Hair Pulling Disorder

Hair pulling disorder, or trichotillomania, is an impulse control disorder that manifests in a continuous need or desire to pull out one's own hair from various areas on the body. Hair pulling may be mild and relatively easy to overcome, or it can be obsessive, constant and even disfiguring. According to the Trichotillomania Learning Center, an estimated 2 million to 10 million people in America have the condition. Nonetheless, it is a newly recognized disorder and has not been extensively researched.

Symptoms

• People with trichotillomania generally experience irresistible urges to pull out their hair, feelings of tension that are relieved by pulling and/or satisfied, relaxed feelings associated with pulling. Sometimes, the sensation of rubbing pulled hairs against the lips or chewing on them provides some form of enjoyment or relief. Moderate to severe hair loss from the scalp, arms and legs, chest, pubic areas, eyebrows or eyelashes may occur. Hair pulling usually starts in adolescence.

Effects

• Trichotillomania can result in the person becoming socially isolated, whether voluntarily or from pressure from others, and feelings of embarrassment, self-consciousness and general anxiety are common effects in chronic hair-pullers. Additionally, physical effects such as permanently damaged hair follicles, repetitive motion injuries like carpal tunnel syndrome, irritated or scarred skin or complications from swallowing hair can occur.

Causes

• There is no consensus on what causes trichotillomania, but genetic mutations and neurochemical abnormalities may be factors. Trichotillomania is often hereditary, and there may be a link between trichotillomania and Tourette's syndrome.

  Sometimes hair pulling is triggered by traumatic childhood events, while in other cases, pulling is the direct result of the hair being uncomfortable or undesirable. According to the Mayo Clinic, people with trichotillomania are sometimes also afflicted with obsessive-compulsive disorder, eating disorders or depression, so for some, the behavior is an outlet for anxiety or other negative feelings. Others begin pulling hair simply because they find it pleasurable or enjoyable in some way.

Diagnosis

• According to the Diagnostic and Statistical Manual of Mental Disorders, a patient must meet five criteria to receive a trichotillomania diagnosis. He or she must show noticeable hair loss from repeated hair pulling, feel tense before pulling or when trying to resist the urge to pull and get enjoyment or relief when pulling. Additionally, the hair loss can't be explained by another medical condition, and the pulling must distress the patient in some way. Skin and hair biopsies may be necessary for damage analysis.

Treatment

• The most common treatment for trichotillomania is cognitive-behavioral therapy (CBT), which involves identifying what emotions or external factors trigger a patient to start pulling hair and addressing those triggers directly. CBT promotes self-awareness about pulling and why it happens, and teaches patients methods to use for breaking the habit. Acceptance and commitment therapy can also help hair-pullers learn to accept their urges without continuing to act on them. Anti-depressants can be effective treatments for trichotillomania, but usually work better when taken along with therapy.