Definition

Trichotillomania, or hair-pulling disorder, is a mental disorder in which a person cannot resist the urge to pull out hair repeatedly, even though they have tried to stop. People who experience trichotillomania also have an irresistible urge to pull out hair on other parts of the body, such as eyebrows and eyelashes.

In some people, trichotillomania can be mild and easily controlled. However, in some people, the desire to pull their hair is great.

Causes

The cause of trichotillomania is not known for certain. However, it is thought to be caused by:

• There is stress or anxiety, which is responded to by pulling or pulling out hair.
• Chemical imbalance in the brain. This is similar to obsessive-compulsive disorder.
• Changes in hormone levels, for example during puberty

Risk factor

Several factors can increase the risk of developing trichotillomania, namely:

• Family history. Genetic factors play a role in the development of trichotillomania, which can occur in people with close relatives with similar histories.
• Age. Trichotillomania usually appears before early adolescence, most often between the ages of 10 and 13 years, and is often a long-term life problem. 
• Other diseases. People with trichotillomania may also have other disorders, such as depression, anxiety, or obsessive-compulsive disorder.
• Stress. A severe stressful situation or an event that causes severe stress can trigger trichotillomania in some people.

Although trichotillomania is much more common in women than men, this is thought to be because more women are seeking medical help. In early childhood, boys and girls are at equal risk for trichotillomania.

Symptoms

Signs and symptoms of trichotillomania that are often encountered are as follows:

• An intense desire to pull out his hair and feels pressure if he doesn't. After removing the hair, the person feels relief. This happens over and over again. Most people with trichotillomania pull out scalp hair, but some may pull hair from other areas of the body, such as eyebrows, eyelashes, pubic hair, mustache, or beard.
• Keep trying to stop pulling out hair and have reduced the frequency, but to no avail.
• Bald areas on the head can have an unusual shape and be heavier on one side of the head. Hair becomes thin, not only on the head area but also on the eyebrows and eyelashes.
• Biting, chewing, or eating hair that is pulled.
• Playing with plucked hair or rubbing it on the face or lips.
• There is significant stress or problems at work, school, or in social situations due to the habit of hair pulling.

Many people with trichotillomania also pull at the skin, bite their nails, or bite their lips. Sometimes, pulling hair from pets or dolls or materials such as cloth or blankets can be a sign of trichotillomania. Most people with trichotillomania pull their hair secretly and will generally try to hide the condition from others.

Trichotillomania can be related to emotions, such as:

• Negative emotions. For many people with trichotillomania, hair pulling is a way to deal with negative or uncomfortable feelings, such as stress, anxiety, pressure, boredom, loneliness, fatigue, or frustration.
• Positive emotions. People with trichotillomania often find that pulling out their hair provides satisfaction. As a result, they will continue to pull their hair to maintain these positive feelings.

Trichotillomania is a long-term (chronic) disorder. Without therapy, the severity of symptoms can vary over time. For example, hormonal changes during menstruation can worsen symptoms in women.

Diagnosis

The doctor will conduct several examinations and interviews with the patient to confirm the diagnosis of trichotillomania. Some things that are done include:

• Check the severity of hair loss
• Ask about hair loss
• Rule out other possibilities that cause hair-pulling habits or hair loss through several examinations.
• Identify any physical or mental problems that may be related to hair-pulling habits

The doctor can also perform further examinations, such as taking scalp tissue or hair samples, to rule out other causes, such as infection.

Management

Trichotillomania is usually treated using a type of cognitive behavioral therapy called habit restoration training. This aims to help you replace bad habits with something not detrimental. This therapy usually includes:

• Write a diary about your hair-pulling habits
• Identify hair-pulling triggers and learn about ways to prevent it
• Replace the hair-pulling action with another action, for example, squeezing or squeezing the ball
• Get emotional encouragement and support from those closest to you
• Medications such as antidepressants are usually not used to treat trichotillomania.

Things you can do yourself when you feel a strong urge to pull your hair are as follows:

• Squeezing or gripping a ball or other similar object
• Make a fist and tighten your arm muscles
• Use finger toys
• Use a tight bandana or hat, like a beanie
• Create words that you can repeat out loud until the urge to pull your hair disappears
• Take a relaxing bath to relieve stress or anxiety
• Practice deep breathing until the urge to pull your hair disappears
• Sport
• Put plaster on fingertips
• Cut hair short

In addition, being open about your condition to people you trust can also help because sometimes hiding something will make anxiety worse.

Complications

Although it doesn't have the potential to cause anything serious, trichotillomania can have a significant negative impact on your life. Complications that can occur include:

• Stress. Many people with trichotillomania report feelings of embarrassment. They feel low self-esteem, depression, and anxiety, and sometimes resort to using alcohol or drugs.
• Problems with social and occupational functioning. Embarrassment due to hair loss can cause a person to avoid social activities and work opportunities. People with trichotillomania may wear wigs, style their hair to cover bald patches or use false eyelashes. Some people may avoid intimacy for fear that their condition will be revealed.
• Skin and hair damage. Constant hair pulling can lead to sores and other damage, such as scalp infections or other areas where hair is frequently pulled, and can permanently affect hair growth.
• Hair clumps. Eating hair can cause the formation of large hair clumps in the digestive tract. Within a few years, these clots can cause weight loss, vomiting, gastrointestinal obstruction, and even death.

Prevention

There is no proven way to prevent trichotillomania. However, getting therapy as soon as possible when symptoms begin can be very helpful. Learning about stress management is also a good thing because stress often triggers hair-pulling behavior.

When to see a doctor?

You should consult a doctor if you often pull your hair or you notice that your child does it frequently. You should also consult a doctor if you or your child have a habit of eating hair. This can cause hair clumps in the stomach which can cause serious illness.

The doctor can examine the bald area to check for other causes that could cause hair loss, such as skin infections.

If your doctor suspects you have trichotillomania, you will be referred to a psychiatrist for a therapy called cognitive behavioral therapy.

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