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Trichotillomania: Causes, Symptoms, and Solutions

Faiq Shaikh, M.D.
Trichotillomania: Causes, Symptoms, and Solutions

“You know, sometimes I feel well and vital in the world, and sometimes I just feel so distressed I want to pull my hair out by the roots.” ~Sharon Stone.

For many, there is something natural about feeling like you want to pull all of your hair out when you’re stressed or overwhelmed. But for millions of others, this is more than a feeling – it is a reality.

The condition, known as “trichotillomania,” effects as much as 4% of the population at some point in their life (roughly 280,000,000 people in the world), and is a common and frequent symptom of stress and anxiety. It’s also not well known, and many people struggle with the condition in silence.

What is Trichotillomania?

Trichotillomania is the name for the desire or compulsion to pull out your own hair. It is a complicated issue, one that is believed to be directly related to anxiety and stress, but can also run in families and occur for no apparent reason at all. 

Those who struggle with trichotillomania often find that they are frequently tugging on their hairs hard enough to pull it out by the root. In some cases, when the trichotillomania is frequent or is concentrated into a single area, it may result in the development of visible bald spots on the scalp.

The term “trichotillomania” was coined in the 1800’s. It translates to “hair pulling madness.”

Trichotillomania Symptoms

Most people that struggle with trichotillomania are aware that they have the problem. But many do not realize they’re pulling out their own hair while they’re doing it – only after they have been pulling their hair for a while, or when someone points it out to them.

The symptoms of trichotillomania are:

Keep in mind that hair pulling is not limited to the scalp either. Although it is more common to pull hairs on the top of the head, some people pull on their eyebrow hairs, facial hair, chest hair, and underarm hair.

Usually, although not always, the hairs are pulled only one at a time.

Hair loss can be permanent, but usually, the hairs will grow back if you learn to control the trichotillomania. However, because the condition can be embarrassing, some people also struggle with low self-esteem, social phobia, and other related conditions.

Trichotillomania Causes – Why Do People Pull Their Hair?

There is evidence that trichotillomania can run in families, meaning that somehow there is a genetic cause. But not everyone with parents who pulled their hair is going to develop the condition. Usually, the development of trichotillomania is brought on by one of the following:

Some people also pull their hair due to boredom, where they are lost in thought and their hands simply are unsure what to do. Interestingly, there is evidence that those that are bored experience an excitatory effect when they pull their hair, even though those with anxiety experience a calming effect.

If it seems as though the cause of trichotillomania is not entirely clear, that’s because it is not. There doesn’t appear to be a specific reason that people choose to pull their hair. But there also isn’t a clear reason that some people bite their nails, and yet millions of people do.

Most likely, it is an instinctual behavior left over from our days as primates. Perhaps early man needed to pull out hair for comfort, and even though modern man can shave and get haircuts, the instinct is triggered by stress.

No matter the cause, those with trichotillomania generally don’t want to have the habit, but either:

It can eventually develop into a common habit, and once anything becomes a habit it becomes far more difficult to control without help.

Trichotillomania Treatments

Trichotillomania is very treatable. There is a small catch though. While most people do not want the consequences of hair pulling, such as baldness, there is a conscious or subconscious desire to pull out hair. Remember, the compulsion itself is the desire to pull out their own hair.

Any time a person wants to do something on any level – even a subconscious level – stopping it can be a bit tricky. There will be that part of you that wants to keep plucking away, and this part may be especially problematic when you’re bored, anxious, stressed, or simply not paying attention.

That’s why before you even look at trichotillomania treatments, you’ll need to start with the following:

Mindfulness Mindfulness is not a cure for trichotillomania, but it does play a role in your ability to treat it. Those that have trichotillomania rarely realize they’re pulling their hair, or at least do not necessarily feel like they can stop and control it. Mindfulness is an important starting point. With mindfulness, you train yourself to be aware of when you’re pulling your hair so that you can make sure you have control over the habit. You can do this by:

Essentially mindfulness is simply an awareness of the present. Habits are more common when you’re lost in your own thoughts or busy with other things. That’s why many people with trichotillomania pull their hair while driving or while sitting at home watching TV: their mind isn’t on what their hands are doing, they’re just thinking about their anxieties.

Training yourself to be more aware of the present and your behaviors through these regular reminders is an important step for avoiding trichotillomania.

Busy Hands Also, if your hands aren’t free you cannot pull your hair. A large part of curing trichotillomania is simply breaking the habit. Keeping your hands busy is a great way to start breaking that habit.

But what can you do with your hands?

Some ideas include:

If your hands aren’t free to pull your hair, then the habit of pulling your hair cannot take place. Some experts also recommend wearing a hat for a while (if the hair pulling is one your head) so that you’re unable to touch your hair to pull it. This will also help you realize when you’re about to pull your hair – if you reach up and touch your hat, chances are you were going to start hair pulling.

Treatment for Trichotillomania

Treatment for trichotillomania is a bit more complicated. Interestingly, the two starter strategies discussed above are commonly used together in the treatment for trichotillomania as well, within a type of therapy called “Mindfulness-Based Cognitive Behavioral Therapy.”

In this therapy, the client is thought how to control their thoughts and behaviors using cognitive behavioral therapy techniques, which include things like learning how you respond to stress and anxiety, being able to separate your thoughts from your sense of self, and replacing the behavior.

In addition, the most successful way to stop trichotillomania is to control your stress and anxiety. If you don’t feel anxious, and you are able to cope with stress, you are less likely to experience symptoms.

However, there are some strategies you can try to do at home. In addition to mindfulness and keeping your hands busy, you can also try:

Boredom-based trichotillomania also has a simple cure – find ways to be less bored. You can also try to engage in more physical activities, which tire the body and make it less prone to boredom behaviors.

Similarly, anxiety based trichotillomania does require that you learn how to control and regulate your anxiety better, because as long as stress continues to affect you unimpeded, you may continue to find that your hands have the urge to start pulling. But if you can cure your anxiety, so too would you prevent this stress hair pulling habit.

Treating Trichotillomania is Probable, Not Just Possible

There is considerable good news: trichotillomania is highly treatable for those that want to treat it. For many, the reason it becomes such a significant problem is because it can take months or years for someone to seek out help. Once you start focusing on reducing and curing the condition, you’ll find that you are in much more control over when it occurs.

Recurrence IS an issue, however, because any habit that is triggered by stress and anxiety runs the risk of coming back when you’re under future stress. That is why controlling your anxiety is always going to be a critical part of any trichotillomania treatment plan.

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