What is Trichotillomania (Hair Pulling Disease)?
Hair pulling disease ( tricotillomania) is defined as a psychiatric disorder in which significant hair loss occurs due to repetitive hair pulling behavior. In Greek, “thrix” means hair, “tillein”; The term trichotillomania , derived from the combination of the words “mania” translated as “to suffer” and “madness”, was first defined by the French dermatologist Hallopeau in 1889. This mental disorder, which involves irresistible, recurring urges to pull hair, is classified under Obsessive-Compulsive disorders.
Hair pulling disease is a recurring and irresistible urge to completely or partially pluck eyebrows and eyelashes, or to pull hair from the face or another part of the body. However, pulling hair from the scalp can cause varying degrees of hair loss. Hair pulling and subsequent hair loss due to stress cause many problems for the individual, such as impairment of functionality in social and professional life. Now let’s examine together the reasons that lead a person to trichotillomania , the symptoms of the disease and the treatment methods.
What Causes Hair Pulling Disease?
Clinical studies cannot clearly answer the question of why hair pulling disease occurs. However, as a result of clinical studies, recurrent hair pulling disease has been found to be associated with some risk factors and health problems. We can list these risk factors and health problems as follows.
Family History:
The first risk factor thought to be associated with alopecia areata is thought to be genetic background. Accordingly,individuals who have observed symptoms of trichotillomania in their first-degree relatives are more likely to develop hair pulling disease .
Age:
Hair pulling disease is a behavioral disorder that usually manifests itself just before or during adolescence. To be more precise, it is observed more frequently in children between the ages of 10 and 13.
Other Behavior Disorders:
Hair pulling disease can present itself with body-oriented behavioral disorders such as nail biting behavior, skin picking and eating behavior, which have similar characteristics to this disorder. However, trichotillomania ; It may accompany disorders such as obsessive-compulsive disorder (OCD), anxiety disorder, depression, autism spectrum disorders, attention deficit and hyperactivity disorder (ADHD).
Stress:
Stressful situations or events may trigger hair pulling disease in some people . During these periods, symptoms often begin with hair receding from the scalp, making the child feel less anxious or stressed. Many people don’t even realize they’re pulling their hair. The realization that one is pulling one’s hair can lead to greater anxiety and feelings of shame. This situation; The emergence of an alarming situation, followed by hair pulling behavior, creates temporary relief as a result of this behavior, followed by anxiety, shame, and a cycle of hair pulling again.
Gender:
Studies show that hair pulling disease, which occurs during adolescence, is seen equally in boys and girls. Hair loss , which is observed in adulthood , is more common in women than in men. Another study has shown that hair pulling behavior in women is related to menstrual cycles and that the mental state during the premenstrual period can trigger trichotillomania behavior. In addition to all these, it is stated that the symptoms of hair loss may worsen during pregnancy.
What are the symptoms of Hair Pulling Disease?
The most basic feature of hair pulling disorder is the repetitive pulling out of one’s own hair. However, hair pulling behavior can also be directed to any hairy skin area of the body. We can list the areas where hair pulling behavior is most common as follows:
- Head area (hair)
- Eyebrows
- Eyelashes
- Face (beard and moustache)
- Inguinal and peri-rectal area
- Armpit
Negative emotions such as feeling of loss of control and shame are clearly evident in people with hair pulling disease . The state of tension arising from the urge to tear out the hair, repeated hair pulling and plucking behavior and the feeling of relief afterwards, constantly playing with the hair apart from the plucking behavior; Curling, pulling, balding areas appearing on the scalp surface and progressive hair lossare symptoms of hair pulling disease .
How is Hair Pulling Disease Diagnosed?
Examination by a specialist physician is very important in making the correct diagnosis for hair loss disease . The specialist physician evaluates the symptoms seen in the patient, listens to the patient’s history and performs a physical examination.Examinations such as x-rays or blood tests are not required to diagnose trichotillomania, but if the specialist deems it necessary, some laboratory tests may be requested to examine some skin problems .
In the DSM-V (Diagnostic and Statistical Book of Mental Disorders) , the diagnosis of trichotillomania is included in the obsessive-compulsive and related disorders section, which also includes obsessive-compulsive disorder (OCD), skin picking disorder, body dysmorphic disorder and hoarding disorder, and is met with the following diagnostic criteria: is explained:
Recurrent pulling out of one’s hair, resulting in hair loss
Recurrent attempts to reduce or stop hair pulling
Clinically significant distress or significant impairment in social, occupational, or other important areas of functioning
Hair pulling or hair loss is not due to another health condition
- The symptoms of hair-pulling diseasecannot be explained by the presence of another mental disorder.
How is Hair Pulling Disease Treated?
The main treatment approach for trichotillomania is a psychotherapy plan that includes a cognitive behavioral therapy approach. Medication is also administered as part of the treatment program. With the psychotherapy method, the patient first learns the symptoms of the disease and the factors that trigger the disease.
The psychotherapy technique also teaches the person to relax as a way to relieve some of the tension associated with the urge and helps the person develop a different behavior to use when the urge to pull hair arises. To increase the effect of the psychotherapy method, drug therapy is also applied. In this context, antipsychotics and antidepressants are used to help curb very intense impulses.
Many people suffering from trichotillomania experience shame, struggle with low self-esteem, and make a variety of efforts to hide their hair loss. Negative emotional experiences such as stress and anxiety often exacerbate hair pulling, creating a vicious cycle. In proportion to the decrease in hair caused by hair pulling disease , psychological disorders such as depression and anxiety may become more severe and lead to increased hair pulling behavior. For this reason, it is very important to detect the disease at an early stage and start treatment without delay in order to prevent the patient from falling into such a vicious circle.
