Trichotillomania is a psychological disorder that some individuals suffer from, characterized by repeated pulling, picking, or scraping of hair, which leads to damage to the scalp. This obsession is not limited to the scalp only, but extends to include pulling hair from eyebrows, eyelashes, and other parts of the body. Let's explore more about this disorder through the Dalili Medical website.

**Is Trichotillomania a psychological disorder?**

 

Recently, Trichotillomania has been classified as an obsessive-compulsive disorder according to the Diagnostic and Statistical Manual of Mental Disorders.

**Does Trichotillomania affect hair growth?**

 

Many studies indicate that pulling hair may stimulate more hair growth in the same area, as about 1,300 hairs can regrow after pulling 200 hairs from the scalp, which means that Trichotillomania does not hinder growth.

**Are there cases that have been cured of trichotillomania?**

 

Yes, there are many cases that have been able to overcome hair-pulling disorder.

**Is behavioral therapy the best solution for trichotillomania?**

 

Cognitive behavioral therapy is considered one of the best treatments available for trichotillomania, as it helps individuals avoid triggers and learn to replace these behaviors.

**Is trichotillomania curable?**

 

Trichotillomania may improve spontaneously in children under the age of six, while in adults it can last for months, years, or even a lifetime. However, treatment can help reduce symptoms and stress, especially when received in the early stages.

**What is trichotillomania?**

 

It is a psychological disorder that causes a strong and urgent feeling to pull hair from the scalp, eyebrows, or other areas, despite repeated attempts to stop. After pulling hair, the person feels temporary relief, but this feeling quickly fades, prompting him to return to pulling hair again. Over time, hairless patches may appear in the affected areas. Although it feels good after pulling, a person may experience negative feelings such as guilt, shame, and low self-esteem due to having hairless areas. This disorder often affects teenagers and young adults, and females are more likely to develop it than males.

**Causes of Trichotillomania**

 

1. **Biological factors**: Genetics play a major role in the development of Trichotillomania, as this disorder can be passed down through generations. If a close relative has a history of this problem, the likelihood of developing it in a person increases.

2. **Psychological factors**: Anxiety and stress are major factors that contribute to the emergence of Trichotillomania. Studies indicate that psychological stress can negatively affect the health of the scalp and hair growth, which increases a person's desire to pull hair excessively.

3. **Psychological impact**: Trichotillomania can affect a person's mental health, as they may feel anxious and depressed as a result of this disorder. Hair loss can lead to a deterioration in self-confidence and increased social isolation.

4. **Social factors**: Social pressures play a role in exacerbating trichotillomania, as societal expectations regarding personal appearance can contribute to increased psychological stress.

5. **Family history**: Genetics may play a role in developing trichotillomania, as individuals who have relatives with the condition can develop it.

6. **Age**: Trichotillomania often appears in early adolescence, with those affected usually between the ages of 11 and 13. Infants may also be susceptible to this condition, but it is often mild and goes away on its own.

7. **Negative feelings**: For many people, hair pulling is a way to cope with negative feelings such as stress and anxiety.

**Symptoms of trichotillomania**

 

Repeated hair pulling and the inability to resist this habit, along with a feeling of relief after doing it, are the main symptoms of this disorder. Hair pulling is most often done from the scalp, but it can also include eyebrows and eyelashes, and may extend to include beard or moustache hair, and even pubic hair.

Hair pulling may be triggered by stress or anxiety, but it can also occur in relaxed situations, such as while reading or watching TV.

**Other signs and symptoms of trichotillomania include:**

 

- Irregular patches of hairless hair appearing as a result of the pulling.

- Decreased hair density due to excessive hair loss.

- Irritation in the areas where the hair is pulled, with a possible tingling or itching sensation.

- Picking at or twirling the hair around your fingers.

- Wearing a scarf or hat to cover the bald spots on your head.

- Using false eyelashes or drawing in your eyebrows to hide the gaps.

**What drives you to pull your hair?**

 

The exact causes behind this disorder are still unknown, but there are several theories that suggest that the following factors may be behind this habit:

- **Addiction to the habit:** Hair pulling is considered a type of addiction, as the feeling of relief after pulling leads the person to do it again.

