
There are various drugs such as N-acetylcysteine, clomipramine, and olanzapine, which are thought to be effective in the treatment of trichotillomania. The doctor may prescribe one of these medications to the patient when deemed necessary. If the alopecia areata is left untreated, it may cause some complications. These complications are:
Emotional Distress: Many trichotillomania patients have been reported to feel emotions such as shame and humiliation. This may lead to problems such as lack of self-confidence, depression, anxiety, alcohol and substance use in patients.
Problems in Social and Business Life: Open, bald areas on the scalp may cause the person to feel embarrassed. For this reason, the person may stay away from social activities and job offers. In his private life, a person may avoid establishing closeness with other people for fear that his hair-pulling behavior will be noticed.
Damage to Skin and Hair: Continuous hair plucking behavior can cause some problems such as infection of the scalp. Hair growth in the areas where the hair was removed may stop permanently.
Trichobezoar: Eating the plucked hair leads to the formation of hair balls called trichobezoars in the digestive system. Over time, these hairballs can cause serious consequences such as vomiting, weight loss, intestinal obstruction and even death.
Hair pulling disease is a mental disorder. Trichotillomania can have serious consequences if the patient is not treated and given the necessary support. For this reason, people who have behaviors such as hair pulling and hair eating should definitely consult a specialist.