What Is Hair-Pulling Disorder, And How Can It Affect Your Life?
If you experience trichotillomania, or hair-pulling disorder, you likely already know that it can affect your life significantly, whether by making it difficult to interact with others or feel in control of your behavior. Because this disorder can be connected to other mental health conditions, particularly obsessive-compulsive disorder (OCD), hair-pulling disorder is more than a bad habit and can be challenging to manage on your own.
In many cases, the compulsion to pull hair can be so strong that it interferes with daily functioning. For example, some individuals may pull their hair automatically in response to stress or other stimuli.
With the right support, though, it can be possible for people who pull out their hair to find relief from symptoms of hair-pulling disorder and become a more confident, happier version of themselves. Online therapy may be one way to get the professional help you deserve.
What is hair-pulling disorder, or trichotillomania?
Hair-pulling disorder, often known formally as trichotillomania, is a mental health disorder that usually involves recurrent, intense urges to pull hair from your scalp, eyebrows, or other parts of the body. Those experiencing hair-pulling disorder often find it difficult or even impossible to resist the overwhelming impulse to pull their hair, even if they want to.
How hair-pulling disorder, or trichotillomania, can affect you
Someone with trichotillomania may try to stop pulling their hair, but the compulsions and impulses are often too strong to ignore. It's estimated that less than 2% of people live with this disorder, which may be why many people aren’t aware of trichotillomania until they experience it firsthand.
Though it is generally focused on pulling hair out from the scalp, eyebrows, or eyelids, trichotillomania can cause irresistible urges to pull out any kind of body hair. It's important to watch for the signs and symptoms of this disorder because it may lead to serious consequences if left untreated. Excessive hair-pulling can result in baldness, which may cause significant emotional distress, and untreated compulsions can also escalate into behaviors that even more significantly impact daily life.
As a result, many people with trichotillomania may go to significant lengths to disguise their hair loss and other symptoms of the disorder, such as wearing false eyelashes or wigs, which can be a stressful experience as well.
Hair loss and other symptoms of hair-pulling disorder
Perhaps the most obvious sign of hair-pulling disorder can be the repeated pulling of hair itself. Those with the disorder may pick at their eyebrows, eyelashes, scalp, or their pubic hair often. Also notable in many cases can be hair loss and bald spots that may appear in these areas.
As mentioned, someone living with trichotillomania may dedicate a lot of effort to trying to hide their behavior. They may feel an increasing sense of guilt or shame that motivates them to withdraw from others, a tendency that can exacerbate symptoms. The urge to cover up unusual-shaped bald patches, and hair-pulling habits, in general, might lead someone living with hair-pulling disorder to turn to potentially unhealthy coping mechanisms that can affect their well-being, like excessive substance use, or lead to the development of skin conditions or other mental health disorders.
If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.
Frustration, stress, or anxiety: what causes a person to pull hair?
Understanding the intensity of the urge to pull hair that can come with trichotillomania may be a key part of differentiating it from other mental health disorder symptoms. Typically, an individual may feel frustrated, tense, or overwhelming anxiety right before they engage in the behavior, which may be likelier to trigger trichotillomania the longer they try to resist the impulse.
As soon as they pull the hair, they might associate the action with positive feelings or pleasure that can seem intensely rewarding, though it’s often short-lived. This pattern is often cyclical, and the impulse to pull hair again may return soon after relief is found.
Other behaviors involving hair may also be commonplace for those experiencing this disorder. They may play with their hair after they pull it out, eat it, examine it, chew on it, or engage in any number of other activities involving the hair. Eating hair can lead to serious health concerns, such as weight loss or hairballs forming in the digestive tract that may need to be surgically removed.
By watching for any of these types of behaviors, it can be possible to encourage someone with this disorder to seek the help they may need to manage symptoms.
Risk factors for pulling hair as a disorder
While hair-pulling disorder often manifests anywhere between early childhood to early teens, a person of any age can develop it. It commonly runs in families, which generally means that if someone in your immediate family has the disorder, you may have a higher likelihood of developing it yourself. Knowing your risk may help you keep an eye out for symptoms and learn to identify them in others who are close to you.
The link to obsessive-compulsive disorder
Additionally, those with obsessive-compulsive disorder (OCD) may experience trichotillomania as a manifestation of its symptoms. Because it's usually considered an impulse control disorder, trichotillomania can be tied to the anxiety that may occur because of OCD or similar mental health disorders. If you’re living with OCD, an anxiety disorder, or another condition that may produce heightened feelings of anxiety, it's possible that trichotillomania could be connected to it.
