Trichotillomania

Daria used to make up excuses for the bald spot on the back of her head. Sometimes she said her head rubbed against the headboard of her bed when she was asleep. Other times she said the baseball caps she had to wear at work were too tight. She knew people doubted her stories, especially family members. But she couldn't face telling them what was really happening: She'd been pulling her hair out since she was 12.

Daria had no idea why she pulled her hair. She just knew that she couldn't stop. Many times, she did it without even thinking. Daria's mom noticed her doing it while watching TV. The two of them did some research and learned about a condition that some people have called trichotillomania.

What Is Trichotillomania?
Trichotillomania (pronounced: trik-oh-till-oh-may-nee-ah) is a type of psychological condition that involves strong urges to pull hair.

Doctors used to believe trichotillomania was rare. But that thinking is now changing as experts gain a better understanding of the condition and more people come forward for help. Trichotillomania affects more girls than guys. Most people who have it develop it during adolescence. But trichotillomania can start when a person is as young as 1 year old.

What Happens With Trichotillomania?
People with trichotillomania pull hair out at the root from places like the scalp, eyebrows, eyelashes, or pubic area. Some people pull large handfuls of hair, which can leave bald patches on the scalp or eyebrows. Other people pull out their hair one strand at a time. Some inspect the strand after pulling it out, or play with the hair after it's been pulled. About half of people with the condition put the hair in their mouths after pulling it.

It might be hard to understand why someone would pull their own hair or eyelashes out — or why they wouldn't just stop. But trichotillomania isn't just an ordinary habit that a person can easily stop. It's a medical condition.

Trichotillomania is a type of compulsive behavior. This means that people with the condition feel an overwhelming urge to pull their hair. People with trichotillomania also may have other compulsive habits, such as nail biting or skin picking. Some people with trichotillomania also have problems like depression, anxiety, or obsessive-compulsive disorder (OCD). Compulsive behaviors like trichotillomania can sometimes run in families.

People with trichotillomania may feel embarrassment, frustration, shame, or depression about the condition. They may worry about what others will think or say. They may feel nagged by people who don't understand that they're not doing this on purpose. They usually try to hide the behavior from other people, and this can make it difficult to get help.

Having trichotillomania can affect how people feel about themselves. Some people are self-conscious about how hair pulling affects their appearance. Because of this, they might feel less confident about making friends or dating. Others might feel powerless to control the urge to pull or blame themselves for not being able to stop. Feelings like these can cause a person's self esteem to suffer.

Why Do People Feel Compelled to Pull Their Hair?
Doctors don't know for certain what causes trichotillomania. Some think it might be related to OCD since OCD and trichotillomania both involve compulsions. Since compulsions arise as an effort to reduce tension, the urges that lead to hair pulling can be stronger when a person is stressed out or worried.

Experts think that compulsive behaviors like hair pulling may be caused by an imbalance of chemicals in the brain. These chemicals, called neurotransmitters (pronounced: nur-oh-tranz-mit-urs), are part of the brain's communication center. When something interferes with how neurotransmitters work, it can cause problems like compulsive behaviors.

Some people with trichotillomania say that they notice sensations in their scalp or skin. For example, it may be a tingling feeling that can only be relieved by pulling, like the feeling of relief that comes from scratching an itch. Some people say that they notice a satisfying feeling when they pull their hair. Others don't even notice when they pull, and do it without thinking.

Any relief that comes with hair pulling usually only lasts for a moment. The urge almost always returns. That's because when the mind becomes used to giving in to the powerful urges that go with compulsive behaviors, the behavior is reinforced The mind gets trapped in a cycle of expecting to have the urge satisfied. The longer this goes on, the harder it can become to resist the urge.

The Hair Pulling "Habit" and You: How to Solve the Trichotillomania Puzzle, Revised Edition

How Do People Overcome the Hair-Pulling Urge?
Because trichotillomania is a medical condition, it's not something most people can just stop doing when they feel like it. People with trichotillomania usually need help from medical experts before they can stop. With the right help, though, most overcome their hair-pulling urges. When someone is able to stop pulling, hair usually grows back.

Overcoming hair-pulling urges may involve talk therapy, medication, or a combination of both.

Therapists teach people with trichotillomania special behavior techniques that help them recognize the urge to pull hair before it becomes too strong to resist. The person learns ways to resist the urge so that it eventually grows weaker and then goes away. A therapist can also help a person regain confidence and self-esteem.

Because the urges behind compulsive habits like hair pulling are so strong, someone may feel more tension or anxiety when first trying to resist the urge. That's why it helps to work with an expert who can offer support and practical advice about how to reverse this powerful habit.

Some doctors may prescribe medications that can help the brain deal better with urges, making them easier to resist. Medication therapy can help to correct the imbalance of chemicals in the brain.

Many people find it helpful to keep their hands busy with a different activity (like squeezing a stress ball or drawing) during times when pulling is the worst. In the beginning, Daria found that knitting while watching TV helped keep her hands busy at a time when she might feel the urge to pull her hair.

Homework time was harder, though. Daria worked with her therapist to realize that she tended to pull more during homework because she was worrying about doing well on a project or test. Daria and her therapist talked about ways to deal homework stress. Daria discovered that being a perfectionist was adding to her tension. When she began to feel more relaxed — and still do excellent work — her confidence blossomed.

If you're worried about hair pulling, talk to a parent, school counselor, or someone you trust about getting help overcoming the problem.

Source: Kids Health