What Is Hair-Pulling Disorder?
Trichotillomania (TTM), often known as hair-pulling disorder, is an impulse control disorder in which the patient is unable to resist the urge to pull out their own hair despite their best efforts. The scalp, brows, and eyelids are the most commonly affected areas. This causes considerable hair loss, which manifests itself as irregular bald patches. TTM is not the same as obsessive-compulsive disorder (OCD), yet both can co-exist.
TTM is more likely to run in families, in which case a family member is more likely to be affected.
Causes of Hair-Pulling Disorder
Hair-pulling disorder, or TTM, is a mental illness that is accompanied by behavioral abnormalities. The specific cause, however, is yet unknown. The following are some of the possible causes.
Emotional Stress
Trichotillomania is thought to be an outward representation of mental tension, anxiety, and/or sadness. This is viewed as an addiction to self-harm (hair-pulling) as a means of coping with mental discomfort. TTM is also associated with the symptoms of post-traumatic stress disorder.
Hormonal Imbalance
TTM has long been known to affect women more than males. As a result, changes in hormonal patterns in adolescent girls during menarche throughout puberty can trigger this mental condition.
Neurotransmitters Imbalance
Trichotillomania is caused by an imbalance of chemicals in the brain (neurotransmitters) that send messages from one section of the brain to another. Changes in our mood, such as happiness or melancholy, can be caused by an imbalance of neurotransmitters like serotonin and dopamine, which is typically linked to TTM.
Habit Formation
Hair-pulling offers a person a sense of relaxation or satisfaction, thus the more they do it, the stronger the impulse and habit develop. The Neurocognitive Model, which views TTM as a habit disorder, can explain these findings. This is because the brain’s basal ganglia are in charge of habit formation, whereas the frontal lobes are in charge of repressing or inhibiting such habits.
Altered Gene Function
Genetically changed functions are assumed to be the cause of TTM. Because TTM is sometimes linked to other disorders, such as OCD, a genetic link has been proposed. This could have an impact on TTM pathogenesis, illness progression, and prognosis.
Symptoms of Hair-Pulling Disorder
The Strong Desire to Pull one’s Hair
TTM patients experience a strong desire to pull their hair out. This might happen as a result of a stressful situation that acts as a trigger, or it can happen for no apparent reason. The person feels stiff and irritable till they can rip their hair out. Once the hair is ripped off, they person begins to feel joy, gratification, relief, and/or satisfaction.
Bald Patches
Pulling hair repeatedly develops bald patches on the scalp. They can be uneven in shape, and they frequently occur on one side disproportionately. These patches are also found on the brows, eyelashes, beard, mustache, and even the pubic and perianal regions.
Embarrassment
Trichotillomania patients experience a significant deal of shame, which can sometimes lead to melancholy. They attempt to hide their bald patches from view and avoid making eye contact with others. They may also experience feelings of remorse, frustration, and low self-esteem, all of which can have an impact on self-image and are similar to body dysmorphic disorder.
Isolation Preference
Some sufferers are so ashamed of themselves that they would rather live in seclusion. For fear of exposing their illness, they avoid friends as well as any physical relationships. They may not even want to marry for the same reason.
Strange behavioral patterns related to TTM may be displayed by the affected person. Hair pulling rituals and patterns such as a fondness for a particular type of hair are examples of this. Examining the hair root, twirling the hair, drawing the hair between the teeth, biting, chewing, and swallowing the pulled hair are some of the other symptoms.
TTM disrupts and impairs critical areas of functioning such as social, occupational, among others. This shows up as a refusal to go to work, school, or other public or social gatherings.
Complications of Trichotillomania
TTM may result in a variety of complications. The following are a few examples:
Psychiatric Issues
TTM frequently results in psychiatric problems. Anxiety disorders, mood disorders, substance addiction disorders, eating disorders, and personality disorders are all examples of these. Disruptive behavior problems are the most common issues among youth.
Alopecia (Hair Loss)
TTM causes significant hair loss as a result of continual hair tugging, which is known as traction alopecia. This results in bald spots on the head, which lowers self-confidence and self-esteem significantly.
Reduced Quality of Life
Because the patient is constantly plagued by emotions of guilt, humiliation, loneliness, and embarrassment, their quality of life might deteriorate significantly. This has a significant impact on social functioning, such as school/work absenteeism, fewer friends, and trouble in intimate relationships. Many of the sufferers also get dissatisfied and irritated as a result of their inability to control their cravings, leading to substance misuse.
Trichobezoars
As a result of swallowing the pulled hair, hairballs might form in the stomach or intestine. Peptic perforation, obstructive jaundice, and severe pancreatitis can all result from this. In severe situations, surgery to remove the trichobezoars may be required.
How to Diagnose Hair-Pulling Disorder
To diagnose and evaluate the condition of patients suffering from TTM, a variety of diagnostic techniques are often deployed. All of this is based on a set of questions that patients are asked to complete. These questions are used to examine their mental state in relation to the condition.
The doctor develops a diagnosis based on the responses of the patients. Photographic evidence is also obtained in addition to these questions.
How to Treat Trichotillomania
TTM treatment options for children, adolescents, and adults are currently available in a variety of forms. Cognitive behavioral therapy (CBT), counseling, support groups, hypnotherapy, medication, and a combination of therapies are some of the options. The following are some of the most popular TTM therapy strategies:
Cognitive Behavioral Therapy (CBT)
CBT is a three-way strategy that includes:
Awareness Training
This entails using ways to help the patient become more aware of their condition through self-monitoring.
Competing Response Training
Also known as habit-reversal training, this helps to educate the patient to substitute hair pulling with a physically incompatible behavior such as squeezing a stress ball.
Impulse Control
This entails identifying and avoiding the triggers that lead to hair pulling.
Pharmacotherapy
This is a treatment method that involves the use of medications to treat TTM. The following are a few examples of pharmaceutical molecules.
New Pharmacological Agents
Three new pharmacologic agents for the treatment of TTM have recently been discovered to be effective. An opioid antagonist (naltrexone), a glutamate modulator (N-acetylcysteine [NAC]), and an atypical neuroleptic are among the options (olanzapine).
SSRIs (Selective Serotonin Reuptake Inhibitors)
These antidepressants are commonly used to treat anxiety disorders and severe depression, however, studies have shown that SSRIs should not be used as a first-line treatment for TTM. Combination therapy with SSRI and CBT, on the other hand, has been shown to be superior to either SSRI or CBT alone.
Clomipramine
This is a tricyclic antidepressant with serotonergic and other properties that have been shown to be effective in the treatment of TTM, however, it has been relegated to second-line therapy for TTM due to its poor side effects.
Now that you Know…
Trichotillomania is an uncommon medical condition that can have a significant impact on one’s quality of life. Many people are unaware that there are therapies for trichotillomania. HRT (habit reversal therapy) is considered beneficial, and in most cases, it is the first-line treatment.
Medications that can alleviate the symptoms of trichotillomania are still being studied by researchers. If someone suspects they have trichotillomania, they should seek medical help. The patient will be referred to a professional for treatment, such as behavioral therapy. This has the potential to improve a person’s life quality.
