Understanding the Hair Pulling Disorder Called Trichotillomania
Lexi moved around a lot as a military kid. While she enjoyed living in exciting new places, finding friends was sometimes difficult. While in middle school, she moved again and had a difficult time assimilating. Both at school and in sports, she was bullied. To help alleviate the overwhelming tension and fear she felt, Lexi began pulling her hair out.
What is Trichotillomania?
Trichotillomania is a mental health condition characterized by a person’s compulsive need to pull out hair from their scalp, eyebrows, eyelashes, arms, legs, or pubic area. Repeatedly pulling hair from the same location can result in bald patches or missing eyebrows or eyelashes. Hair pulling can be automatic, where the person doesn’t realize they are doing it (like when watching television), or focused, where they pull out hair to relieve tension.
Hair pulling often begins in childhood, between the ages of 10 and 13. This condition affects up to 10 million Americans, according to the Massachusetts General Hospital Trichotillomania Clinic. It often appears between the ages of 10 and 13 but can also occur as early as 22 months of age.
What Causes Trichotillomania?
While the exact cause of hair pulling is unknown, it falls under the category of obsessive-compulsive disorder (OCD). Certain factors, such as stressful events, boredom, and isolation, can lead someone to begin pulling their hair. Having a close relative with trichotillomania can also increase one’s risk.
Children who pull out their hair often do so as a way of self-soothing but typically grow out of this behavior. In adolescents, teens, and adults, the disorder tends to be long-term. Because it is a mental health condition, it typically does not successfully go away without treatment. Often, the condition also includes picking skin and/or scabs, biting nails, and chewing lips.
What are the Symptoms of this Hair Pulling Disorder?
The most common symptoms of trichotillomania include:
- Repeated pulling out of hair that results in bald patches
- An increasing sense of tension before pulling out the hair, followed by a sense of relief after the hair is removed
- Pulling out specific types of hair
- Biting, chewing, or eating pulled-out hair
- Repeatedly but unsuccessfully trying to stop pulling out hair
How Does Hair Pulling Affect Mental Health?
As you can likely imagine, bald spots can cause feelings of embarrassment and shame. People with the condition may also experience anxiety, low self-esteem, and depression due to feeling like they cannot control the urge to pull out their hair.
People with the condition will often style their hair to cover the bald spots, wear a hat, and avoid activities that can expose their hair loss. Over time, hair pulling can cause scarring and other damage that can permanently impact their ability to grow hair in the area. Some people with the condition eat their hair, which can lead to matted hairballs that can block the digestive tract.
How is Trichotillomania Treated?
As previously mentioned, trichotillomania rarely goes away on its own and is considered a long-term condition. The first step in treating the condition is to consult with your child or teen’s pediatric provider. They will examine the hair loss check, check for possible medical causes, and talk with your child to learn more about possible behaviors and emotions that may be related to their hair pulling.
Treatment typically involves various types of therapy, including habit reversal training and cognitive-behavioral therapy (CBT). With habit reversal training, the focus is on teaching your child to recognize situations where hair pulling is likely to occur and substitute other behaviors instead. Medicines, such as antidepressants, may also be used, although none have been approved by the FDA specifically for this condition.
If you have concerns about hair pulling, we recommend scheduling an appointment with your child’s healthcare provider. The sooner treatment begins, the better. Remember, this is a long-term condition that rarely improves without help, and we are here to support you and your child.
