Isolation is a hallmark symptom of trichotillomania. People who pull don’t want to be seen because they don’t want anyone to notice how their hairline is different or that they no longer have eyebrows. In therapy, we encourage people with trich to get social support. Now everyone has to isolate.                      

The pandemic of anxiety

Governments around the world are locking down their countries, states, and cities. It’s bad enough that a super contagious silent virus prowls the air, but now we have to adjust to a new way of doing things by staying home.

Therapists call changes in lifestyle like moving or a relationship change a “significant life event” that contributes to very high stress levels. Often these stress levels go unnoticed because people view these events as “normal.” The COVID-19 pandemic sandwiches two very high stress level significant life events: threat of disease and a complete shutdown of life.  

Anecdotal evidence suggests that trich follows a fairly predictable course over one’s lifetime. Most symptoms start around middle to late childhood with the onset of puberty and increases in severity during adolescence and twenties. However, most people experience lower symptom severity in their 30s and 40s. The changes later in life may result from a variety of factors including changing hormones, improved sense of self or learning to manage pulling behaviors through therapy. However, neurology points to something else.

Good old-fashioned psychotherapy remains the most effective treatment for trichotillomania. A recently published evaluation of the research suggests that pharmacological treatments lag behind behavioral and cognitive-behavioral therapies.  

The Research Says

A meta-analysis looks at all the available research conducted within a subject area to determine if broader conclusions can be made. In the case of this meta-analysis, the researchers looked for psychological and pharmacological interventions for trichotillomania used with children under age 18. Although they found 129 studies conducted, only 6 met the criteria of being a well-designed study.

What other conditions are most closely related?

In an effort to understand the risk factors for trichotillomania, researchers continue to look for genetic links between trich and other disorders. As a member of the obsessive-compulsive disorder (OCD) diagnostic family, there are many similarities between the disorders. One of the most common reasons for misdiagnosis is that trich looks very much like OCD. This blog article from the archives offers a refresher on the differences.