Compulsive Hair Pulling – a ‘trichy’ problem

Trichotillomania - Compulsive Hair Pulling

We all have habits and behaviours we find undesirable, but find no harm in engaging in them either. But what happens when the behaviour does begin to affect our daily lives and the urge to engage in the behaviour overpowers us? This is when we can no longer consider it to be just a ‘bad habit’ and start to see the emergence of a clinical disorder. 

For people who compulsively pull out their own hair, this disorder is known as Trichotillomania. It is estimated that 3-4% of the population is affected by trichotillomania, with new cases on the rise. This may be attributed to the increased awareness of trichotillomania as a clinical condition through the hard work and efforts of support organizations such as the Trichotillomania Learning Centre (TLC) and the Canadian Body-Focused Repetitive Behaviours Support Network (CBSN).

How is it diagnosed?

Trichotillomania was only first recognized in the DSM-III Revised edition (DSM-III-R) in 1987. Since then the diagnostic criteria have been revised to the current version found in the DSM-5. It is categorized under Obsessive Compulsive and Related Disorders (OCD-R) and is characterized by recurrent body-focused repetitive hair pulling and repeated attempts to decrease or stop the behaviour. There are many similarities in presentation of the behavior with other mental illnesses such as Body Dysmorphic Disorder, where the individual engages in repetitive grooming such as the removal of perceived imperfections on the body. However there are distinct differences that distinguishes compulsive hair pulling from other mental illness.

The criteria for diagnosis are as follows:

·       Recurrent pulling out of one’s hair, resulting in hair loss

·       Repeated attempts to decrease or stop the hair-pulling behaviour

·       The hair pulling causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

·       The hair pulling or hair loss cannot be attributed to another medical condition (e.g. a dermatologic condition)

·       The hair pulling cannot be better explained by the symptoms of another mental disorder (e.g. attempts to improve a perceived defect or flaw in appearance as in body dysmorphic disorder)

One of the key features of trichotillomania compared with deliberate self-harming behaviours such as cutting, is that the intent is never to harm the body, instead the urge is to experience the actual act of pulling the hair out which can even be pleasurable or relaxing. Many report experiencing a mounting sense of tension just prior to pulling which is released once the person succumbs to the urge to pull. However this sense of release is quickly replaced by feelings of shame and guilt.  Another characteristic is that hair pulling can be both focussed and automatic. Automatic hair pulling is very difficult to treat as the person is not aware of the urge to pull until they find themselves already pulling.

The burden of trich

Trichotillomania can have a negative impact on an individual’s day to day functioning in that they can spend large amounts of time engaging in the behavior causing lateness and lack of productivity at work. When hair loss and hair thinning becomes noticeable it can also affect the person’s social functioning in that he or she may avoid social interactions or avoid contexts where hair loss will be more apparent such as the beach.

There is hope

As awareness of trichotillomania increases, more and more people are coming out of the shadows to seek help, consequently having a ripple effect on the increased awareness of the disorder among health professionals. We have seen a host of new research studies conducted to understand trichotillomania and to develop effective treatment. Thus far Cognitive-Behavioral Therapy (CBT) is thought to be the most effective talk-based therapy, with promising results showing for the use of supplements such as NAC (N-Acetylcysteine). There is no quick fix for overcoming trichotillomania and each individual presents with different needs.

The writer, Tasneem Abrahams, is an expert on BFRB treatment, and treats trichotillomania patients via TrichStop’s Online Therapy Program

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