Understanding Hair Pulling Disorder Diagnosis and Treatment

Understanding Hair Pulling Disorder

Hair pulling disorder, also known as trichotillomania, is a mental health condition characterized by the compulsive urge to pull out one's own hair. This disorder often develops during childhood or adolescence and can persist into adulthood. Women are four times more likely than men to develop trichotillomania, which results in noticeable hair loss or thinning. If you suspect you or a loved one may be dealing with compulsive hair pulling, here is what you need to know about getting properly diagnosed and treated.

Common Signs and Symptoms

The main sign of trichotillomania is the inability to stop pulling out hair from the scalp, eyebrows, eyelashes or other areas of the body. Hair pulling may occur consciously or involuntarily in response to certain triggers. Many people with this disorder describe feeling mounting tension before pulling out hair, followed by pleasure, gratification or relief afterward. This leads to a self-perpetuating cycle of hair pulling over time.

People with trichotillomania may pull hair in focused sessions or absentmindedly throughout the day. Hair pulling can happen during activities like watching TV, reading, driving or talking on the phone. Some common locations for hair loss include:

• Scalp
• Eyebrows
• Eyelashes
• Pubic area
• Legs
• Armpits
• Face

In addition to hair loss in affected areas, trichotillomania may cause:

• Redness, irritation or scarring of the skin where hair was pulled out
• Constant urges to pull out hair
• Anxiety, tension or pleasure before/after pulling hair
• Hair ingestion (swallowing the pulled-out strands)
• Isolation or avoidance of social settings
• Low self-esteem

Causes and Risk Factors

Researchers don't know the exact causes of trichotillomania, but these factors may play a role:

• Genetics: People with a family history of hair pulling or other body-focused repetitive behaviors may be more likely to develop trichotillomania.
• Brain chemistry: Imbalances in neurotransmitters like serotonin may contribute to compulsive hair pulling.
• Stress and emotions: Many people pull hair to cope with negative emotions or relieve stress.
• Trauma or triggers: Past trauma, abuse, depression or anxiety can trigger the urge to pull hair.

Trichotillomania often begins in late childhood or early adolescence. Age of onset is usually between 9 and 13 years old. Females are four times more likely to develop this disorder. However, experts believe trichotillomania is underdiagnosed in males.

Getting an Accurate Diagnosis

Since hair pulling is often done privately and people are ashamed to talk about it, trichotillomania often goes undiagnosed. Many people with this disorder try to hide bald patches or thinning hair. Early diagnosis leads to better treatment outcomes, so it's important to recognize symptoms and seek professional help.

To get an accurate trichotillomania diagnosis, a mental health professional like a psychologist or psychiatrist will:

• Ask about your symptoms, including when you pull hair, associated feelings and impact.
• Rule out other causes of hair loss like alopecia areata.
• Evaluate for skin irritation, scarring or hair ingestion.
• Assess the impact on your social life, self-esteem and daily functioning.
• Screen for co-occurring conditions like depression, anxiety or OCD.

No lab tests can diagnose trichotillomania. Your provider may order blood work or scalp biopsies to rule out medical causes of hair loss.

Available Treatment Options

Getting professional treatment is important for overcoming trichotillomania and preventing permanent hair loss or damage. Treatment focuses on understanding why you pull hair and developing healthier coping strategies. Options may include:

• Habit reversal training (HRT): This behavioral therapy helps you become more aware of hair pulling triggers. You also learn to substitute hair pulling with healthier activities.
• Cognitive behavioral therapy (CBT): Changing dysfunctional thought patterns that trigger hair pulling is the focus of CBT.
• Dialectical behavior therapy (DBT): DBT helps you develop distress tolerance skills and self-soothing techniques.
• Acceptance and commitment therapy (ACT): This approach focuses on accepting thoughts and feelings without reacting to them.
• Hypnosis: This technique uses relaxation and focused awareness to change subconscious thoughts.
• Medications: Antidepressants like SSRIs may curb hair pulling urges. Anti-anxiety meds help reduce stress.
• Support groups: Group therapy provides community support from others dealing with trichotillomania.

Treatment works best when started early. psychotherapy combined with medication and support groups often produces the best results. Getting family involved also improves treatment success.

Complications of Trichotillomania

Without proper treatment, trichotillomania can lead to:

• Permanent hair loss or bald patches
• Skin damage from repeated irritation
• Infection around hair follicles
• Stomach obstruction from hair ingestion
• Social isolation and relationship issues
• Low self-esteem and depression
• Body dysmorphic disorder
• Impaired academic/work performance

Early intervention provides the best chance to fully recover from trichotillomania and regain healthy hair and skin. Ongoing maintenance therapy helps prevent relapse.

Coping Strategies and Self-Help

Along with professional treatment, these self-help tips can aid your trichotillomania recovery:

• Identify your hair pulling triggers so you can avoid or manage them.
• Limit time spent focused on hair pulling compulsions.
• Find healthy replacements for hair pulling like squeezing a stress ball.
• Reduce stress through relaxation techniques, exercise or meditation.
• Avoid mirrors and lighting that makes hair easy to access or see.
• Use bracelets or bandages to prevent pulling from scalp, brows or lashes.
• Join a support community to share challenges and success stories.
• Practice self-love and do esteem-boosting activities like a new hobby.

Building a circle of support with loved ones also helps promote recovery. Be patient on the road to overcoming trichotillomania. It may take time to retrain your brain and break the hair pulling cycle.

Seeking Treatment for Hair Pulling Disorder

Trichotillomania is a challenging but treatable condition characterized by irresistible urges to pull out hair. If you recognize symptoms of compulsive hair pulling in yourself or a loved one, seek help from a doctor or mental health professional. With proper treatment and support, you or your child can overcome trichotillomania and regain healthy, full hair.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.