The trichotillomania It is a psychological disorder that is characterized mainly by the strong desire that the person feels to pull their hair. The pulls are so strong and so frequent that they end up causing baldness that can be detected with the naked eye. Usually, the hair that is pulled is that of the head or face (such as eyelashes).
To be considered a disorder, the problem has to reach a certain intensity, occur for a long time, and generate anxiety in the person suffering from it. Often affected people try to stop pulling their hair, but are unable to do so on their own.
In general, trichotillomania often occurs alongside other psychological disorders. It is usually associated with the repetitive behaviors of obsessive-compulsive disorder; But hair pulling can also be due to excess anxiety. In other cases, the cause may be a dysmorphic disorder, or another similar problem..
To overcome trichotillomania, the use of therapy is usually necessary. The most used to treat this condition is cognitive-behavioral, although there are other approaches that can also be effective. In some cases, those affected may have to take medication to end up eliminating the problem.
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In this section we will see the most common characteristics that people with trichotillomania present.
The main symptom of people with trichotillomania is the presence of intense pulling on the hair in certain areas of the hair. These jerks usually appear recurrently, although in some cases they can disappear for more or less long periods before reappearing..
To be considered that the pulls really indicate the presence of trichotillomania, they have to cause bald areas that can be detected with the naked eye. That is, it is not enough for the person to pull their hair from time to time; those affected by this disorder pull out their hair continuously.
The most common area to pull hair from is the head. However, those affected can also pull hair from other areas, such as the beard, eyelashes, eyebrows or armpits. Pulling can involve, for example, pulling each hair out by the roots, breaking it in half, or a mix of both behaviors.
The way in which hair-pulling behavior occurs varies from person to person. Some of those affected by trichotillomania do not realize what they are doing, and only know that they have a problem detecting bald spots on their head, beard or affected area.
Other individuals, on the other hand, find great pleasure in pulling their hair, and adopt conscious rituals during which they carry out this behavior. For example, they can pull each hair until they find the “right point” of tension, pull it out and eat it, or pull it out following an established order..
Unconscious trichotillomania often occurs in children, while adults and adolescents are often aware of what they are doing.
Another of the key symptoms of trichotillomania is that the individuals who suffer from it know perfectly well that they have a problem. Those who consciously pull their hair are unable to stop, causing anxiety or emotional distress..
On the contrary, people who inadvertently pull their hair feel bad when they see the bald spots that their behavior is leaving them. This often causes embarrassment and a great sense of lack of control.
In most cases of trichotillomania, in addition, affected people have symptoms of other psychological disorders. Some of the most common are obsessive-compulsive disorder, body dysmorphia, generalized or social anxiety, or certain eating disorders.
Finally, due to the discomfort caused by their lack of hair, many people with trichotillomania try to prevent others from realizing what is happening to them.
To achieve this, they can resort, for example, to haircuts that hide bald areas, to make up their eyebrows or eyelashes, to wear a hat or directly to avoid social situations.
These attempts to hide hair loss are often accompanied by low self-esteem, embarrassment, and discomfort of all kinds. If the problem is not treated, it can lead to the person becoming totally isolated from others or the development of a more serious emotional disorder..
Due to the low incidence of this disorder, sufficient studies have not yet been possible to allow us to know why it occurs. However, below you will find a list of the possible causes that are more accepted within the scientific community right now..
Because most people with trichotillomania suffer from some type of mental disorder, some psychologists have a theory that these may actually be the cause of the problem and not simply a coincidence.
This would be seen clearly in the case of obsessive-compulsive disorder. People who suffer from this pathology carry out certain behaviors that serve to alleviate their emotional discomfort. For people with trichotillomania, the act of pulling or pulling their hair could just be one of them..
The relationship of other disorders to trichotillomania may be more difficult to explain, but is still present as well. In the case of people with dysmorphic disorder, the cause of the person pulling their hair could be that they look ugly, and that they are trying to change their image in a way that is not functional..
In some cases, trichotillomania may just be a form of addiction. As in all problems of this type, the cause would be the presence of a series of reinforcements and punishments that have made the behavior of pulling the hair more and more likely..
