What is trichotillomania?

Trichotillomania is an enfeebling psychiatric condition characterized by recurrent pulling of one’s hair, leading to hair loss and marked functional impairment. It is classified under obsessive-compulsive and related disorder and involves irresistible urges to pull hair from scalp, eyebrows, eyelids and other areas of the body. Some people with trichotillomania also heat their pulled hair; this condition is known as trichophagia. It can cause significant problems related to the gastrointestinal tract.

Symptoms of trichotillomania

A person with trichotillomania may experience the following behavioural and physical symptoms:

  • Repetitive pulling of hair   without awareness and a sense of relief after pulling
  • Inability to stop  
  • Anxiety
  • Stress
  • Skin irritation or tingling effect after pulling
  • Playing with pulled hair, rubbing across the face or skin
  • Noticeable hair loss, bald patches due to hair pulling

Psychosocial dysfunction, low self-esteem, and social anxiety are also associated with trichotillomania.

Emotional states 

Hair pulling can also involve varying degrees of awareness;

  • Focused hair pulling: People engage to experience tension relief from pulling hair.
  • Automatic hair pulling: Without realizing that they are pulling hair. They do it when they are bored, watching television or doing any mindless activity.
  • Mixed hair pulling: engage in a mix of both behavioural styles i.e.

   Focused and automatic hair pulling.

Treatments: 

   Psychotherapy: HRT (Habit reversal Therapy) Consists of 5 stages

  1.  Awareness training: The individual identifies psychological and environmental factors that can trigger hair pulling.
  2.  Competing for response training: Replaces hair-pulling behaviour with some other behaviour.
  3.  Motivation and compliance: Individuals to receive praise from family and friends for progress.
  4.  Relaxation training: The patient is relaxed through meditation and deep breathing that relieves stress.
  5.  Generalization training: New skill practices so that new behaviour becomes permanent.

Medications:

  • Selective Serotonin Reuptake Inhibitors (SSRIs), antidepressants
  • Clomipramine, a tricyclic antidepressant 
  • Olanzapine an antipsychotic drug

Sometimes, trichotillomania goes away on its own with time.

Submitted by “Ghazia Tehrim”