Trichotillomania, also known as Trich or TTM, is a compulsive disorder resulting in alopecia from repetitive hair manipulations by the client’s own hand. TTM is one of the self-induced primary psychiatric disorders. They usually do this by biting, combing, or pinching the hair until it breaks off.
Trichotillomania is a form of traumatic alopecia. The causative trauma to the hair occurs because of the client’s repetitive hair-pulling behavior. The hair pulling may be one of several phenomenological related behaviors, People who have TTM may also bite their nails excessively and pick at cuticles resulting in bleeding.
This disorder can cause bald spots or patches to form on the scalp and can lead to social withdrawal and isolation because they may be embarrassed about how they look. TTM has both psychological and biological causes, but there are no easy answers as to why people develop this disorder.
Symptoms of Trichotillomania
The first sign is the inability to stop pulling even when their behavior is causing problems.
People who have TTM feel an intense urge to pull their hair out and they are experiencing growing tension until they do. Once pulling their hair out, they feel a sense of relief.
Hair pulling can be triggered or accompanied by different emotional states, like stress, anxiety, boredom, or tension.
The act of pulling can also provide a feeling of release, gratification or even pleasure.
Individual can sometimes pull their hair out in response to a stressful situation or could be done without really thinking about it.
Most individuals with TTM pull out hair from their scalp, however some pull out hair from other areas, such as their:
- eyebrows
- eyelashes
- genital area
- beard or moustache
Rubbing pulled out hair across face or lips.
Preoccupation anxiety, depression, career, or academic decline.
TTM may cause feelings of shame and low self-esteem.
Causes of Trichotillomania
Reason for trichotillomania is unclear. But as with many other complex disorders, TTM is a result from a combination of genetics and environmental factors.
Risk factors
These factors tend to increase the risk of trichotillomania:
- Family history. Genetic factors may play a role in the development of TTM, and the disorder might occur in those with a close relative with the disorder.
- Age. TTM typically develops just before or during their early teens. Primarily often between the ages of 10 and 13 years — and it is often a lifelong problem. Infants also can be prone to hair pulling, but this is usually mild and goes away on its own without treatment.
- Other disorders. People who have TTM may also have other disorders, such as depression, anxiety, or obsessive-compulsive disorder (OCD).
- Stress. Severely stressful situations or events may trigger TTM in some individuals.
Complications
While it might not seem particularly serious, TTM can have a major negative impact on your life. Complications may include:
- Emotional distress. Many people with TTM report feeling shame, humiliation, and embarrassment. They may experience low self-esteem, depression, anxiety, and start using alcohol or drugs. Because of their condition.
- Problems with social and work functioning. Shame because of hair loss may lead them to avoid social activities and job opportunities. Individuals with TTM may wear wigs, style their hair to disguise bald patches or wear false eyelashes.
- Skin and hair damage. Constant hair pulling can cause scarring and other damage, including infections, to the skin on your scalp or the specific area where hair is pulled and can permanently affect hair growth.
- Hairballs. Eating your hair may lead to a large, matted hairball (trichobezoar) in your digestive tract. Over a period of years, the hairball can cause weight loss, vomiting, intestinal obstruction and even death.
Treatment
The most common approach to stop the bad habit is behavioral therapy.
The 3 essentials of cognitive behavioral therapy are as follows:
- Self-monitoring: The client keeps records of hair-touching behavior. A basic, not a fine detailed, recording plan. Client simply records the daily frequency of hair touching by putting a stroke on a sheet of paper each time they touch their hair each day. The daily records are used to give the client awareness of the habit and help them reduce the frequency in touching their hair.
- Habit-reversal training: The client should institute competing responses. The competing response should be incompatible with hair pulling (making tight fists and holding for 2 min).
- Stimulus control (organizing the client’s environment): Because hair manipulations usually occur when the client is engaged in stressful activities or sometimes by being alone. Change the environment by performing daily physical exercise and being around people is helpful. Other activities that may be helpful to keep hands busy or away from the head include needlework, taking a walk, or wearing bandages on the fingers.