trichotillomania is a rare disorder characterized by the irresistible urge to pull at one’s hair, usually the scalp, eyebrows and eyelashes .

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Although individuals suffering from this pathology are aware of the damage that can be done by acting in this way, they are unable to stop or control this impulse. In addition, it is common that in moments of stress these individuals try to pull out hair as a way to calm down, so a vicious circle is produced that can cause greater damage, both physically and psychologically.

What is Trichotillomania?

This condition usually appears around age 13 and is officially classified as an impulse control disorder , like pyromania, kleptomania, or pathological gambling. It is also closely linked to Obsessive-Compulsive Disorder, as they share many of the same symptoms and mismatched psychological mechanisms.

It has a prevalence of 1% of the population and affects both men and women, although the latter are more likely to seek treatment.

Symptoms

Trichotillomania is characterized by the presence of the following symptoms :

  • Recurrent hair pulling causing significant hair loss (as shown in the photograph).
  • An increase in the perception of tension just before pulling your hair or resisting this act.
  • Pleasure, gratification or release when pulling the hair.
  • The disturbance is not explained by another mental disorder or medical condition.
  • The alteration causes significant discomfort or deterioration in social, work or other important areas of activity. For example, a loss of self-esteem as a result of partial alopecia caused by hair pulling.

Warning Signs

The onset of this disorder occurs around the age of 13, although in some cases it may start earlier . Frequently, a stressful event can be associated with this pathology, for example, changing schools, abuse, family conflicts or the death of someone close to you can generate anxiety and nervousness and cause the debut of this disorder.

Some experts say that the symptoms can be caused, or at least strongly influenced, by the hormonal changes characteristic of puberty.

Most likely causes

Adolescence is a critical time for the development of self-esteem, body image, self-confidence, or intimate relationships. During this period, people who suffer from this pathology can be ridiculed by their own family, friends or classmates. But, in addition, these people may feel a great deal of guilt or shame for not being able to stop this type of behavior. Even a small hairless patch can cause serious emotional problems for the person suffering from this condition.

In many cases, people who suffer from trichotillomania manage to lead a normal life: get married, have children… But in some cases, there are individuals who avoid intimate relationships for fear of exposing their disorder or.

There is no specific cause for trichotillomania. Although some researchers think that it is possible that at the biological level there is a neurochemical imbalance at the brain level, mainly a deficit of serotonin. There may also be a combination of factors such as genetic predisposition and an aggravating stress or circumstance. For example, a traumatic event.

Comorbidity (associated disorders)

It is common for people with trichotillomania to show symptoms of Obsessive Compulsive Disorder (OCD) such as counting or hand washing. In fact, there are many similarities between trichotillomania and OCD, which is why some experts consider it a subtype of Obsessive Compulsive Disorder .

Depressive disorder is also common to occur along with trichotillomania. There may be a direct relationship between the neurotransmitters involved in depression and this condition (and also OCD), as both pathologies are associated with low levels of serotonin. Although there could also be a relationship between depression and low self-esteem caused by trichotillomania, because pulling out one’s hair can be demoralizing. On the other hand, when the hair is pulled out, wounds may arise that cause physical and emotional pain .

Treatment

Trichotillomania can be treated in two ways, according to research conducted in this field.

1. Psychotherapy

On the one hand, cognitive behavioural therapy is very effective . On the other hand, and in some serious cases, it is necessary to administer drugs. However, the ideal is a combination of both treatments.

With cognitive behavioral therapy, patients learn to identify and manage symptoms and employ strategies that help them improve their quality of life . You can learn more about this type of therapy in our article: “Cognitive Behavioral Therapy: what is it and what are its principles?

2. Pharmacology

Medication can also be effective in treating symptoms, although, for long-term results, cognitive behavioral therapy is necessary. Some medications (antidepressants or mood stabilizers) used to treat this condition are

  • Fluoxetine (Prozac)
  • Fluvoxamine (Luvox)
  • Sertraline (Zoloft)
  • Paroxetine (Paxil)
  • Clomipramine (Anafranil)
  • Valproato (Depakote)
  • Lithobid (Lithobid, Eskalith)

Bibliographic references:

  • Christenson GA, Crow SJ (1996). “The characterization and treatment of trichotillomania. The Journal of clinical psychiatry. 57 Suppl 8: pp. 42-7; discussion. pp. 48 – 49.
  • Christenson GA, Mackenzie TB, Mitchell JE (1991). “Characteristics of 60 adult chronic hair pullers. The American journal of psychiatry 148 (3): pp. 365-70.
  • Salaam K, Carr J, Grewal H, Sholevar E, Baron D. (2005). Untreated trichotillomania and trichophagia: surgical emergency in a teenage girl. Psychosomatics.
  • Woods D. W., Wetterneck C. T., Flessner C. A. (2006). “A controlled evaluation of acceptance and commitment therapy plus habit reversal for trichotillomania”. Behaviour research and therapy (in English) 44 (5): pp. 639 – 56.
  • Zuchner S, Cuccaro ML, Tran-Viet KN, et al. SLITRK1 mutations in trichotillomania. Mol. Psychiatry.