With trichotillomania, a person has the need to pull hair. This may include eyelashes, eyebrows, head hair, arm hair, etc. In addition to the more well-known impulse control disorders such as pyromania and kleptomania, the obsession with pulling hair also occurs. What started out as an innocent act of pulling a few hairs can ultimately lead to hair loss, discomfort and even negative social and functional consequences. A pleasant and relaxed feeling is often experienced immediately after pulling.
Trichotillomania
Trichotillomania (trich = hair, till = pulling, mania = madness) was first described by the dermatologist Hallopeau. It is a disorder that occurs with a high amount of stress, where pulling is seen as a way to relax. Because it then leads to more stress (due to social consequences, baldness and a feeling of discomfort), it ultimately works as a vicious circle. However, it is not always the case that it leads to feelings of relief and relaxation, because not everyone is aware of doing it. It is therefore often automatic behavior.
The most common is pulling of the hair on the head, followed by eyebrows and eyes. It also happens that pubic hair or chest hair is pulled. Only one hair is usually pulled at a time, meaning the person may have to do it for extended periods of time. Hair pulling is often linked to a certain situation or environment, for example in your own bedroom.
In addition to baldness, more physical problems can occur, such as infections and problems with the stomach and intestines (when the hair is also eaten).
Causes
As already mentioned, trichotillomania often occurs with stress. It is therefore commonly seen in individuals with high anxiety, depression, post-traumatic stress disorder and other obsessive-compulsive disorders. Genes that are thought to make one more susceptible to the disorder have also been examined, and areas in the brain have been found that may be associated with it (e.g. the cerebellum, which is said to be smaller).
Prevalence
The disorder occurs in approximately 1% of the population, more in women than in men. It often occurs during puberty, although it occurs at all ages. However, the disorder may also be underdiagnosed because those with the disorder are often ashamed of their behavior and try to hide it (e.g., wearing long sleeves or a wig).
Therapy
The treatment of trichotillomania is very difficult because relapses are common. It is especially important in the treatment to make the unconscious behavior conscious and, if there is relief and relaxation, to remove this pleasant feeling.
The most effective treatment is through cognitive behavioral therapy. Medication or hypnosis can also be used. Firstly, a patient is made aware of his/her behavior (e.g. diary recording). During this period, one may still continue the behavior. Then an additional behavior is often added to make the pulling less tempting (e.g. walking around the block before pulling the hair). Finally, the behavior is unlearned by punishing it when it is done. This involves positive punishment, such as helping someone with something, doing chores around the house, or exercising more for a healthier body.
Relapse
Although the treatment can progress very quickly, a single hair pull can lead to the patient having to start all over again.