Trichotillomania or Hair-Pulling disorder is characterised by the recurrent pulling out of one’s own hair.
Individuals may pull hair out from any part of their body and some common areas are:
Individuals with Trichotillomania usually make repeated attempts to decrease or stop the hair-pulling behaviour. Hair-pulling (including chewing) causes significant distress for the individual and impairs important areas of the person’s life (relationships, socially and at work). In order to diagnosed with this disorder the symptoms cannot be attributed to any other medical condition (e.g. dermatological condition) or be better explained by another psychological disorder (eg Body Dysmorphic Disorder) (DSM V, 2013).
How long will this behaviour last?
The development of Trichotillomania is different amongst individuals. Hair-pulling may be seen in infants; however, this behaviour typically resolves during early development. The onset of Trichotillomania commonly coincides around puberty and is generally a chronic condition if left untreated.
- Trichotillomania frequently affects adolescent females more than adolescent males (ratio approximately 10:1). Among children the ratio of male to females with Trichotillomania is roughly equal.
- Genetic factors – The disorder is more common in individuals with Obsessive Compulsive Disorder (OCD), who have first degree relatives with the disorder (e.g. father, mother, sisters, brothers).
- Co-morbidity – Trichotillomania is commonly accompanied by major depressive disorder and excoriation (skin picking).
It is important to note that the diagnosis of Trichotillomania is not given if the hair loss is associated with other medical conditions such as inflammation of the skin or a dermatological condition.
Functional difficulties associated with Trichotillomania
- Trichotillomania is associated with individual distress, social and occupational impairment.
- Damage – Irreversible damage to hair growth and the quality of the hair is common as a result of hair-pulling.
- Avoidance – Individuals may avoid social situations (including school and work) where their behaviour may be observed or the result of the hair-pulling is evident (bare patches).
- Musculoskeletal damage – Infrequently hair-pulling behaviour may lead to carpal tunnel syndrome, back, shoulder and neck pain (DSM V, 2013).
- Dental damage – teeth may wear or break as a result of hair biting.
- Other medical conditions – Swallowing hair may lead to abdominal pain, nausea, vomiting, bowel obstruction or even perforation.
What can I do to help someone living with Trichotillomania?
- Contact your GP or medical specialist to rule out any biological and dermatological causes for the loss of hair.
- Discuss intervention and management options with an experienced psychologist or mental health professional.
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American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing. pp. 251- 254.