Trichotillomania: What You Should Know

Trichotillomania: What You Should Know

Vijai P. Sharma, Ph.D

On my website, the largest number of questions and requests for help I receive pertain to the problem of hair pulling. I had no idea how prevalent this problem is until I posted an article about the subject on my website. Since then e-mails have been have been regularly coming in with personal disclosures form people who had not confided the problem to anyone.

The psychiatric term for hair pulling is "trichotillomania," which we will refer to as "trich" for the sake of brevity.

This article with basic information about trich will be posted on my website too in the hope of helping people who are not yet ready to approach a clinic for face-to-face help, yet. In another article, I will share a few ideas about treatment and self-help tips to deal with the problem.

Trich is an automatic or compulsive hair pulling. To determine whether one has the problem, the following criteria adopted from the Diagnostic Statistical Manual, Fourth version (DSM IV) may be utilized:
1. Hair pulling is a recurring behavior.
2. The behavior results in significant hair loss or bald spots over time.
3. Despite the self-torment and the wish to stop the behavior, the individual is unable to do so.
4. Increase in tension before hair pulling or when attempting to resist it.
5. Release of tension after the hair pulling.
6. Hair pulling is not a part of another mental or medical disorder, such as schizophrenia, autism or alopecia.

Perhaps, one to two percent of people suffer from the hair pulling problem. More women than men tend to have the problem. Hair pulling cuts across all ages. The incidence in children, adolescents and adults may be alike. However, a lot of young children grow out of it just as they grow out of other habitual behaviors such as thumb sucking, nail biting or stuttering.

Hair pullers usually have a preferred site for hair pulling, such as the scalp, eyebrows, eyelashes or other hairy body parts. The scalp appears to be the most preferred site. Eyelashes and eyebrows are the second most common sites. However, some pull hair from more than one site. Thus, hair loss may be limited to one area or spread to several areas.

Understandably, people try to hide the problem, especially, if it involves a body part that is visible. Since two thirds of people pluck hair from the scalp, a wig comes in handy for a woman while a man may blame it on the "male balding pattern."

Some, instead of discarding the pulled hair, swallow it. The term for this symptom is, "trichophagia." Some children are more prone to developing trichophagia. The problem can be a serious hazard to one's health as the hair cannot be digested and processed like food. Hair can lump into a ball and cause such complications as anemia, intestinal obstruction or bleeding.

Some of the behaviors associated with hair pulling may consist of biting the hair roots, splitting the hair (literally), rolling it between the fingers, looking at it, etc.

There is a condition that may be best referred to as, "trichotillomania by proxy." Instead of pulling their own hair, the afflicted individuals tend to pull the hair of their pets. They may or may not be aware of their problem behavior because they might see hair pulling as part of the grooming their pet.

Hair pulling is more likely to occur in the following situations:
1. At times of stress, such as work pressure, relationship conflicts, examination and tests.
2. During a sedentary or passive activity such as reading, watching television, or talking on the phone.
3. During the state of emotional excitement or negative emotions such as anger, hopelessness or helplessness.

Some individuals experience an itching sensation rather than a conscious feeling of tension or an urge for hair pulling. The tension might occur only when one resists the urge to pull out hair.

The afflicted individuals may pull hair automatically while engaged in thinking about something else or doing another activity. Being unaware, they may consciously not experience any tension beforehand. However, at some point, seeing the pile of hair beside them, they may experience remorse and frustration for what they've done. Only a careful analysis of the hair pulling behavior can determine if the hair pulling is part of obsessive-compulsive behavior. A person with obsessive-compulsive tendencies may be very exact regarding which hair to pull and may carefully examine the hair and identify the "right one" to pull.

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Copyright 2002, Mind Publications 


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