Trichotillomania: Causes, Symptoms, Risk Factors, Diagnosis, Treatment and Complications

Trichotillomania, commonly known as hair-pulling condition, is a mental disorder characterized by persistent, uncontrollable cravings to pull out hair from the scalp, brows, or other parts of the body despite trying to stop.

Hair removal from the scalp frequently leaves patchy bald regions, which is extremely distressing and can make it difficult to function in social or professional situations. Trichotillomaniacs may make great efforts to conceal their baldness. Trichotillomaniacs may make considerable efforts to hide their baldness.

For other people, trichotillomania may be mild and largely under control. Some individuals experience a strong compulsive urge to pull out their hair. 

Many people's hair pulling has been reduced or completely stopped because of several treatment choices.

Causes Of Trichotillomania

There is no known cause of trichotillomania. But like many other complicated illnesses, trichotillomania likely has both hereditary and environmental causes.

Symptoms Of Trichotillomania

Trichotillomania frequently exhibits the following symptoms:

• Pulling your hair out repeatedly, typically from your scalp, eyebrows, or eyelashes, but occasionally from other body parts, and the sites may change over time.
• Prior to pulling or when you attempt to avoid pulling, a rising sense of tension
• Following hair pulling, a feeling of pleasure or relief
• Observable hair loss, such as short hair or thinned or bald patches on your scalp or other parts of your body, such as sparse or absent eyelashes or eyebrows
• A preference for a certain type of hair, rituals associated with hair pulling, or hair-pulling habits
• Eating, biting, or chewing on a pulled-out hair
• Attempting repeatedly to stop ripping your hair out or to do it less frequently yet failing
• Significant anxiety or issues with job, school, or social circumstances as a result of hair-pulling
• Many trichotillomaniacs also pick at their skin, bite their nails, or chew their lips. Pulling hair from dolls, pets, or objects like garments or blankets might occasionally be an early warning sign. Trichotillomaniacs typically pull their hair in private and try to hide the disorder from others.

Hair pulling can be:

• Focused- Some people purposefully rip their hair out in order to release tension or anguish, such as when they have a strong impulse to do so. When pulling their hair, some people may develop intricate rituals, such as selecting the perfect strand or biting the pulled hair.
• Automatic- When bored, reading, or watching TV, for example, some people pluck their hair without even realizing it.

Depending on the circumstance and attitude, the same person may pull their hair out deliberately or automatically. Hair pulling might be triggered by certain postures or rituals, such as resting your head on your palm or brushing your hair.

Emotions may be associated with trichotillomania:

• Negative emotions- Hair pulling is a common trichotillomaniac's way to compensate for unpleasant or stressful emotions including stress, anxiety, tension, boredom, loneliness, exhaustion, or frustration.
• Positive emotions-  Many trichotillomaniacs discover that pulling out their hair feels good and offers some relief. As a result, individuals keep pulling their hair in an effort to keep up these good emotions.

Trichotillomania is a chronic (long-term) disorder. The intensity of symptoms can change over time if they are not treated. Menstruation's hormonal changes, for instance, can make symptoms worse in women. If untreated, symptoms in some people can recur for weeks, months, or even years at a time. Rarely, hair pulling stops a few years after it first begins.

Risk Factors Of Trichotillomania

Trichotillomania is more likely to occur as a result of the following factors:

• Family background- Trichotillomania may be inherited, and people who have a close family who have the disorder may also develop it.
• Age- Trichotillomania typically appears immediately before or during the early teen years, most frequently between the ages of 10 and 13 years, and it is frequently a lifetime issue. Hair pulling in babies is also a possibility, although it's typically moderate and resolves on its own without intervention.
• Various medical conditions- Trichotillomania patients may also suffer from other mental illnesses such as depression, anxiety, or OCD.
• Stress- Some people's trichotillomania may be triggered by extremely stressful circumstances or occurrences.
• Gender- Despite the fact that considerably more women than males receive treatment for trichotillomania, this may be because they are more willing to consult a doctor. Boys and girls both seem to be influenced similarly in early childhood.

Diagnosis Of Trichotillomania

The following tests may be used to assess whether you have trichotillomania:

• Assessing the extent of your hair loss
• Talking to you about your hair loss and asking you questions
• Identifying any physical or mental health issues that may be related to hair pulling excluding any further potential reasons for hair loss or pulling out your hair through testing decided by your doctor
• The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association for use as a guide for diagnosis

Treatment Of Trichotillomania

There is not much data available about trichotillomania treatment. Many people have been able to quit pulling their hair completely or at least significantly lessen it due to some treatment alternatives.

Therapy

Therapy for trichotillomania might be of the following types:

• Habit reversal training. The main treatment for trichotillomania is behavioral therapy. You learn to identify circumstances where you're prone to scream and how to replace such behaviors with others. For instance, you might tighten your hands to aid in suppressing the urge. Along with habit reversal training, other therapies may be employed. Decoupling is a variation of this method that entails swiftly moving your hand away from your hair and towards another area.
• Cognitive behavioral treatment. You can evaluate any mistaken beliefs you might have about hair pulling with the use of this therapy.
• Therapeutic acceptance and devotion. You can learn to accept your cravings to rip your hair out without acting on them with the help of this therapy.
• Treatment plans may include therapies for trichotillomania as well as other mental health conditions, such as depression, anxiety, or substance misuse.

Medications

Although the Food and Drug Administration has not approved any drugs, especially for the treatment of trichotillomania, several drugs may help reduce some symptoms.

For instance, your physician might suggest an antidepressant-like clomipramine (Anafranil). N-acetylcysteine, an amino acid that affects neurotransmitters linked to mood, and olanzapine (Zyprexa), an atypical antipsychotic, are two more drugs that studies suggest may be helpful.

Any medication your doctor offers, discuss it with them. Always weigh the potential negative effects of drugs against any potential advantages.

Complications Of Trichotillomania

Even though it might not seem to be a serious problem at first, trichotillomania can have a substantial detrimental impact on your life. Possible obstacles include:

• Feelings of distress. Numerous trichotillomania patients admit to feeling guilty, ashamed, and embarrassed. They may also utilize illegal substances, feel anxious or sad, or have low self-esteem as a result of their illness.
• Occupational and social functioning problems. Out of embarrassment caused by hair loss, you can avoid social events and career opportunities. People with trichotillomania may wear wigs, style their hair to conceal bald spots or apply fake lashes. Because they fear their sickness may be revealed, some people may avoid personal interactions.
• Damage to hair and skin. Constant hair pulling can harm the skin on your scalp or the exact place where hair is pulled, leaving scars, and can even result in infections. It can also have a long-term negative impact on hair development.
• Hairballs. A huge, matted hairball (trichobezoar) could develop in your digestive tract as a result of eating your hair. The hairball can result in weight loss, vomiting, intestinal obstruction, and even death over a period of years.

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