The habit of pulling ones hair when bored, tired, or deep in thought is not an uncommon one and just because you pull your hair does not necessarily indicate the presence of a disorder. But according to the Diagnostic and Statistical Manual (DSM5) a diagnosis for trichotillomania or compulsive hair pulling disorder should be considered when the person is unable to stop engaging in the behaviour despite it causing visible hair loss and balding, and functional impairment is evident as a result of the behaviour. This indicates that a bad habit has evolved into a clinical condition and therefore treatment is required.
Trichotillomania, or hair pulling disorder can cause intense emotional and psychological problems for the individual. Feelings of guilt, shame and loneliness are just some of the negative feelings associated with this condition. Not surprisingly experiencing such negative feelings toward oneself over a prolonged period of time can lead to depression. Symptoms of depression include sadness, lethargy, loss of appetite, feelings of hopelessness and failure, low self-esteem and suicidal thoughts or feelings. But what if the person has depression as a primary diagnosis? Could the depression conversely be a trigger for trichotillomania? One research study found that in a sample of 303 outpatients with major depressive Disorder (MDD), as many as 5% endorsed symptoms of trichotillomania.
Repetitive behaviours such as hair pulling and other stereotypic movements are commonly seen in individuals on the Autistic Spectrum. This begs the question – is there a link between compulsive hair pulling and autism? Autism Spectrum Disorder (ASD) and autism are both general terms for a group of complex disorders of brain development and are characterized by difficulties in social interaction, verbal and nonverbal communication and repetitive behaviours..
Trichology is 'the science of the scalp and hair in health and disease' and is regarded as a specialist branch of Dermatology. Trichologists are academically trained in hair and scalp biology and disorders, and as such are able to advise on, diagnose and treat hair loss, problems of the scalp, and hair breakage and damage. Although health professionals can train in trichology, on its own, trichology is not regulated by health professional licensing. This means that it is not against the law for an untrained person to call themselves a trichologist. However there are organizations who guide the development and ethics of the profession and provide accreditation to trichologists to provide assurance to potential clients.
By nature trichotillomania already causes the sufferer great shame and embarrassment, especially when there is noticeable hair loss. But what happens when the behaviour is focussed in the pubic region? While this may be easier to hide, it is also the most under reported symptom of compulsive hair pulling due to the extremely private and shameful nature of the behaviour. While trichotillomania and other body-focussed repetitive behaviours (BFRBs) are gaining momentum in awareness from the increasing number of people speaking out about their experiences with this condition, those who pick in the pubic region remain hidden in the dark.
In order to effectively treat any condition we first need to understand the cause. With increasing awareness of body-focussed repetitive behaviours (BFRBs) such as trichotillomania, research in the field has also increased. One of the questions inevitably raised is whether there is a neurobiological cause for BFRBs that could be treated through diet or medication. One of the theories centres on the role of neurotransmitters in skin picking and hair pulling behaviours.
As a health professional working with body-focussed repetitive behaviour (BFRB) such as excoriation (skin picking) disorder, the most important interaction I have with a client is the very first time they describe their experience of the disorder and how it impacts on their lives. I recognize this as a moment of real vulnerability as the individual opens themselves up to the possibility of judgement, often speaking about their behaviours for the first time. As health professionals this is great power bestowed upon us, but as the saying goes - with great power comes great responsibility! It is important that we appreciate the trust the client has placed in us.
A New Year has come and gone and just like that the vigour and excitement at the prospect of a new beginning is replaced by the reality of life. The turn of the proverbial calendar page from December 31 to January 1 fills us with hope as many of us resolve to do better, to be better. Sadly, only 8% of the 45% of Americans who set New Year’s Resolutions in 2014, achieved their goals. The stats are even more against you if your resolution is around self improvement, including the goal to stop hair pulling, skin picking or any one of the body-focussed repetitive behaviours (BFRBs). Of course this does not mean that we should not set New Year’s resolutions or that we should not resolve to stop pulling. What it means is that we need to reassess how we go about making these goals a reality. And for most of us, the part we are missing, is the PLAN!
Hair pulling was first described in the literature in 1885, and the term trichotillomania (which is greek for "hair" and "madness") was coined by the French dermatologist François Henri Hallopeau in 1889. The recent uprising of awareness campaigns and advocacy among the increasingly vocal trich community has seen objections from trich sufferers to the term trichotillomania due to the perceived negative stigma attched to the word "mania"and its reference to madness.
It is not uncommon for people to subconsciously play with, twirl or pull at their hair when anxious, tired or bored, nor is it uncommon for people to routinely pull out grey hairs or split ends. For many repetitive hair pulling is just a bad habit that has no real impact on their daily lives. But for some, this practice can be so consuming that it starts to have a negative impact on day to day functioning, their social lives, and can cause significant emotional distress. In these instances, hair pulling has evolved from a bad habit into a recognized clinical disorder known as trichotillomania, or compulsive hair pulling disorder.
Online Test for Trichotillomania
Find Out The Severity of Your Hair Pulling With This Free Online Test