- **Psychological problems:** Such as stress and depression, as these feelings can be a motivation for pulling as a means of venting.

- **Distraction:** Some people resort to pulling hair as a way to distract themselves from the problems or pain they feel.

- **Brain dysfunction:** Studies have shown that the brains of people with trichotillomania may exhibit abnormal functions.

- **Genetic changes:** Some genetic changes may lead to the development of this condition, and it may also be hereditary.

- **Serotonin deficiency:** Low levels of serotonin may be associated with an increased likelihood of hair pulling.

- **Hormonal changes:** Trichotillomania is common in age groups that experience hormonal changes, such as adolescence.

**Diagnosis of Trichotillomania**

 

Your doctor will conduct a comprehensive evaluation to determine if you have Trichotillomania, which may include:

- ExaminationThe amount of hair lost.

- Discuss your hair loss with you, and you may be asked to fill out a questionnaire.

- Rule out other possible causes of hair loss through tests prescribed by your doctor.

To be diagnosed with trichotillomania, you must meet the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which include:

- Repetitive hair pulling that results in noticeable hair loss.

- Repeated attempts to stop or reduce the frequency of hair pulling.

- The pulling causes significant distress or problems at work, school, or social situations.

- The hair loss is not associated with any other medical or skin condition or symptoms of another mental disorder.

**Treatment of Trichotillomania**

 

There are several types of Trichotillomania (TTM), as follows:

1. **Impulsive pulling**: Characterized by repeated pulling that results from an urgent desire, where the person feels pleasure while pulling, but it is often followed by feelings of regret.

2. **Compulsive pulling**: In this case, pulling is a response to an increasing feeling of distress, where the person uses pulling as a way to relieve this distress, without any feeling of pleasure.

3. **Automatic pulling**: Here, pulling occurs automatically, where the person is not fully aware of what he is doing while he is busy with other activities. In this type, the person does not enjoy pulling and does not seek to relieve a specific distress.

**Automatic pulling**: This means pulling hair unconsciously, and this may occur in situations such as feeling bored, or while reading, or watching TV.

**Focused pulling**: In this case, hair is deliberately pulled as a way to relieve stress or distress. The person may develop certain rituals for pulling, such as searching for the appropriate hair, playing with the pulled out hair, or even biting or eating it.

**Automatic and focused pulling**: Depending on the mood or situation, certain positions or activities may lead to hair pulling, such as placing the head on the hand or combing the hair.

**Relationship of Hair-Pulling Compulsion to Emotional State**

Hair-pulling compulsion can be linked to emotions, including:

- **Negative feelings**: Pulling may be a way to cope with negative or uncomfortable feelings, such as stress, anxiety, boredom, loneliness, extreme fatigue, or frustration.

- **Positive feelings**: A person may feel satisfied and comfortable while pulling, which may cause them to continue this habit to maintain those positive feelings.

Hair-pulling compulsion is a long-term disorder, and if left untreated, symptoms may come and go over weeks, months, or even years. The severity of symptoms can also vary over time. For example, hormonal changes during menstruation may worsen symptoms in some women. In rare cases, pulling may stop a few years after it started.

**When should you see a doctor for hair-pulling compulsion?**

 

If you are having trouble stopping your hair-pulling, or you feel embarrassed or ashamed of your appearance because of it, it is important to consult a specialist. Hair pulling is not just a bad habit, it is a mental health condition that is unlikely to improve without proper treatment.

**Who is most at risk for developing trichotillomania?**

 

- **Family history:** People who have a first-degree relative (such as a parent or sibling) with the disorder are at higher risk.

- **Childhood trauma:** According to the National Organization for Rare Diseases (NORD), people who have experienced traumatic experiences in their childhood may be at higher risk for developing the disorder, although there is not enough research to support this hypothesis.

- **Changes in brain function:** Certain changes in brain function and chemicals may affect a person’s ability to control impulsive behaviors such as hair pulling.

**Hair pulling side effects**

 

Pulling hair from the head is a common habit among many people, but it can have negative effects on health and hair. Potential side effects include:

- **Scalp irritation:** Frequent pulling can irritate the scalp and skin.

- **Hair damage:** Excessive plucking can damage or break hair follicles, reducing the strength and shine of hair.

