We are all familiar with the main symptoms of depression: sadness, lethargy, changes in appetite, feelings of hopelessness and failure, low self-esteem and suicidal thoughts or feelings. These are all very serious, and hard enough to handle in their own. But what happens when depression moves from the internal to the external? The physical symptoms of depression can be just as distressing as the mental ones: cutting, burning, and other forms of self-harm are common among people struggling with depression, but there are lesser-known conditions that can be triggered by depression. One of the least understood, and often un-diagnosed of these is trichotillomania.

What is it?

Trichotillomania or simply just “trich” is an disorder on the Obsessive Compulsive Disorder Spectrum and is characterized by the irresistible urge to pull out one’s hair and is usually persistent and difficult to treat. This usually leads to hair loss or balding (depending on the affected area of pulling), distress and in many cases, functional or social impairment. This hair pulling disorder affects just a small percentage of the general population (1% to 4%) but unfortunately, it is often a mistreated and underdiagnosed disorder. Although it is usually thought to be a disorder that primarily affects women; the male patients’ clinical presentation may be unique. When assessing and treating this disorder, sex difference may be a major factor. In most cases, there are many similarities in male and female patients of trich, but there are important differences to note as well.

What is trichotillomania?

The Mayo Clinic states that trichotillomania is an impulse control disorder that becomes an overwhelming compulsion to pull out your hair at the roots. The sufferer knows that the compulsion is not healthy but is unable to control himself or herself. The results are not only physical, i.e. bald patches that the sufferer goes to great lengths to cover up, but also emotional, which is to say depression, anxiety, and shame. Paradoxically, the act of hair pulling provides an immediate release from the compulsion until it builds up again. The compulsion to pull hair can be slight and relatively easy to control with therapy or severe and virtually uncontrollable.