Because of this, it can be important to watch for symptoms that don't fit with other disorders you've been diagnosed with so you can be diagnosed properly.
Body-focused repetitive behaviors
Finally, those who experience high amounts of stress, even in the absence of a mental health diagnosis, may be susceptible to this disorder. For many who live with it, trichotillomania usually acts as a stress reliever. They may pull at their hair while watching TV or whenever they feel anxious. Pulling hair can seem like a way to express and let go of pent-up stress in the body. Though it may temporarily relieve tension and offer an outlet for stress, this sort of behavior can quickly and easily spiral out of an individual’s control.
Getting help for the disorder of pulling hair
If you or someone you know shows signs of hair-pulling disorder, it can be beneficial to speak with both a physician and a licensed mental health professional. Seeking a medical opinion or physical exam can help you make sure that the symptoms you're experiencing aren't the result of an underlying medical condition or the side effects of a medication you're taking.
Meanwhile, a mental health professional can help you understand what might be driving you to pull your hair, what you can do to halt the behavior, and other strategies for addressing underlying emotions in a healthier way. They may use methods such as cognitive behavioral therapy, where mindfulness-based practices such as deep breathing or using stress balls can help replace the negative behavior with a positive one.
Another exercise called habit reversal training has also been suggested by research as an effective way to treat TTM. It uses four components to help people refrain from impulsive habits:
Techniques for coping with impulsive habits
A therapist might also suggest techniques like the following for addressing symptoms of trichotillomania:
Mindfully and verbally describe pulling your hair in a mirror any time you engage in the behavior
Having your therapist point out when you pull your hair until you’re able to recognize the patterns on your own
Learning what triggers lead to pulling your hair, such as urges, thoughts, or experiencing stress or frustration
Identifying the situations that may cause you to pull your hair to prepare yourself for any urges that may arise
Because hair-pulling disorder is normally considered a type of impulse control disorder and often coincides with other mental health disorders, including obsessive-compulsive disorder (OCD), it may be difficult to manage symptoms on your own. Resources that make receiving care and support more convenient may be useful, especially if you’re not comfortable navigating traditional in-person treatment options.
Online therapy for hair-pulling disorder
Online therapy may empower you to connect with a professional without leaving the comfort of your own home. It can also enable you to choose between a phone call and an online chat if you don’t feel comfortable with the video call format.
Current research suggests that online therapy can be just as effective as in-person therapy for treating symptoms of a variety of mental health disorders. A 2022 study investigated the efficacy of online therapy for treating trichotillomania and skin-picking disorder and found that it could be an effective and acceptable form of treatment.
Takeaway
Hair-pulling disorder, or trichotillomania, is a mental health disorder usually characterized by excessive and oftentimes uncontrollable pulling of the hair on the face, scalp, or body. Though its symptoms can be challenging to manage and may require professional intervention, it can be possible to take control of the urge to pull. Seeking the guidance of a therapist and a physician, if necessary, can set you on a path toward success.
What causes hair pulling?
There is not a single known cause of hair pulling disorder, though several genetic and environmental factors may increase the risk of developing the disorder:
- Family history: Trichotillomania is more common in those who have a close relative with the disorder.
- Brain differences: People with the disorder may have structural brain differences, such as different levels of gray and white matter in certain regions of the brain.
- Gender: Chronic hair pulling most commonly affects women.
- Other mental health conditions: Anxiety disorders, depressive disorders, ADHD, and obsessive compulsive disorder may increase the risk of trichotillomania.
Trichotillomania often develops as a coping mechanism for managing stress or negative emotions. In many cases, hair picking also provides a positive sense of relief, satisfaction, or gratification.
Is hair pulling an anxiety disorder caused by stress or frustration?
Though hair pulling may be used as a maladaptive coping strategy for managing anxiety, it is not classified as an anxiety disorder. Trichotillomania (hair-pulling disorder) is classed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Editions (DSM-5) as one of several obsessive-compulsive and related disorders. To meet diagnostic criteria, the following must be present:
- Recurrent hair pulling, resulting in noticeable hair loss
- Repeated attempts at habit reversal
- Hair pulling is not better explained by other psychiatric disorders or medical conditions
- Hair pulling causes significant distress, low self-esteem, or impairment in functioning
Trichotillomania is a relatively common disorder that often co-occurs with anxiety disorders. Many people note that hair pulling worsens when they are experiencing a period of increased anxiety or intense stress. Additionally, hair pulling that causes skin and hair damage, including permanent hair loss, can drive psychosocial impairment such as social avoidance or social anxiety.
