Trichotillomania is a recurrent compulsion to pull hair. The disorder is often misunderstood, and those who suffer from this condition can frequently go undiagnosed and untreated, which can lead to physical and emotional pain.
Symptoms of trichotillomania often begin at the onset of puberty, and can affect 1-2% of the population. Most sufferers of this condition are found to be female. The compulsion to pull hair is the primary diagnostic feature, and any area of the body can be the target. The most common areas are the scalp, eyebrows, and eyelids.
Trichotillomania can interfere with daily life in that episodes of pulling at hair can take up a considerable amount of time, sometimes several hours per day. Furthermore, sufferers can spend a lot of time covering up the damage done by hair pulling, in order to hide their compulsions from other people.
This behaviour can cause significant interference and distress. Many people try to stop or decrease hair-pulling without very much success, which can fuel the negative emotion cycle of guilt, shame, and embarrassment. Sometimes the distress is so great that sufferers of the condition can experience problems at school, work, or in personal relationships. This is often because they isolate themselves, withdrawing from social interactions for fear of judgement or ridicule about their condition.
The compulsion to pull can be different for everyone. In some cases, hair pulling provides an emotional release. It becomes a way to either focus on a different type of pain, or to experience it in cases of self-harm for emotional numbing. In other cases, it becomes a way of self-soothing; pulling hair can lead to gratification or pleasure for some sufferers. While these cases are described as being done by a person who is fully conscious of their actions, sometimes those who have these compulsions can be unaware of their behaviour.
As one might imagine, there are many physical risks involved in compulsive hair pulling. These include:
• Doing permanent damage to skin and hair follicles; pulling hair out at the roots on the scalp can result in the hair not being able to grow back, leaving people with bald spots. Sometimes, when the hair is pulled out, the resulting skin can rupture, causing bleeding and increased risk of infection as well as discomfort.
• If eyelashes are pulled, this can sometimes lead to a condition called blepharitis. This is a painful inflammation of the eyelids that leads to swelling, and feelings of itching and burning.
• Some sufferers swallow the pulled hair, which can cause digestive problems.
Compulsive hair pulling is a stressful disorder that sufferers work hard to hide from those around them. Due to society’s misunderstanding of the disorder and the stigma attached to it, sufferers are frequently left to deal with trichotillomania alone, often internalising negative emotions. Thus begins the vicious cycle; internalising leads to depression and anxiety, and anxiety often leads to increased hair pulling. One study found that out of 894 people struggling with trichotillomania, 84% of them said anxiety made it worse.(1)
As mentioned previously, trichotillomania is a chronic, recurring disorder that never truly goes away. Its psychological and physical effects get more complicated when the sufferer does not seek help. However, there is treatment available that shows great success in helping people manage their behaviours, and there are healthcare providers, therapists, and support groups that understand the disorder and can help people learn to cope with it.
The gold standard for treatment is a combination of behavioural and cognitive therapy, along with social support. Those who struggle with compulsive hair pulling should look for a provider who specialises in treating body-focused repetitive behaviours. Treatment begins by building awareness of pulling behaviours and what triggers them, followed by finding ways to counter habits and triggers. Concurrently, it is often found that treatment of emotional issues that increase symptoms of anxiety and depression is conducive to recovery; at this time, there is no specific medication to help with trichotillomania, but medication to treat anxiety or depression often helps someone through the treatment process. Furthermore, social support is integral to combating feelings of loneliness, and decreasing the shame and embarrassment associated with trichotillomania.
Trichotillomania can cause significant distress, pain, and dysfunction, but it is treatable. Whether you or someone you love compulsively pulls hair, there is hope in recovery.
Author bio: Trudi Griffin from Trichstop.com is a NCC Licensed Professional Counsellor putting her clinical knowledge, experience, and passion for research to use to write about mental health. She earned a Master of Science degree in Clinical Mental Health Counselling: Addictions and Mental Health from Marquette University (Milwaukee, WI), and is a double graduate of the University of Wisconsin Green Bay with Bachelor’s degrees in Communications and Psychology.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, Fifth edition. Arlington, VA: American Psychiatric Association.
(1) Woods, D.W., Flessner, C.A., Franklin, M.E., Keuthen, N.J., Goodwin, R.D., Stein, D.J. et al. (2006). Trichotillomania learning center-scientific advisory board: the trichotillomania impact project (TIP): Exploring phenomenology, functional impairment, and treatment utilization. J Clin Psychiatry, 67, 1877–1888
If you want to know more about what it’s like to live with the condition, ‘Every Trich In The Book’ by Cara Ward comes out this year. Pre-order it from Trigger now! Here’s what to expect:
Since her early teens, Cara Ward has suffered from trichotillomania (hair pulling disorder) and dermatillomania (skin picking), two forms of mental illness that are still often hidden away in shame. Feeling embarrassed and confused by her own behaviour, Cara kept quiet about it for years.
But in June 2013, she was left housebound by a condition called Red Skin Syndrome. The only way to get better was a harrowing and difficult withdrawal from all topical steroids. Despite her anxiety and doubt about whether she was doing the right thing, she kept going and made a full recovery. As a result, she knew that she could “beat her own mind” and overcome anything else she put her mind to.
And so, over a period of just seven weeks, Cara documented her struggles to gain better control of the disorders that had left her scarred and ashamed for years. Through sheer determination and willpower, Cara found a way to get to the best place she’d ever been with her trichotillomania.
Every Trich in the Book details Cara’s triumph over trich and derma, using humour and honesty along the way.