Trichotillomania is a disease which is characterized by compulsive urge to pull one’s hair. Even though one is trying to resist the urge, one starts to feel tense and the feeling becomes worse if one does not pull out a hair. Once a hair is pulled, one feels pleasant and satisfied. The result of such disorder is hair loss, usually limited to one region. If the disorder is not treated, it may be irreversible.

Why haven’t we heard about trichotillomania before?

Trichotillomania is not a new disorder. There are many descriptions in the Bible which are consistent with the disorder. The first official description of the disorder was given in 1800. However, up till recently, there was little information about the disorder, as the patients usually reported to dermatologists without stating true cause of hair loss. The reason for their little deception was fear that the doctors would define the disorder as insanity.

Trichotillomania is no longer anonymous due to new publications which contain basic information about the disease and successful treatments. Public presentation in many cities has drawn the attention of hundreds of individuals who soon started asking for help.

What are the symptoms of the disease?

Trichotillomania is classified as specific disease group called “impulse control disorder”. This group includes pyromania, kleptomania and gambling addiction. Individuals suffering from this disorder are usually tense, and thus numerous experts believe that the act of hair pulling is actually a sign of relief. The problem becomes more serious after hair pulling, as the individual is afraid of losing both control and entire hair. Aside the fact that the individual is obsessed with such thoughts, she/he may experience extreme anxiety.

After pulling out a hair, many individuals tend to play with it, for instance they touch their lips, pull the hair through their teeth or hands. Sometimes, patients bite the hair root, while some patients eat the entire hair (trichophagia). Sometimes, patients need to undergo a surgical intervention in order to remove undigested hairs which are usually entangled.

Some individuals spend hours looking for “the perfect hair” to pull. Others have “favorite area” (on the scalp or other region) which they sometimes change. It is important to say that any area covered in hair is can be affected- eyelashes, eyebrows, chest, legs, pubic area, etc.

These actions last from several minutes to several hours and repeat on daily basis. They usually pull out hair when they are alone. However, patients often attempt to stop further hair loss by wearing gloves, cutting their nails or wearing very short hair. Unfortunately, these attempts usually result in failure, so one is often left with bitter feeling of defeat.

How and when does trichotillomania occur?

The disorder usually occurs between the ages of 12 and 13. However, there are cases of trichotillomania at younger or even older individuals. The disease may occur after a stressful event, such as parent’s abuse, illness or death of one of the parents. Majority of individuals does not remember a stressful event that could trigger the disease occurrence. Nevertheless, there are individuals who lose the symptoms of the disease once their relations with parents are improved, i.e. after the parents pay more attention to them.

Having in mind that the disease usually occurs in adolescence period, some authors believe that it is the result of hormone changes. Some children, who first pull out and then eat their hair have a lack of iron in organism. They lose the symptoms of the disease once they increase iron intake. However, many authors claim that this is a disorder on the level of neurotransmitters (substance which transmits a message to the brain). The proof of this statement is the fact that trichotillomania is very similar to obsessive-compulsive disorder which is the result of disorder of neurotransmitter called serotonin. Aside from basic symptoms, many patients suffer from compulsive counting, checking and washing which are characteristic for obsessive-compulsive disorder. Therefore, many authors consider trichotillomania as subtype or kind of obsessive-compulsive disorder. This statement is supported by the fact that these two problems often occur in the same family (which is a sign of genetic predisposition), as well as by the fact that the same medications help at both diseases.

Trichotillomania has a better prognosis if it starts before the age of six. In this case, the disease usually disappears in the same way as it has occurred. Diseases symptoms may disappear in the positive period of patient’s life. Unfortunately, if the disease is not treated, it could be triggered by the occurrence of stress or unfavorable period in patient’s life.

Does trichotillomania have consequences?

The answer is - yes. Trichotillomania can have twofold consequences- physical and psychological. As for physical consequences, one can permanently lose hair on specific part of the body. As for psychological consequences, which are (in adolescent age) much more important, one feels shame due to the inability to control one’s behavior and excessive fear of the consequences. One is often afraid of insanity, which is the most frequent reason for hiding this problem Parents and other family members rarely understand the nature of the problem. They frequently say “Why don’t you simply stop?” thus increasing child’s feeling of guilt and tendency for self-depreciation. Hair loss is often very visible, so the child faces teasing and undervaluing from their friends. All of this can have serious consequences for adolescents, especially in terms of self-confidence and relations with their peers, which has long-term and sometimes serious consequences later in life.

Individuals suffering from trichotillomania hardly achieve a satisfactory quality of life. They often avoid many activities (spending time with their friends, swimming, etc.), wear hats, wigs, false lashes, large sunglasses or draw their eyebrows, which usually make them look strange. It happens that many individuals enter into marriage and continue their life normally. However, there are patients who avoid intimacy because they are afraid that their secret will be revealed.

Trichotillomania is usually accompanied by depression which is a common response to long-term demoralization and low self-esteem. Feeling of helplessness and inability to solve the problem also affect mood disorder. There are records of attempts of suicide, self-injuries, abuse of various substances. Nail biting, thumb sucking, compulsive scratching may also accompany trichotillomania.

How can we treat trichotillomania?

The treatment is adjusted to each patient. However, it is of outmost importance to start the treatment by giving patients information about the disease character, having in mind that it significantly reduces tense and fear, and consequently facilitates further treatment. Information help the patients understand that they are not the only ones who are facing this strange problem and thus decrease the feeling of isolation and self-accusations. It is of outmost importance to ensure patients that this is not the case of insanity and that there is an adequate psychiatric treatment which can help them solve their problem.

Treatment based on support, the so called supportive treatment has proved to be useful.



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