Open Mind

I just learned that my 27-year old granddaughter has a disorder called Trichotillomania. It causes her to pull out her hair to the point of having small bald spots on her head. I’d like more formal information on this condition. What can you tell me? 

Trichotillomania is classified as an impulse control disorder. Symptoms include:

• Recurrent pulling out of one’s hair resulting in noticeable hair loss

• An increasing sense of tension immediately before pulling out hair or when resisting the behavior

• Pleasure, gratification or relief when pulling out the hair

• The disturbance is not accounted for by another mental disorder and is not due to a general medical condition, such as a dermatological condition

• The disturbance causes significant distress or impairment in social, occupational or other important areas of functioning

People often start compulsive hair-pulling around the ages of 12 to 13, but it’s not uncommon for it to start at a younger or older age. Frequently, a stressful event can be associated with the onset, such as change of schools, abuse, family conflict or the death of a parent. The symptoms also may be triggered by pubertal hormonal changes.

There is no certain cause of trichotillomania, but is currently looked at as a medical illness. One biological theory is that a disruption occurs in the chemical messengers between nerve cells in parts of the brain. There may be also a combination of factors such as a genetic predisposition and an aggravating stress or circumstance. Additionally, it could be a symptom caused by different factors in different individuals just as a cough can be produced by a multitude of different medical problems. Finding the cause(s) will take more research.

Many people with trichotillomania also experience symptoms of Obsessive Compulsive Disorder (OCD) such as compulsive counting, checking or washing. There are so many similarities between hair pulling and other compulsive symptoms that some consider it a subtype or variant of OCD. This idea is supported by the tendency for the two problems to run in families and the fact that OCD medications can be helpful in treating trichotillomania. Depression frequently occurs in individuals with this illness. There may be a direct neuro-biochemical relationship and/or it may be secondary to the chronic demoralization and low self-esteem caused by the hair-pulling.

Two methods of treatment that have been scientifically researched and found to be effective are behavioral therapy and medications. In behavioral therapy, people learn a structured method of keeping track of the symptoms and associated behaviors, increasing one’s awareness of pulling, substituting incompatible behaviors, and several other techniques aimed at reversing the “habit” of pulling. Although medications clearly help some people temporarily, symptoms are likely to return when the medication is stopped unless behavioral therapy is incorporated into treatment. Medications may help to reduce the depression and any obsessive-compulsive symptoms the person may experience.

For more information, contact Trichotillomania Learning Center, Inc. at 831-457-1004 and www.trich.org or Obsessive-Compulsive Foundation at 203-401-2070 and www.ocfoundation.org. 

Education Department
Mental Health Association of Greater St. Louis
314-773-1399
www.mhagstl.org

Information for this article taken from Mental Health America (formerly National Mental Health Association) at www.mentalhealthamerica.net

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