Trichotillomania: A Psychological Cause of Hair Loss

A Psychological Cause of Hair Loss

For years, I had been pulling out my hair and playing with them. I used to do this when certain situations call for it, like when I’m bored, or while watching movies or reading. I have no exact idea of how and why it started. My reason is that it does feel good, and it seems that my day is not complete without me being able to pull a particular strand of my hair, that which has a white pigment on the tip, or that which is coarse.

That was few years ago, and it was until someone told me that pulling one’s hair compulsively is a disorder that I started wrestling with this baffling urge. I tried several ways just to stop it. I even used to tie my wrists or place them on my pockets, but without me noticing, my hands find their way back to my head.

Well, I am not alone. This disorder is so widespread that millions of people around the world are suffering from it. But, although widespread and common, constant hair pulling is not a matter to be ignored. Obviously, it is a potent cause of hair loss and it may even lead someone to get bald if not controlled. And, much to your surprise, there’s a name for that compulsive action – trichotillomania.

What is Trichotillomania?

Trichotillomania is commonly defined as a kind of baldness or hair loss caused by the constant pulling or twisting of the hair until it loses its strength and breaks off. This act is said to be compulsive and obsessive that it triggers a trichotillomaniac to pull his or her hair repetitively for the sense that it feels good, the reason that trichotillomania is known worldwide as an obsessive-compulsive disorder.

Numerous researches have noted that trichotillomania does not only cover the act of pulling ones hair on the head. The truth of the matter is, it involves the act of pulling someone’s beard, eyebrows, eyelashes and even pubic hairs. This is highly common in women, but men are also affected.

Well, I have read an article telling of someone who suffers from this disorder as she constantly pulls here eyelashes until she obtained a hairless eye. According to that writer, her experience bothered her most and her parents and siblings that she was driven to consult an expert to talk about it. She managed to approach a number of trichotillomania victims and it was during that time that she realized she wasn’t alone and that trichotillomania can be cured by time, with self control.

So, if you also happen to be affected by this condition, take time to think and approach someone you know who can help you battle with this baffling disorder. But, before you seek for help, it’s better to delve much into the basics of trichotillomania. Besides, this topic is worth knowing.

Types of Trichotillomania

Trichollomania can be classified into two main types: the obsessive-compulsive disorder, and the habit. Let’s take a closer look at these types by reading the following details.

Trichotillomania as an Obsessive-Compulsive Disorder

Recent researches have revealed that people who suffer from tension before pulling and who feel a sense of gratification upon pulling can be considered as victims of trichotillomania as a type of obsessive compulsive spectrum disorder.

Now, what exactly is obsessive compulsive spectrum disorder?

The term “obsessive-compulsive spectrum” basically refers to a sequence of major conditions associated with psychiatric. This is usually identified by the presence of obsessions and compulsions.

When I say “obsessions”, I’m actually referring to those ideas and thoughts that can cause much distress and anxiety to you. This has something to do with thinking so much about things. An example of this could be someone who compulsively washes his or her hands thinking that germs or dirt are on it. That person is obsessed about germs, triggering him to wash his or her hands repeatedly.

Note that someone who is affected by obsession can get paranoid under stress. The idea behind this is that when you think and think and think about something, what happens is that you will keep on thinking about things that are not really happening. This is also true with pulling your hair for the fact that if you think and think about having bad hairs, the result would be the act of constant pulling. Perhaps an effective treatment for this is reducing and managing stress in most cases.

On the other hand, the term “compulsions” has something to do with the act performed to reduce the anxiety produced by obsessions. To put it simply, compulsions refer to those repetitive behaviors you do to gratify your obsessions. This is where the actual act of pulling one’s own hair comes in.

Experts have recognized the obsessive compulsive disorder in the following definitions:

  • Pulling out one’s hair recurrently resulting in hair loss or baldness that is highly noticeable.
  • A sense of gratification, relief or pleasure upon pulling out the hair.
  • A sense of tension that tends to increase immediately prior to the act of pulling out the hair or when one attempts to control or resist the behavior.
  • When a clinically significant distress is caused by the disturbance. This also holds true when impairment in occupational, social or other necessary areas of functioning are affected.
  • When the disturbance is not properly accounted for by another form of mental disorder, and if the disturbance is not caused by a general medication condition.

Trichotillomania as a Habit

A number of reliable researches have noted that the act of pulling one’s hair can be developed into a habit. This happens basically when the person affected is not totally aware that he or she is doing the thing. It can also be considered as a habit when the person doing it does not feel any sense of pleasure, relief or gratification from it.

According to some studies, trichotillomania can be developed as a habit even during childhood. When this disorder occurs at that early stage, the tendency is individuals may perform it until they grow old. There are some, however, who grow out of it, but most of the population wrestles with this psychological disorder well into adulthood, being unaware of the fact that as they continue to pull out their hairs, they are preparing themselves to get bald.

Symptoms of Trichotillomania

Just like the other psychological disorders, trichotillomania is highly manifested by a number of signs and symptoms. These symptoms are common to children, teenagers and adults, but they frequently seem to start around the time of puberty, from 12 to 13 years of age. Much to your surprise, the symptoms of trichotillomania may even start much younger or older than such age. An evidence to support this is when babies develop hair pulling activity as soon as they are capable of grasping their hair. Note that in this earliest onset, the act is highly considered as a psychiatric disorder.