- **Increased hair loss:** Continued plucking can lead to increased hair loss, especially if done in an unkind manner or using inappropriate tools.

- **Infection and inflammation:** Wounds resulting from plucking can open the way for infection or inflammation in the scalp.

- **Hair gaps and bald spots:** Continued plucking can damage hair follicles, resulting in empty spots. In some cases, the body may be able to heal these spots, while in other cases they may remain bald for life. The psychological impact of these spots can be very negative, prompting a person to pluck more hair due to stress and tension.

- **Allergies and inflammation:** Itching and skin irritation are common complications, and plucking can lead to inflammation and bacterial infections due to wounds and lack of sterilization.

- **Social problems:** People with trichotillomania have problems interacting socially because they feel ashamed of their appearance, and family and friends may need to consult a specialist for support.

- **Anxiety and depression:** Trichotillomania can lead to depression and anxiety, and depression may develop into a chronic condition and social isolation.

- **The danger of hair pulling and eating:** Although hair pulling is not a fatal disease, trichotillomania can lead to hair accumulating in the stomach, causing serious health problems such as chronic constipation or intestinal obstruction, which may require urgent surgical intervention.

### Trichotillomania in children

 

Although cases of trichotillomania are common among adults, this disorder often begins before the age of seventeen, and may even appear in early childhood, before the age of six. The most common age group for detecting this disorder is between 9 and 13 years. Therefore, it is necessary to pay attention to the signs of trichotillomania Hair pulling in children, which includes:

- Repeatedly twisting or pulling hair.

- Feeling stressed before doing this act.

- Feeling comfortable after pulling hair.

- Sometimes, the child may put the pulled hair in his mouth.

- If asked, the child may deny that he is pulling hair or try to hide it.

- Showing other self-harming behaviors.

- The child suffers from some type of depression or anxiety.

- Having a negative self-image or diminishing his value.

### Complications of hair pulling mania

 

People with hair pulling mania are often unaware of what they are doing until after they are done, which increases their feelings of anxiety and leads to a return to hair pulling, creating a vicious cycle. This cycle worsens the condition and causes many complications, including:

1. **Digestive system problems**: In some cases, swallowing hair can lead to serious health problems such as intestinal obstruction and difficulty passing stool.

2. **Temporary baldness**: Baldness is considered one of the negative complications that affect the external appearance, which may lead to a worsening of the psychological state and the deterioration of social relationships, as the affected person may distance himself from others due to feeling shy.

3. **Itching or tingling in the hair-pulling area**: It is normal for a person to feel itchy when plucking a single hair, but it becomes painful when plucking many hairs, which may sometimes require the use of painkillers.

### Psychotherapy

 

Psychotherapy is the basis for treating hair-pulling obsession, as it aims to identify the psychological motives behind this behavior and overcome them. The types of psychotherapy used vary, the most prominent of which are:

- **Cognitive behavioral therapy**: It is considered one of the most effective treatments for confronting hair-pulling obsession, as it focuses on dealing with the thoughts and feelings that stimulate this behavior, and works to enhance positive thinking.

Cognitive behavioral therapy includes techniques such as habit reversal training, which includes:

- Monitoring hair-pulling behavior in terms of times, duration, and intensity.

- Identifying and recording the psychological triggers and environmental factors that lead to the desire to pull hair.

- Replacing the hair pulling behavior with another behavior that helps relieve stress, such as using a stress ball or keeping the hand closed.

- Preventing yourself from doing this behavior by wearing gloves or covering the hair.

- Practicing relaxation techniques such as deep breathing and yoga to overcome stress and anxiety.

**Acceptance and Commitment Therapy**

 

Acceptance and Commitment Therapy is a type of behavioral therapy that aims to enhance emotional flexibility in individuals, helping them express their negative thoughts and feelings. This therapy involves accepting these feelings and living with them to avoid their negative impact, in addition to committing to avoiding the behavior of hair pulling. Acceptance and commitment helps to break the connection between the trigger and the unwanted behavior, which reduces the symptoms associated with it.

**Group Therapy**

 

Group therapy is useful in treating hair pulling obsession, especially for people who suffer from loneliness and isolation. Sharing experiences and advice with others who are facing the same disorder helps to reduce the psychological burden and enhances the ability of individuals to overcome this ordeal, as the person realizes that he is not alone in facing this challenge.