What can be the reinforcements and punishments present in this disorder? One of the most likely is the relief that pulling or pulling hair can produce in situations of stress or anxiety. By momentarily calming down after performing this behavior, the person would do it more and more times until they end up developing an addiction.
For people without underlying stress or anxiety, the very act of pulling hair can be very reinforcing. By starting with the pull, a tension is created in the skin that breaks when the hair is pulled out. This tension-relief dynamic can act as a reinforcer that would be at the base of the addiction..
Finally, it has been found that many of the people who suffer from trichotillomania have anatomical differences in certain key areas of their brain. These differences could explain why the behavior appears in the first place, as well as why it remains.
For example, it is known that the prefrontal lobe is in charge of suppressing and regulating problem behaviors; this area of the brain appears to have fewer connections to other parts in people with trichotillomania.
Other brain areas that may play an important role in the development of this disorder are the caudate nucleus, the cerebellum, and the basal ganglia. The causes for these anatomical differences can be both genetic and due to the environment in which the individual was immersed during their childhood..
Trichotillomania is generally not considered a very serious psychological disorder. However, if it is not treated and the symptoms become more serious, it can end up causing great discomfort in those individuals who suffer from it. Next we will see some of the most common consequences of this problem.
If the habit of pulling hair is very exaggerated and is carried out for a long enough time, the person could end up suffering a kind of baldness caused by trichotillomania. The reason is that, by pulling enough hair by the roots, completely depopulated areas could appear.
This is only an aesthetic problem; but self-induced baldness can cause great discomfort in individuals who suffer from it.
Several of the symptoms, such as the embarrassment felt by those affected by the hair-pulling behavior or the presence of bald spots, can make patients with trichotillomania not feel comfortable in the presence of other people. This can lead to social isolation and avoidance of other individuals..
In the most severe cases, trichotillomania can even lead to social anxiety disorder. This problem is much more difficult to treat, and can be a serious impediment to the life of the affected person.
Lack of self-esteem, social avoidance, and discontent with one's own body image can combine to lead to a more serious mood disorder. Some of the most common are generalized anxiety or depression; both are often devastating to the individuals who suffer them.
Fortunately, not all people with trichotillomania develop this type of disorder. Still, you need to be aware that this can happen, and try to fix the problem behavior as soon as possible..
Although it is rare, in some cases people with trichotillomania may end up suffering from physical problems related to the disorder..
Some of the most common are carpal tunnel syndrome due to repetitive movements, or certain infections related to hair pulling.
In cases where the problem behavior also includes the ingestion of hair (trichophagia), the person also runs the risk of suffering the formation of a hairball in their digestive system, known as "trichobezoar".
Although this is not frequent, if it occurs it can end up posing a very serious risk to the patient's life.
The treatment given to people with trichotillomania depends on their age. Most young children with this problem eventually fix it on their own. On the other hand, in the case of adolescents and adults, it is usually necessary to intervene if you want to eliminate it.
Normally, the most common treatment for trichotillomania is cognitive behavioral therapy to alleviate the symptoms. However, the use of certain medications, or the use of other therapies to end underlying psychological problems may also be considered..
A version of cognitive behavioral therapy, known as "habit reduction training," has been shown to be the most effective approach to treating trichotillomania..
The procedure is very simple: the person is trained to recognize their impulses to pull their hair, at the same time that they are taught to redirect this energy to another behavior.
Other psychological therapies that also seem to be effective in treating this problem are hypnosis, biofeedback, and acceptance and commitment therapy..
Although some type of cognitive therapy is generally used to treat trichotillomania, sometimes the use of psychotropic drugs can amplify the effect of these approaches and help end the problem more quickly.
Today, no specific medication has yet been approved to end this disorder; but there are several that have been shown to be quite effective in achieving this. For example, some antidepressants may reduce problem behavior, such as clomipramine or naltrexone.
On the contrary, other medications frequently used to treat similar disorders (such as serotonin reuptake inhibitors) appear to be counterproductive in the case of trichotillomania..
Right now, more studies are needed to decide if there is any medication that is effective in treating all cases of this disorder. Until then, the exclusive use of psychological therapies seems to be the best option.
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