Compulsive hair pulling can lead to baldness or hair thinning, which has a negative impact on an individual's self esteem. This is particularly true for woman who are expected to match societal expectations of having a full head of beautiful hair. Many trichotillomania sufferers find that the disorder leads to them socially isolating themselves due to the shame and guilt associated with the behaviour, and the embarassment about the appearance of balding spots. In addition to this, the lack of awareness of compulsive hair pulling as a clinical condition means that most people do not seek help or support and therefore struggle with this condition on their own. However there is hope for those with trichotillomania, with a variety of treatment options available.
Trichotillomania is often a misunderstood mental health condition. This is because many people are too embarrassed to seek professional opinion about something they assume to be just a bad habit. Fortunately, thanks to the awareness raising efforts of organisations such as the Trichotillomania Leaning Centre (TLC), the disorder has recently enjoyed increased attention from the medical and research fraternity. More and more research studies are being conducted to understand the causes and effects of the disorder and to develop treatement options. Hence it is important to contribute to the studies by becoming a participant and sharing your experience of trichotillomania.
Hair twirling may seem to be a harmless habit, but there is a real risk that it can develop into something more serious. It is not uncommon for people to sub-consciously engage in repetitive behaviours such as foot tapping, shaking the legs or hair twirling in response to stress, anxiety or even tiredness. According to sensory integration theory these behaviours serve to soothe excessive or elicit dampened sensory stimuli. While for most people this will never be more than a habitual response, for some this can signal the beginning of compulsive hair pulling disorder.
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.
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