Trichotillomania (Hair Pulling Disorder)

Hair is just hair to some people. Hair to someone with Trich is much more than that. It has a profound impact on self- esteem, relationships, social situations etc. So although it may just be hair for you, for someone with Trich its pretty much a daily battle with their identity.

Trichotillomania, also known as trich, is when someone can’t resist the urge to pull out their hair. They may pull out the hair on their head or in other places, such as their eyebrows or eyelashes. Trich is more common in teenagers and young adults, and tends to affect girls more often than boys.

Trichotillomania (pronounced trik-o-till-o-MAY-nee-uh), also referred to as “hair-pulling disorder,” is a mental disorder classified under Obsessive-Compulsive and Related Disorders and involves recurrent, irresistible urges to pull hair from the scalp, eyebrows, eyelids, and other areas of the body, despite repeated attempts to stop or decrease hair pulling.

Hair pulling from the face can result in complete or partial removal of the eyebrows and eyelashes, while hair pulling from the scalp can result in varying degrees of patches of hair loss. The hair pulling and subsequent hair loss results in distress for the person, and can interfere with social and occupational functioning. For some people, the symptoms of trichotillomania are manageable, but for others, the symptoms can be completely overwhelming.

Symptoms of trichotillomania

People with trich feel an intense urge to pull their hair out and they experience growing tension until they do. After pulling their hair out, they feel a sense of relief. A person may sometimes pull their hair out in response to a stressful situation, or it may be done without really thinking about it. Most people with trich pull out hair from their scalp, but some pull out hair from other areas, such as their:

· eyebrows

· eyelashes

· genital area

· beard or moustache

· Bald patches left on the head tend to have an unusual shape and may affect one side more than the other.

Trich may cause feelings of shame and low self-esteem. Those affected may try to keep their condition to themselves.

Causes of trichotillomania

It’s not entirely clear what causes trich.

It could be:

· your way of dealing with stress or anxiety

· a chemical imbalance in the brain, similar to obsessive compulsive disorder (OCD)

· changes in hormone levels during puberty

· a type of self-harm to seek relief from emotional distress

· For some people, hair pulling can be a type of addiction. The more they pull their hair out, the more they want to keep doing it.

When to see a General Practitioner (GP)

See your GP if you’re pulling your hair out or if you notice that your child is.

You should also see your GP if you or your child has a habit of eating hair. This can cause hairballs to form in the stomach, leading to serious illness.

Your GP may examine areas where the hair is missing to check that nothing else is causing the hair to come out, such as a skin infection.

If your GP thinks you have trich, you may be referred for a type of treatment called cognitive behavioural therapy (CBT).

Treating trichotillomania

Trich is commonly treated using a type of CBT called habit reversal training.

This aims to help you replace a bad habit with something that’s not harmful.

Treatment usually involves:

· keeping a diary of your hair pulling

· working out the triggers for your hair pulling and learning how to avoid them

· replacing hair pulling with another action, like squeezing a stress ball

· involving loved ones to provide emotional support and encouragement

· Antidepressants are no longer considered to be an effective treatment for trich.

· form a ball with your fist and tighten the muscles in that arm

· use a fidget toy

· wear a bandana or a tight-fitting hat, such as a beanie

· come up with a saying that you repeat out loud until the urge to pull passes

· take a soothing bath to ease any stress or anxiety

· practise deep breathing until the urge to pull goes away

· exercise

· put plasters on your fingertips

· cut your hair short

It may also help to open up about your trich to people you trust, as hiding it can sometimes make your anxiety worse. Many people who have learned to manage their trich say that speaking to others about the condition led to a reduction in hair pulling.

Habit Reversal Therapy (HRT), which is a type of behavioral therapy, might be effective in treating trichotillomania.

HRT involves five stages:

Awareness training: The person identifies the psychological and environmental factors that can trigger an episode of hair pulling.

Competing response training: The person practices replacing the hair pulling behavior with a different behavior.

Motivation and compliance: The person engages in activities and behaviors that remind them of the importance of sticking with HRT. This may include receiving praise from family and friends for progress made during therapy.

Relaxation training: The person practices relaxation techniques, such as meditation and deep breathing. These help to reduce stress and associated hair pulling.

Generalization training: The person practices their new skills in different situations so that the new behavior becomes automatic.

Hair pulling can also involve varying degrees of awareness.

Focused hair pulling: Some people engage in focused hair pulling with the intention of experiencing tension relief from pulling. In this case, the hair pulling can include specific rituals, including pulling certain types of hair.

Automatic hair pulling: Some people engage in hair pulling without fully realizing it. This can occur when they are bored, watching TV, or engaged in other mindless activities.

Mixed hair pulling: Many people engage in a mix of both behavioral styles.

Many individuals diagnosed with trichotillomania also have other body-focused repetitive behaviors, including skin picking, nail biting, and lip chewing.

How to talk to a friend about trichotillomania

If you think that your friend or loved one is experiencing symptoms of trichotillomania, it can be hard to know what to say. Here are some tips:

Avoid saying things like:

“Why don’t you just stop pulling your hair?” More than likely, your loved one asks themselves the same thing every day. Saying something like this may make their feelings of guilt and shame worse.

“Just find another way to deal with stress.” Chances are, they have likely tried to do this hundreds of times. Instead, talk to your loved one about what they are feeling and ask how you can best support them.

Say this instead:

“How can I help?” Whether it’s helping find an experienced healthcare professional, locating local support groups, or just listening, you can show that you’re there for them.

About the Author:

Trishna Patnaik, a BSc (in Life Sciences) and MBA (in Marketing) by qualification but an artist by choice. A self-taught artist based in Mumbai, Trishna has been practising art for over 14 years. After she had a professional stint in various reputed corporates, she realised that she wanted to do something more meaningful. She found her true calling in her passion that is painting. Trishna is now a full-time professional painter pursuing her passion to create and explore to the fullest. She says, “It’s a road less travelled but a journey that I look forward to everyday.” Trishna also conducts painting workshops across Mumbai and other metropolitan cities of India.

Trishna is an art therapist and healer. She works with clients on a one on one basis in Mumbai.

Trishna fancies the art of expressive writing and creative writing and is dappling her hands in that too, to soak in the experience and have an engagement with readers, wanderers and thinkers.

It’s a disorder, not a decision.

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