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It’s Enough to Make You Pull Your Hair Out

Allan Schwartz, LCSW, Ph.D. was in private practice for more than thirty years. He is a Licensed Clinical Social Worker in the states ...Read More

There is a disorder known by the complex name of Trichotillomania also known as hair pulling. "Trichotillomania is repetitive twisting and twirling of the hair. The hair loss is usually in a well-defined area with shortened, broken-off hairs and early regrowth of hair. The scalp is the most commonly involved site, but eyelashes and eyebrows may also be involved. The hair loss can also be patchy and poorly defined."*

Some 2.5 million Americans experience this disorder. Hair pulling often begins during childhood or adolescence. Studies show that boys who pull out there hair begin around the age of 8 while girls begin around twelve years of age or with the onset of puberty. By far, the highest percentages of people with this disorder are women who are 4 times more likely to get the disorder than males.

The ancient origins of the word, Trichotillomania, come from Greek root terms meaning "hair," "pulling" and "mania" or madness. Actually, there is nothing mad or crazy about this little understood disorder. Today, psychiatry and medicine define it as an impulse control disorder. The implications are that it is medical in nature and specifically neurological in origin.

*Symptoms:

  • Constant tugging, pulling, or twisting of hair
  • Increasing sense of tension is present before the hair pulling
  • Sense of relief, pleasure, or gratification is reported after the hair pulling
  • Hair pulling leads to an uneven appearance
  • Bare patches or diffuse (all across) loss of hair
  • Hair regrowth in the bare spots feels like stubble
  • Some individuals may develop a bowel obstruction if they eat the hair they pull out
  • Other self-injury behaviors may be present
  • People suffering from this disorder often deny pulling out their hair

*(Information is from U.S. National Library of Medicine)

The reason for many mental health specialists defining this disorder as impulse control is that those with this disorder cannot resist the urge to pull their hair. The impulse to pull one’s hair is so over powering that it cannot be controlled. Once the urge has reached those dimensions, there is no way for the person to resist the urge. The result is that bald spots emerge on the scalp. The presence of these bald spots becomes a source of great distress, particularly for teenage girls at a time when they are at the height of concern about their appearance. In fact, it is the impact on appearance and its social consequences which has the greatest impact on social and emotional adjustment of people with this disorder.

One of the most important facts for sufferers and their loved ones to know about this behavioral disorder is that it is not a bad habit. People can learn to control or alter habits with little difficulty. The overwhelming urge to pull hair places it outside of the category of a learned and bad habit.

It is said that there are two types of trichotillomania: one in which the individual is aware that they want to pull their hair and another: in which the person is so involved and absorbed in an activity that they are unaware of what they are doing.

Among those who know they want to pull their hair there is a feeling extreme distress and depression anxiety leading them to pull their hair out. For these individuals the result is a feeling of relief or an end to a kind of emotional numbness they experienced. For other people there is no awareness that they have started to pull their hair. Among the second group, the process of hair pulling seems to be much less open to awareness much of the time, until sometime after it has started. In all cases, once the person attempts to force themselves to stop the behavior the worse it becomes.

Reports about the prognosis of this disorder are that most children will out grow it within a year. However, if this does not happen then it can and does last into adulthood.

There is no one accepted and proven treatment for this disorder. Among the commonly tried treatments are medication for depression, psychodynamic psychotherapy, cognitive-behavioral therapy and behavior modification. One form of behavior modification is referred to as reverse habit conditioning in which the patient is made aware of the behavior, when it is going to happen and then explores alternative coping mechanisms to the hair pulling.

There will be an upcoming podcast on this site in which a woman who suffers from trichotillomania will be interviewed about her experiences including how she has learned to cope with and reduce the symptoms.

A worthwhile book on the topic is the one by: Fred, Penzell, PhD and is titled: The Hair Pulling Problem: A Complete Guide to Trichotillomania (Oxford Universities Press, 2003). It is written specifically for the public and is quite readable.

Your comments and questions about this disorder are welcome.

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