**Medication**

 

So far, there is no specific medication to treat trichotillomania, but some medications may help reduce anxiety and alleviate symptoms. These medications include:

- **Selective serotonin reuptake inhibitors**: These are a type of antidepressant that helps reduce the symptoms of hair pulling, in addition to the anxiety and depression associated with it. Examples include:

- Fluoxetine

- Sertraline

- Fluvoxamine

- Citalopram

- Escitalopram

- **Tricyclic antidepressants**: Some types, such as clomipramine, may be helpful in reducing the symptoms of trichotillomania, but they may not be suitable for everyone due to their potential side effects.

- **Other medications**: such as naltrexone, olanzapine, and acetylcysteine.

**Basic steps for treating trichotillomania**

 

The steps for treating trichotillomania begin with identifying the circumstances surrounding the compulsive hair-pulling behavior, by the patient observing the signs that precede and accompany these behaviors, in addition to the feelings that follow them. These observations are a basic rule for the therapist in understanding the motivations for hair-pulling and determining the most appropriate treatment.

**Hair-pulling reversal therapy (HRT)**

 

Habit-reversal therapy is the main method for treating trichotillomania, as it focuses on acquiring new habits as an alternative to hair-pulling behavior. This treatment includes several stages:

1. **Awareness**: The patient begins by observing the circumstances surrounding the hair-pulling attacks, and the therapist works to define the nature of the disorder and its motivations.

2. **Competitive response and habit reversal**: Hair-pulling behavior is replaced with a new behavior, such as squeezing a rubber ball or engaging in physical activities.

3. **Developing positive motivations**: The family plays an important role in supporting the patient and praising his progress in treatment.

4. **Relaxation and breathing exercises**: The patient learns relaxation and deep breathing skills to help him resist the urge to pull hair.

5. **Generalization training**: The patient practices the acquired skills in different situations to transform the new habit into a stable behavior.

6. **Cognitive behavioral therapy**: Focuses on re-evaluating the concepts and ideas that lead to the desire to pull hair, working to correct them and forming new concepts that help stop this behavior.

**Methods to reduce hair pulling**

 

Some doctors recommend using simple solutions to support the treatment of hair pulling obsession, such as wearing hats, shortening nails to reduce the ability to hold hair, or shaving the hair completely, but it must be emphasized that these methods do not replace psychotherapy and habit reversal treatment.

**How ​​to treat hair pulling at home**

 

Some tips can help reduce hair pulling behavior and treat obsessionHair pulling in children and adults, and these tips include:

- Cutting hair, preferably very short for children to prevent them from pulling it out when they want to.

- Wearing a tight hat on the head.

- Putting tape on the tips of the fingers or wearing gloves to reduce the ability to pull hair.

- Using fidget toys, such as a stress ball, to occupy the hands.

Lifestyle modifications and practicing activities that help relax are important steps in treating hair pulling obsession, and these measures include:

- Practicing relaxation exercises, such as deep breathing and progressive relaxation.

- Exercising regularly to relieve anxiety and promote mental and physical health.

- Following a balanced diet.

- Getting enough sleep, as sleep disorders can increase stress and affect an individual's ability to face daily challenges.

- Sharing feelings and problems related to hair pulling obsession with family or close friends to relieve the psychological burden, reduce feelings of guilt, and obtain support.

- Engaging in favorite hobbies or activities to distract the mind from unwanted behaviors.

**How ​​to deal with people with trichotillomania**

 

The following guidelines can help in dealing with people with trichotillomania properly and supporting them in their treatment journey until recovery:

- Refrain from shouting, scolding, or scolding the person severely, as this may increase their anxiety and discomfort, which may exacerbate the symptoms or push them to hide the behavior.

- Remind the person calmly when you notice the beginning of hair pulling behavior.

- Help them find alternatives that mimic hair pulling to relieve their stress without harming themselves, such as giving them types of brushes to play with, such as hairbrushes or toothbrushes.

- Use simple games designed to relieve feelings of stress and psychological pressure.

- Distract the person with activities that require the use of hands, such as drawing, coloring, or sewing.