Trichotillomania

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Trichotillomania is a disorder that involves recurrent, irresistible urges to pull out hair from your scalp, eyebrows or other areas of your body, despite trying to stop.

Hair pulling from the scalp often leaves patchy bald spots, which causes significant distress and can interfere with social or work functioning. People with trichotillomania may go to great lengths to disguise the loss of hair.

Causes

Trichotillomania results from a combination of genetic and environmental factors. Also, abnormalities in the natural brain chemicals serotonin and dopamine may play a role in trichotillomania.

Symptoms

  • Repeatedly pulling your hair out, typically from your scalp, eyebrows or eyelashes
  • An increasing sense of tension before pulling, or when you try to resist pulling
  • A sense of pleasure or relief after the hair is pulled
  • Shortened hair or thinned or bald areas on the scalp or other areas of your body, including thin or missing eyelashes or eyebrows
  • Biting, chewing or eating pulled-out hair
  • Playing with pulled-out hair or rubbing it across your lips or face

Most people who have trichotillomania also will pick their skin, bite their nails or chew their lips. Most people with trichotillomania pull hair in private and generally try to hide the disorder from others.

For people with trichotillomania, hair pulling can be:

Focused Some people pull their hair intentionally to relieve tension or distress Automatic. Some people pull their hair without even realizing they're doing it, such as when they're bored, reading or watching TV.

The same person may do both focused and automatic hair pulling, depending on the situation and mood. Certain positions or rituals may trigger hair pulling, such as resting your head on your hand or brushing your hair.

Trichotillomania is a long-term chronic disorder. Without treatment, symptoms can vary in severity over time. For some people, if not treated, symptoms can come and go for weeks, months or years at a time. Rarely, hair pulling ends within a few years of starting.

Although it may not seem particularly serious, trichotillomania can have a great impact on your life. Complications may include:

  • Emotional distress. Many people with trichotillomania report feeling shame, humiliation and embarrassment and experience low self-esteem, depression and anxiety because of their condition.
  • Problems with social and job functioning. Embarrassment because of hair loss may lead you to avoid social activities and occupational opportunities. People with trichotillomania may wear wigs, style their hair to disguise bald patches or wear false eyelashes.
  • Skin and hair damage. Constant hair pulling can cause abrasions and other damage, including infections, to the skin on your scalp or the specific area where hair is pulled, and can affect hair growth.
  • Hairballs. Eating your hair may lead to a large, matted hair ball in your digestive tract. Over a period of years, the hair ball can cause weight loss, vomiting, intestinal obstruction and even death.

Treatment

Habit reversal training is the primary psychotherapy for trichotillomania. This type of therapy helps you learn how to recognize situations where you're likely to pull hair and how to substitute other behaviors instead.

Some medications may help control your symptoms. For example, your doctor may recommend an antidepressant. Other medications that research suggests may have some benefit include an amino acid that influences neurotransmitters related to mood, and olanzapine, an atypical antipsychotic.

Many people with trichotillomania report feeling alone in their experience of hair pulling. It may help to join a support group for people with trichotillomania so that you can meet others with similar experiences who can relate to your feelings.

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