Here are some of the common symptoms of tricho, as it is commonly called:

  • The urge of constant pulling or twisting of the hair.
  • Increasing sense of tension before the act is performed.
  • A sense of relief upon pulling.
  • A sense of gratification and pleasure after the act is executed.
  • Uneven appearance on the head.
  • Diffuse or bare patches due to hair loss.
  • Re-growth of hair on the bare spots.
  • Presence of self-injury behaviors.
  • Bowel obstruction development if they eat the strands they pull.
  • Denial of pulling out their hair.

Note that these symptoms of trichotillomania may lessen or disappear in later years, but there is a tendency for them to reappear during the stressful times.

Who Suffers from Trichotillomania?

As mentioned earlier, trichotillomania may affect children, adolescents and adults. However, in terms of gender, this disorder is found predominant in women, and they occur more often in children than adults. The time that this disorder usual starts to occur is between early childhood and adolescence. And, according to some statistics, as much as one to two percent of the population in the United States alone is affected by this baffling activity.

Causes of Trichotillomania

Up to this time, the real cause of trichotillomania is unknown. No one can exactly pinpoint why this disorder happens and what its real cause. However, there are a lot of possible reasons that have been linked to the occurrence of this disorder. According to some claims, it may be due to a combination of a number of factors such as genetic, chemical imbalances in the brain, or the developmental events that happens earlier in the womb.

Outside from those scientific perceptions about the possible causes of trichotillomania, one particular explanation stands out to be the most possible and it has something to do with medical illness. Well, the theory behind this suggests on a biological level that the act of pulling one’s hair occur when certain disruptions in the system happens. This disruption may involve the chemical messengers that dwell between the nerve cells in parts of the brain. This basically has something to do with the motor actions in the human brain.

Genetic also plays a large part in the development of trichotillomania. This is also present in the case with obsessive compulsive disorder which may involve neurological disturbances in the system.

Much to your surprise, stress is believed to cause this disorder as it is closely related to some body-focused problems like nail biting and skin picking. I think the basis of this association is the notion that when animals are stressed or trapped, what they usually do is they lick, pull or root out their own fur or plumage. This is highly evident in horses that have been known to east their tails, as well as in birds in the wild that tend to pull out their own feathers just to line a nest when no others can be located. So when people pull their own hairs out, they are perhaps reverting to this behavioral instinct that is by fact present within all of us.

Effects of Trichotillomania

Compulsive hair pulling poses a number of unfavorable effects to the victim involved. Some of the notable effects could be physical as some pull out their hairs and damage their scalp or skin out of tension. Other side effects may be considered mental as there are some tends to enter a trancelike phase where they lose track of their surroundings and time while concentrating on the right hairs to pluck. Some may even show a sense of deliberation and concentration when pulling out their hairs alone.

The entire family may also be affected by this behavior, not just the individual who pulls his or her hair. There are some instances in which the family members might feel helpless, angry, or worse, disowning the person out of shame. They may also hide the person affected by this behavior so to appear that they are unaware of the problem.

Dealing with the Problem

So everything about the types, symptoms, causes, effects and who will be affected by trichotillomania has been said. After learning those things, I bet you are now ready to know the possible ways to deal with this disorder. If so, then sit back, relax and read on.

Dealing with trichotillomania may be difficult as it involves changing someone’s behavior. However, treating this disorder is not worth surrendering, but is more challenging. So if you happen to be one of the tricho victims or you have a friend who is affected by this condition, then I bet you would be happy to know that currently there are about two possible ways of treating trichotillomania. The first is through behavioral therapy and the other is through medication.

Behavioral Therapy

When behavioral therapy is considered, the person affected by hair pulling disorder will learn a method of how he or she can keep track of the symptoms and the associated behaviors caused by trichotillomania. This treatment is worth considering as this helps the person to become aware of his or her hair pulling act. Aside from that, certain techniques of reversing the disorder and habit will be learned from the behavioral therapy trainings.

The possible trainings that the person may consider come in three different stages:

  1. Competing Response Training – This is the behavioral therapy training which aims to teach the victim of trichotillomania the positive response he or she can apply to prevent the urge of pulling. A possible technique here could be that clenching of your fist and putting it under the sides of your body whenever a situation calls for hair pulling.
  2. Self-Monitoring Techniques – In this stage, the victim will be asked to keep a daily record of his or her actions to make him or her aware of the rate, frequency and intensity of the behavior.
  3. Display of Improvement – Involved in this training is the deliberate exposure of the victim to situations and behaviors that may lead to the act of hair pulling. This exposure is considered for the person to practice not pulling. A sense of control is required here.


Certain medications are considered for treating trichotillomania. However, it is interesting to know that although medications may assist people to stop pulling one’s hair, the effect is just temporary. There is a great chance for the symptoms of this disorder to reappear. In this case, a behavioral therapy is still deemed necessary. According to some experts, the therapy should be incorporated into the medication treatment.

Here are few of those commonly advised medications for trichotillomania:

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

As what I’ve mentioned earlier, dealing with trichotillomania is difficult. Every person affected by it should try to exercise control and discipline on his behavior, and since what exactly triggers this disorder is still unknown, further research to fully answer this puzzling disorder is highly needed. Thanks to some psychiatrists and psychologists out there that treating tricho is now attended. And, as long as the fact that it feels good to have your hair pulled remains a mystery, proper help and daily effort is no doubt a very important requirement here.

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