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.
There are varying degrees of severity of trichotillomania, but in the severest of cases can cause significant balding and damage to the hair follicles, hindering hair regrowth. Emma Simonsen has suffered with trichotillomania since she was 13 years of old. It started when she experienced bad split ends and had to pull them, until she felt that she could no longer stop. Emma realized that she might have this condition when she already developed bald patches. Like many trich sufferers, the lack of awareness that the condition exists means that it often goes misdiagnosed and therefore untreated for many years.
Trichotillomania is listed by the Genetic and Rare Diseases Information Centre (GARD), as well as the National Organization for Rare Disorders (NORD) as a rare disease. In the US a condition is considered rare if it affects less than 200,000 Americans, and are often referred to as orphan diseases. But is this really true? Are there only 200,000 or fewer sufferers – or are there far more, who either go undiagnosed or do not report the condition at all, even in anonymous studies? Trichotillomania has deep roots in self-consciousness, guilt, and shame, and it is widely underreported due to these factors.
Trichotillomania is one of the least understood and lesser known psychological conditions affecting people today. Classified as a Body-Focused Repetitive Behavior (BFRB), it is a condition in which a person habitually and repetitively pulls out their body hair, either from the scalp, face, pubic area, or anywhere else that there is hair. It can often go undiagnosed for a long time, because people with the condition generally are extremely private about the behaviour and will deny there is a problem even when the hair loss becomes apparent. If you are concerned about yourself or someone close to you, knowing about who is most vulnerable to the condition as well as the symptoms can help you decide if further action and treatment are needed.
Trichotillomania affects all people at all ages. There is evidence of onset varying from childhood to late adulthood and for varying reasons, from genetic predisposition to comorbid mental health conditions such as Obessive Compulsive Disorder (OCD) and Anxiety Disorder. One thing that is certain about this condition, along with all the other Body-Focussed Repetitive Behaviours (BFRBs) such as Dermatillomania and Trichophagia, is that it has a harmful impact on the body, which is a cause of tremendous shame and embarrassment for the sufferer.
When inflicted with a debilitating condition such as trichotillomania, we yearn to understand why we are struggling with the behaviour, what causes it, and whether it can be prevented. It is also important to establish the cause of a condition when trying to find a cure or treatment that works. One of the major debates regarding the cause of trichotillomania is whether it is genetic.
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