We joke “I’m pulling my hair out” when we’re stressed. But hair pulling is actually a real and even dangerous habit for some people, referred to as ‘trichotillomania’.
What is trichotillomania?
Trichotillomania, or “trich”, for short, is a long-term mental health disorder where you can’t stop yourself from pulling out your hair.
Also referred to as ‘hair pulling disorder’, it usually involves pulling out the hair on your head or your eyebrows and lashes, to the extent you have visible hair loss like a bald patch. But it can also be other forms of hair you are into pulling, including arm and leg hair, your beard or moustache, or even pubic hair.
Some people also have post-pulling rituals. This could be rubbing the hair, discarding of it in a special way, or even eating it.
What type of person has trichotillomania?
It most commonly begins in adolescents aged 10 to 13 and has been connected to going through puberty.
Females are ten times more likely to have this issue than males.
Why is hair pulling a big deal?
Very young children might hair pull briefly and then stop. Or you might find you do it very rarely and it’s manageable. You can work your way through it with distractions, or by telling someone about the urge.
For a long time it was assumed that everyone with trichotillomania did it because of an uncontrollable urge. The idea was that the urge made you tense and uncomfortable, so you pulled to feel relief, like a sort of addiction.
While for some people this is the case, it’s certainly not the way it works for all sufferers.
‘Automatic pulling’ sees you not even realise you are pulling out your hair. It’s unconscious, like a form of self-soothing.
‘Focused pulling’ means you consciously pull out your hair to deal with stress and anxiety or other difficult emotions. Or even boredom.
Sometimes trichotillomania isa form of self-harm. You seek the release of physical pain to escape emotional pain.
It’s thought to be a mix of a genetic predisposition and then environmental factors.
You’d be born with a brain that was more susceptible to trichotillomania. This might mean you were prone to a neurotransmitter imbalance of dopamine and serotonin seen in some cases, similar to those with OCD . In other cases a gene mutation is thought to cause the disorder .
In the ICD-11, the new version of the manual put out by the World Health Organisation and used in the rest of the world and the UK, hair pulling is also being moved from an impulse control disorder to under ‘obsessive compulsive or related disorders’. It has a sub category of‘body-focused repetitive behaviour disorders’.
The therapy most commonly offered in the UK is usually a type ofcognitive behavioural therapy (CBT) called ‘habit reversal training’. You’ll learn how to recognise the thoughts and experiences that trigger you to hair pull, and find other ways of being or occupying yourself so that you don’t hair pull. You’ll also work on managing your emotions and getting positive support from others.
Worried you or your child has hair pulling disorder? Or already have a diagnosis and want support? Get in touch now to talk to a child or adult psychiatrist or a counselling psychologist and start a treatment plan that helps you move forward.
Still have a question about ‘what is trichotillomania’? Or want to share you own experience with hair pulling disorder? Use the comment box below.