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What is Trichotillomania?
Trichotillomania is currently classified as an impulse control disorder in the 4th Edition of the Diagnostic and Statistical Manual of Mental Disorders. However, it also shares features with obsessive-compulsive disorder and other obsessive-compulsive spectrum disorders such as self-injurious skin picking.
The current diagnostic criteria include:
- Recurrent pulling of one’s own hair resulting in noticeable hair loss
- An increasing sense of tension immediately before pulling out the hair or when attempting to not pull
- Pleasure, gratification, or relief while pulling hair
- The hair pulling is not better accounted for by another mental disorder or an underlying dermatologic condition.
- The disturbance causes significant distress or disturbance in social, occupational, or other important areas of functioning (APA, 1994).
Of note, many people do not meet all of these criteria, but still pull their hair to a bothersome degree.
Demographics of Trichotillomania
- TTM is estimated to have a 1-3% prevalence in the general population.
- Research and clinical experience indicate that trichotillomania affects more women than men. Studies estimate that over 90% of people with trichotillomania are female.
- The female predominance could be overstated, however, since men are less likely to seek psychological treatment. Furthermore, men are more able to hide their baldness or to explain it as a natural part of aging.
- The mean age of onset is in early adolescence (11-13 years of age) though children as young as 1 year of age with TTM have been reported in the literature.
Patterns of Hair Pulling
Sometimes a stressful event such as abuse, a death, or divorce, can precede the pulling. Some people report pulling after seeing another person pull their hair. While many report a stressor prior to their first onset of pulling, many people also report no preceding event or trigger for their first pulling episode.
The body sites and pattern of hair pulling can be quite diverse.
- Patients may pull from the body, scalp, eyelashes, eyebrows, pubic region, face, or extremities.
- Some pull from a few specific spots, while others pull from many different locations in the body.
- The body sites that are the focus of pulling can change over time.
There are many reasons people have reported for hair pulling. Some of the most common ones include:
- Dealing with stress, boredom, or fatigue.
- Getting rid of irregularities such as thick, coarse, or gray hair.
- Alleviating a physical sensation on the skin such as tingling or pressure.
- Attempting to reduce tension or other negative feelings.
Consequences to Pulling
Hair pulling can affect all areas of life including a person’s physical, psychological, and social well being.
Psychological Problems: - Noticeable hair loss causes many people with trichotillomania to feel depressed and unattractive.
- Individuals often feel frustrated and confused at their inability to stop pulling.
- Often, people will hide their hair pulling from friends and loved ones, leading to even more feelings of shame and isolation.
Social Problems:
- The shame of hair pulling can also lead individuals to avoid certain activities such as professional hair-cuts, swimming, intimate sexual encounters, or windy or well-lit places.
- Hair pulling can often result in nagging from a spouse or parent, degrading remarks, or put-downs from friends or loved ones, furthering the shame and isolation resulting from the disorder.
Medical Problems:
- Repeated pulling can lead to damage of the hair follicle.
- Skin damage as a result of pulling can lead to serious infections, requiring medical attention.
- Pullers can have occult neuromuscular problems from postures adopted while pulling.
- Damaged hair follicles are also more likely to produce hair that is discolored, coarse, or kinky. This irregular hair can in turn lead to more pulling.
- On rare occasions, ingestion of extracted hairs can lead to trichobezoars which can be fatal.
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