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Compulsive Hair Pulling
Trichotillomania
Compulsive hair pulling is called Trichotillomania, pronounced - trik-o-til-o-MAY-ne-uh. Trichotillomania is repetitive (to do again and again) twisting and twirling of the hair.
Trichotillomania is a chronic (lasting a long time) psychiatric (pertaining to mental illness) condition characterised by uncontrollable, self-inflicted, hair pulling or twisting of the hair until it breaks off, resulting in noticeable hair loss. The hair pulling may occur anywhere on the body, with the scalp and eyelashes most commonly affected. Onset is often during childhood or early adolescence.
Pulling hair from the scalp often leaves patchy bald spots on the head. The majority of individuals with this disorder disguise their hair loss very well.
Because of the secrecy and shame about their behaviour, many remain silent sufferers, and treatment is often delayed.
Causes
The causes of trichotillomania are not clearly understood. Trichotillomania may affect as much as 4 percent of the population. Women are four times more likely to be affected than men. In very young children, a more equal sex ratio is observed. People with this disorder often will first seek the help of a doctor who treats skin problems (dermatologist).
Symptoms
Symptoms usually begin before the age of 17. The hair may come out in round patches or across the scalp. The effect is an uneven appearance. The person may pluck other hairy areas, such as the eyebrows, eyelashes, or body hair. These symptoms are usually seen in children:
- An uneven appearance to the hair
- Bare patches or all around (diffuse) loss of hair
- Bowel blockage (obstruction) if people eat the hair they pull out
- Constant tugging, pulling, or twisting of hair
- Denying the hair pulling
- Hair regrowth that feels like stubble in the bare spots
- Increasing sense of tension before the hair pulling
- Other self-injury behaviors
- Sense of relief, pleasure, or gratification after the hair pulling
Exams and Tests
A piece of tissue may be removed (biopsy) to rule out other causes, such as a scalp infection, and to explain the hair loss.
Treatment
Experts don't agree on the use of medication for treatment, however, naltrexone and selective serotonin reuptake inhibitors (SSRIs) have been shown effective in reducing some symptoms. Behaviour therapy includes habit reversal coupled with exposure therapy and response prevention.
Outlook (Prognosis)
Typically, trichotillomania is limited to younger children who tend to outgrow the behavior. For most, the hair pulling ends within 12 months. Children who start pulling hair early (before age 6) tend to do better than those who start later.
Possible Complications
People can have complications when they eat the pulled-out hair (trichophagia). This can cause a blockage in the intestines or lead to poor nutrition.
Prevention
Early detection is the best form of prevention because it leads to early treatment. Decreasing stress can help, because stress may increase compulsive behavior.
References:
1) National Library of Medicine (NLM) - MedlinePlus - February 2008 - www.nlm.nih.gov/medlineplus
2) U.S. Department of Health and Human Services - National Institutes of Health - Office of Dietary Supplements (ODS) - March 1999 - grande.nal.usda.gov/ibids
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