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.
  • Chemical Imbalance. Similar to obsessive-compulsive disorder (OCD), trichotillomania can be caused by a chemical imbalacne in the brain or changes in hormone levels.
  • Self-harm. 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.

Diagnosing 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.

Trichotillomania Statistics and Risk Factors

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.

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.

Trichotillomania Treatment

While there is no medication for trichotillomania exclusively, antidepressants, NACs and naltrexone can help with certain symptoms. Therapy is also an effective form of treatment for trichotillomania. Common therapies include:

  • Habit reversal training: Habit reversal training (HRT) is one of the most commonly used techniques for treating trichotillomania. It bases its approach to building personal awareness of hair pulling and identifying hair-pulling triggers. HRT addresses these triggers, so the individual can develop new, healthier behaviors to respond to common triggers instead of engaging in hair pulling.
  • Cognitive Behavioral Therapy: Cognitive behavioral therapy (CBT) may be particularly effective for trichotillomania. While similar in approach to habit-reversal training, CBT focuses more on changing the thoughts associated with hair pulling and allowing this change to influence behaviors.
  • Acceptance and Commitment Therapy: Acceptance and commitment therapy (ACT) helps people with trichotillomania break the bond between the craving to pull hair and the act of pulling. The goal is for the person to learn to accept their hair pulling urges without acting on them.

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. A trichotillomania treatment plan is likely to include a combination of therapies that address symptoms of trichotillomania along with any co-occurring disorders.

Trichotillomania and Substance Abuse

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.

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 a 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.

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.

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