What Is Trichotillomania?
Trichotillomania is characterized by the uncontrollable urge to pull out one’s hair. For some people, this behavior may not reach a level of clinical concern. Professionals debate whether trichotillomania is a mental illness or not. Trichotillomania, once categorized as an impulse control disorder, now classifies as an obsessive-compulsive disorder. This change of category has only added to confusions associated with trichotillomania.
Symptoms of Trichotillomania
Signs of trichotillomania initially may go unnoticed by others. This behavior most commonly occurs in private. Hair plucking may be rotated to avoid a noticeable pattern of hair loss. For these reasons, a person usually must report their trichotillomania symptoms to others before they are recognized.
To meet the criteria for trichotillomania, a person must have made attempts to stop or reduce their hair pulling. The hair pulling must cause distress or impairment to qualify for the diagnosis of trichotillomania.
Causes of Trichotillomania Disorder
There is little known about what causes trichotillomania. Researchers have identified several possible factors that may lead to the development of trichotillomania. Two of the most likely causes of trichotillomania include ineffective coping skills and self-harm.
Ineffective Coping Skills
If a person has not developed healthy and effective coping skills, they may develop maladaptive behaviors during periods of extreme stress. For some people, their coping mechanism may involve hair pulling. In these cases, hair pulling often produces a feeling of relief.
When a person attempts to hide self-injurious behaviors, more discreet forms of self-injury may develop. Hair pulling is a commonly used discreet form of self-harm used to relieve distress. Hair pulling reinforces the behavior by providing relief, and it may eventually develop into trichotillomania.
When diagnosing trichotillomania, the clinician must first ensure that the hair pulling is not a result of another disorder. Once a clinician determines that hair pulling is unrelated to other health conditions, they must determine how and when hair pulling occurs. Exploring reasons for pulling and thoughts and feelings occurring before and after pulling is critical for developing an effective treatment plan.
Who Is at Risk for Trichotillomania?
Females are more likely than men to develop trichotillomania. Some estimates put the gender-gap ratio as high as 10 females for every 1 male with the disorder. People with anxiety disorders are at an increased risk of developing trichotillomania. A family history of anxiety disorders may link to trichotillomania. People who have a first-degree relative with obsessive-compulsive disorder (OCD) may be predisposed to developing trichotillomania.
While it may be difficult to estimate how many people have trichotillomania, between 1 percent and 5 percent of the total population meets the criteria for trichotillomania at some point. Trichotillomania statistics help to clarify the progression of this disorder. Trichotillomania may wax and wane over the lifespan but usually first emerges during childhood.
The areas on the body where a person pulls their hair may also change over time. While many people with the disorder pull from the scalp, other areas — including eyelashes, eyebrows, the pubic region and legs — are subject to pulling as well.
Trichotillomania treatment can include a wide range of approaches, from trichotillomania habit reversal training to medication management.
Medications for Treating Trichotillomania
While there is no medication for trichotillomania exclusively, several viable treatment options are available, including:
Antidepressant medications, especially selective serotonin reuptake inhibitors (SSRIs), may assist a person in coping with feelings that may lead to hair pulling. These drugs include medications such as Celexa, Lexapro, Prozac, and Zoloft.
N-acetylcysteine is an antioxidant available over the counter that has shown some success with reducing compulsive behaviors such as trichotillomania. NAC does not require a prescription and can be found in most pharmacies with the supplements.
Naltrexone is frequently used to reduce urges and cravings associated with substance use disorders. This medication has shown some utility in treating trichotillomania. Naltrexone, sometimes referred to by the brand name Vivitrol, may be especially useful in treating trichotillomania with co-occurring substance use.
Therapy for Treating Trichotillomania
A trichotillomania treatment plan is likely to include a combination of therapies.
Psychoeducation is often used at the beginning of services to normalize the condition and reduce the shame and secrecy associated with it.
Trichotillomania Habit Reversal Training
Trichotillomania habit reversal training is one of the most commonly used techniques. It bases its approach to building personal awareness of hair pulling and identifying hair-pulling triggers. This therapy addresses these triggers, so the individual can develop new, healthier behaviors to respond to common triggers instead of engaging in hair pulling.
Trichotillomania Cognitive Behavioral Therapy
Trichotillomania cognitive behavioral therapy may be particularly effective. While similar in approach to habit-reversal training, trichotillomania cognitive behavioral therapy focuses more on changing the thoughts associated with hair pulling and allowing this change to influence behaviors.
Hypnotherapy for Trichotillomania
Hypnotherapy for trichotillomania has not been proven to be clinically effective but may be helpful for some people. This approach often is more successful with younger patients.
Effects of Substance Abuse on Trichotillomania Symptoms
While trichotillomania usually develops initially during childhood, it may resurface during various times in a person’s life. Extreme stress contributes to a recurrence of trichotillomania. Another common result of experiencing stress is substance use. Usually, the presence of both indicates a need to develop healthy coping skills. Developing healthy coping skills should be one of the initial focuses of treatment.
Trichotillomania and Alcohol
For a person who has been able to stop hair pulling, alcohol may cause a trichotillomania recurrence. Reducing inhibitions and increasing impulsivity is likely to open the door for old behaviors to re-emerge.
Trichotillomania and Marijuana
There is little research on marijuana and trichotillomania. Though not proven, some people believe that marijuana could reduce hair pulling behaviors. Further, marijuana may cause anxiety and paranoia in some people, which could lead to an increase in hair pulling.
Trichotillomania and Stimulants
Stimulants are the most commonly used substance with co-occurring hair pulling behaviors. When stimulant use is present, it is important to examine the reason and practice of hair pulling.
A common symptom of stimulant use is skin picking, which, in some cases, may manifest as hair plucking. It is critical to identify if drug use causes hair pulling or if the hair pulling is also present without drug use. Stimulant drugs may increase anxiety, which is a common trigger for hair pulling in those with trichotillomania. Some of the most common stimulants associated with hair pulling include:
- Crack cocaine
- Prescription stimulant medications (e.g. Adderall, Ritalin)
Drug Abuse as a Cause of Trichotillomania
While it is rare for trichotillomania to develop because of drug use, when stimulant use and hair pulling behaviors occur together, it is possible. A person may experience relief or gratification when they first pull hair as the result of drug use. Over time, as the pleasurable emotional experience reinforces this behavior, the hair pulling may begin to occur independently of substance use.
Treatment for Trichotillomania with Co-Occurring Substance Abuse
When both disorders occur together, it is essential to treat them concurrently. Teaching effective coping strategies can aid in reducing the need to resort to unhealthy coping practices. Developing the ability to delay an impulse is another important goal of treatment, as this can prevent recurrence of both substance use and hair pulling. With some modifications, the same treatment approaches are likely to be beneficial for both trichotillomania and substance use disorders.
If you or a loved one experience a mental health and substance use disorder, treatment might be necessary. Some rehab centers, like The Recovery Village, offer evidence-based approaches to treating addiction and mental illness. To learn more about treatment, contact The Recovery Village today.