Trichotillomania, more commonly known as hair pulling disorder is a psychological condition manifesting as an uncontrollable impulse or urge to pull ones hair out, to the point of noticeable hair loss. Individuals with trichotillomania generally report a sense of self soothing through this hair pulling habit, however the habit itself causes intense feelings of shame and embarrassment in most of them. This condition is more common than it is believed to be as most people fail to recognise this as a disorder and only seek treatment when very obvious bald patches appear. The majority of the patients try to overcome feelings of shame by trying to cosmetically hide their hair loss.
Characteristics of Trichotillomania:
The hair pulling may seem a random act or habit. However, each patient typically has a few characteristics associated with this compulsive hair pulling disorder. Identifying the pattern in your behaviour is the first step to treatment.
- Hair being pulled out or broken can be from any part of the body - the head, face, underarms, genitals etc. Individuals vary in which kind of hair they pull, this may even differ in terms of texture, colour and size of the hair. Some simply pull the hair or break it and throw it away, others may play with it, put it in their mouth etc.
- Most people describe an increasing sense of discomfort or tension immediately before pulling out the hair, i.e. accompanying the impulse to do so or when trying to resist the hair pulling impulse. The hair pulling or breaking behaviour then provides an immediate sense of relief and relaxation. However, this is generally short lived till the impulse quickly reappears.
- People generally pull their hair in relatively private spaces and especially when involved in solo activities or when sitting idle, thinking, working or watching television. Most of them report significant decrease in hair pulling when they are out with other people.
- A person’s emotional state has an important role to play in their hair pulling impulse. Feelings of anxiety, boredom, frustration and anger etc. Individuals generally observe that when they are disturbed, the hair pulling impulse tremendously increases in frequency. Feelings of anxiety, shame and depression may also be experienced as a consequence of trichotillomania and the subsequent hair loss leading to body image concerns and the inability to stop the impulse. Some people begin to socially isolate themselves too.
If you observe any such characteristics associated with your hair pulling it is imperative to be evaluated by a mental health professional. There are specialised techniques that could assist in breaking this habit and reducing the hair pulling impulse. In certain cases, the need for medication may also be evaluated.
In psychotherapy, the most effective method found to deal with trichotillomania is a combination of a few cognitive behavioural techniques. The most popular one is Habit Reversal Technique which involves two basic components.
It involves awareness training to help the person build greater awareness of when, where and how often they pull their hair. To better identify internal and external triggers that lead to hair pulling impulse and also to identify those conditions that worsen or reduce the symptoms. Subsequently, this information is used to develop and implement other competing or incompatible responses which make it difficult to pull the hair in response to the impulse. Alongside, treatment also involves helping the clients deal better with their anxiety and accompanying feelings of shame or embarrassment.