Trichotillomania: Help, I’m pulling my hair out!

What is chronic hair pulling all about?

Believe it or not, there’s a name for chronic hair pulling! According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) it is called “Trichotillomania”. It is a chronic hair pulling condition that leaves a person with significant hair loss or baldness in the area of pulling. Everyone pulls some hair sometimes, but those with Trichotillomania most likely know the hair pulling is “different”. Areas most commonly affected by hair pulling are eyebrows, eyelashes, scalp, arms, and legs. Less common, but possible are underarms (armpits), facial, pubic and peri-rectal areas. If you or someone you know may be suffering from hair pulling this review of the DSM 5 diagnosis of Trichotillomania may help.

Diagnosis

In order to quality for the diagnosis of Trichotillomania, the following criteria must be met:

1. Hair is being pulled and is result in hair loss

2. Attempts to quit or decrease unwanted behavior have failed

3. The hair loss must affect a person’s life in a significant way causing distress or impairment in social circles, work/employment, or other import at areas of function

4. Hair pulling is not caused by any other medical condition like a skin condition etc.

5. Hair pulling isn’t due to another mental disorder (like Body Dysmorphic Disorder)

6. Although the cause of the the disorder is not currently known, it is listed in the Obsessive and Compulsive disorders in the DSM. Typical onset is from age 11-13 years of age and can be a lifelong condition. (Mayo). Hair pulling can happen either as an automatic (involuntarily) or as a focused (conscious) coping skill.

* Important Note: If you read over this criteria and believe that you or a loved one is suffering from chronic hair pulling, Trichotillomania, it is important that you meet with a trained professional who can provide an official diagnosis and help you with appropriate treatment.

Emotional Roller Coaster

Most of the time hair pulling is associated with either anxiety or boredom. Other emotions that may come with hair pulling include tension (urges) or extreme desire for control just before the hair pulling. After the hair is pulled a person may feel pleasure, relief, and gratification.

There can also be a lot of shame associated with this disorder and it is not uncommon for Individuals to try to hide the hair loss in some way or make significant attempts to hide the hair loss. Hair pulling can cause a person to feel out of control, embarrassed and so the distress or impairment requirement (diagnostic Criterion C) is met with this aspect of the disorder. Sometimes a person will even deny the hair pulling to others.

Rituals

Some hair pulling can be accompanied by certain types of preparation behaviors or preferences. This could include picking certain types of hair like only a certain color or texture. It could be pulling the hair out in a specific way perhaps twisting it out or pulling it out with the root. Other behaviors may happen after the hair has been pulled. This could be twisting the hair between fingers, twirling hair around fingers, putting the hair in between teeth, eating the hair, or biting it into pieces. These are just some of the examples included in the DSM 5 and you, or someone you know, may have others unique rituals.

Types

During times of hair pulling there may be various types of behaviors. Trichotillomania is characterized as an obsessive (recurrent thoughts) and compulsive (recurrent behaviors) disorder that affects 1-2% of adults and adolescents. The behavior can really take on two faces:

Focused – a conscious pulling of the hair

Hair pulling happens in response to tensions, urges, and desires the person is aware of at the time.

Automatic – unconscious pulling of the hair.

Hair pulling happens without awareness and it may be hard to track when it’s happening.

Many times people state they have mixed behavior types but one may be a more dominant style.

Check it out:  ABC News about Trichotillomania

Side effects

Trichotillomania may have consequences such as:

• Carpal tunnel  or back, neck and shoulder pain (from pulling at strange angles)

• Stomach pain, nausea, and vomiting from swallowing hair

• Dental damage from chewing hair

• Social or emotional distress

Other Quick Facts

• Hair pulling can be accompanied by other body-focused repetitive behaviors like (but not limited to): skin picking, nail biting, and lip chewing.

• More females suffer than males in a ratio of 10:1

• Some hair pullers may also enjoy pulling out hair from animals, toys, or fibrous materials like clothes, blankets or carpets.

• Typically, hair pulling comes with or just before puberty (ages 11-13)

• Genetic components may play a factor; it is more common in those with a first-degree relative that has OCD (Obsessive-Compulsive Disorder)

• Biting hair only doesn’t qualify a person for the diagnosis

Things that can help

Trichotillomania varies greatly in just how long it lasts. It can last from weeks to years at a time. Some start the habit and then stop without any other episodes occurring. Interesting isn’t it?…

Behavioral log

For those who are not so lucky to have it go away quickly, a behavioral log of when the hair pulling happens may be helpful to see patterns of behavior (times, activities, locations etc.). If the hair pulling happens as an automatic behavior, then it may be helpful to have another person help you observe the behavior for your log.

Relaxation Techniques

If your issue is due to anxiety, some relaxation tips may be helpful. Try breathing, meditating for a few minutes a day, or even taking a walk outside (leave the phone at home!). Others may enjoy affirmations around anxiety, or guided imagery. Try some of the affirmations or guided imagery from Belleruth Napterstek or Kaiser Permanente.

Personal Techniques

Try anything YOU may think will work to help with your unwanted behavior. Do you notice the pulling happening when your inside too long? Not doing it when your hair is wet? When your nails are painted? Don’t underestimate the power of a simple change that is unique to your lifestyle!

Treat underlying anxiety

Although there may be a genetic component associated with this body-focused repetitive behavior, other underlying anxiety issues may exacerbate the issue. Meet with a counselor who can help you work through issues with perfectionism, stressful relationships, social issues or anything that may cause your anxiety to worsen and provide you with a safe place to work out some issues. A counselor can also work with you to try different coping skills when you feel the urge (if it’s a focused behavior).

Find Support

There’s a whole world of support for those who are struggling with Trichotillomania. As a matter of fact the community has coined a term form themselves, “Trichs” (sounds like tricks)! There is a documentary called, Trichsters by Jillian Corsie that shares the struggles and stories of a few Trich survivors. There are a number of support groups online and locally. Try finding a local group for Trichotillomania or obsessive-compulsive recovery atPsychologytoday.com. Groups in person are ideal but online groups may also be helpful.DailyStregnth.org provides one of many online discussion and support groups. It’s important you find a group of people that you feel understand your isolating, and sometimes secret, issue. Even though you may feel like no one understands there are people out there who do. Connect with them, share your story to encourage others, and allow others to encourage which while you each work through the pulling.

Trichotillomania is not who you are….

Trichotillomania sufferers are people you may know! Just as with any diagnosis it is just one aspect of a person and should not be the person’s identity. I hope that those who have read the article and identify with it understand they are not alone! There is a community of people who also have the same issues.

Getting Treatment

If you believe you, or someone you love, has Trichotillomania it is important to receive help from a trained professional. He or she can help you rule out any other diagnosis and provide appropriate treatment.

We would love to work with you! If you would like to scheduled a session, feel free to contact Flourish Counseling Co. at 407-630-7529 or schedule immediately with us online at www.flourishcounseling.co.

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Additional Helpful Resources

Mayo Clinic Article on Trichotillomania

Trichster.com – Trichsters documentary

TrichJournal – YouTube channel

About the Author

Cristina Ally, LMHC, is the owner of Flourish Counseling Co. in Winter Park, Florida. She specializes in women’s issues, sexual abuse recovery and diabetic lifestyle adjustment. She has helped countless individuals and families reach optimal mental and emotional health by providing counseling and trauma resolution in the Orlando area since 2015. She is currently the President of the Mental Health Counselors of Central Florida and is a passionate advocate for mental health.