How do you calm down trichotillomania or hair-pulling disorder?
Many people with trichotillomania pull their hair to manage negative emotions (such as loneliness, stress, anxiety, loneliness, or frustration) or to experience relief and positive emotions. There are several therapy techniques that may help manage trichotillomania:
- Habit reversal therapy (HRT): This strategy involves recognizing hair-pulling triggers and finding alternative behaviors, such as using a fidget toy, putting hands in pockets, or making a fist. HRT can be broken down into the following steps: building awareness, establishing alternative responses, practicing, and eventually fully incorporating new habits into routine.
- Stimulus control: In combination with HRT, people with hair-pulling disorder may find that disposing of tweezers, removing mirrors with bright lights, making it more difficult to pull hair (by wearing a hat, bandana, gloves, or putting bandages on fingers), or removing other triggers can help.
- Cognitive behavioral therapy (CBT): Like many other mental health conditions, it’s thought that trichotillomania symptoms may respond well to CBT.
- Medications: Sometimes, selective serotonin reuptake inhibitors (SSRIs) are prescribed for people with hair-pulling disorder. However, the amino acid N-acetylcysteine (NAC) may more effectively manage trichotillomania. In one study, 56% of people with hair-pulling disorder responded to NAC.
- Addressing social impairment: People with hair-pulling disorder may find that using makeup, false eyelashes, or wigs increases self-confidence and reduces the impact that trichotillomania has on social life.
What are the two types of hair-pulling?
Trichotillomania may be divided into two subtypes:
- Automatic: This type of hair pulling occurs when the person subconsciously pulls their hair or is not fully aware of what they are doing. This may happen more commonly when reading a book, watching the television, or engaging in other passive activities.
- Focused: Focused trichotillomania occurs when a person is fully aware of what they’re doing, often selectively removing hairs with certain characteristics (such as gray hairs, thick hairs, or hairs that do not “feel right”). Focused hair pulling often results in more severe trichotillomania compared to automatic pulling.
People may display only automatic or focused trichotillomania or a combination of the two types.
What are 3 symptoms of trichotillomania?
Symptoms of trichotillomania can vary, but they frequently include:
- Repeatedly pulling one's own hair out, often resulting in reduced hair growth
- Mounting tension prior to pulling hair, or when you refrain from pulling
- A sense of relief after pulling hair out
Trichotillomania is a mental disorder that causes significant distress or social impairment. If you engage in hair pulling, it may be a good idea to seek treatment from a licensed professional. They can help you address trichotillomania and any other mental health conditions that may be co-occurring.
What is the root of trichotillomania?
People may pull their hair out for different reasons. For example, hair pulling may be triggered by:
- Negative emotions: Stress, anxiety, boredom, depression, or uncomfortable feelings may lead people to pull their hair
- Positive emotions: Trichotillomania may be satisfying, pleasurable, or comforting
What is the best medication, therapy, or techniques for coping with trichotillomania?
Selective serotonin reuptake inhibitors (SSRIs) and aripiprazole are some medications that may be prescribed for trichotillomania. However, they may have more moderate effects compared with behavior therapy, such as habit reversal therapy (HRT). Some supplements, such as N-acetylcysteine (NAC) or vitamin D3 may also help manage hair pulling.
What vitamin deficiency causes trichotillomania?
Vitamin D deficiency is associated with several mental disorders, including OCD, depression, and trichotillomania. In some cases, vitamin D3 supplementation may be an effective treatment strategy.
What happens to hairs or scalp if trichotillomania or hair pulling is left untreated?
Untreated trichotillomania may result in serious psychosocial dysfunction, skin infections, hair thinning, and permanent hair loss. Additionally, some people may ingest hair after pulling, which can result in trichobezoars (undigested balls of hair). Trichobezoars can cause bowel obstruction, perforation, and other severe gastrointestinal issues if left untreated.
Is hair-pulling part of ADHD?
Body-focused repetitive behaviors, such as hair pulling, nail-biting, and skin picking are common ADHD comorbidities. Though trichotillomania is recognized as an obsessive-compulsive and related disorder, it relates some similarities to ADHD. The following are commonly seen in people with both ADHD and body-focused repetitive behaviors:
- Low impulse control
- Inattention and “time blindness”
- Stress-related symptoms
- Comorbid OCD
While ADHD and comorbid trichotillomania may have higher levels of impulsivity, ADHD status does correlate with higher hair-picking severity or lower quality of life.
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