Trichotillomania, sometimes called trich or trichotillosis, is a disorder whose onset typically peaks between the ages of 9 and 13. This condition that is marked by the compulsive urge to pull out one’s own hair is obviously indicated by a visible, physical element, but it is also denoted by unseen emotional components such as shame or guilt.
The basic definition of trichotillomania is that it is the uncontrollable impulse to pull out one’s own hair at the root. However, there are many variations on this base description. Sometimes, the condition is also defined by the eating of one’s own hair once it is pulled out. Additionally, the hair that is pulled out due to trichotillomania does not have to be removed from the scalp. The hair can be pulled from the following common areas:
- Eyes, in the form of eyebrows and eyelashes
In some cases, hair is pulled out from less common areas of the body, such as the pubic area, underarms, or in the case of males, the beard and chest areas.
Onset and Prevalence
While current trichotillomania information culled from medical research states that the peak onset of this hair pulling disorder is between the ages of 9 and 13, it is thought that indicators of the condition may be present in infants. The onset of the disorder itself might be set off by depression, stress, or a traumatic event.
The prevalence of the condition is an unknown quantity. This is primarily due to trichotillomania having a strong negative social implication; this social affecting element causes the disorder to be unreported by many sufferers, thus adversely affecting the accuracy of this disorder’s prevailing metrics. That being said the disorder is not as rare as the medical field once thought it to be. This particular upswing is due to experts getting a greater depth of knowledge on the disorder, as well as an increase in people seeking help as they acknowledge that they suffer from the disorder.
Classification of Trichotillomania
The official classification of trichotillomania is that it falls under the umbrella of “Obsessive compulsive and related disorders.” However, this is not necessarily a hard, fast classification, as different sources of hair pulling information break the disorder’s designation down even further by sub-categories that generally link to this larger class.
The primary subcategory relating to this classification stems from the concept that the disorder may lie on the obsessive-compulsive spectrum; a classification category that encompasses other conditions related to obsessive-compulsive disorder (OCD), such as nail biting, skin picking, or various tic disorders. Furthermore, it is not uncommon for the disorder to be designated as a form of OCD. While that is generally an accepted classification, it should be noted that there are some differences between trichotillomania and what is basically defined as OCD, including differing peak age of onset, gender differences, and neural dysfunction.
Other sources of trichotillomania information designate the condition as an impulse control disorder (ICD). The condition is also occasionally designated as a form of body dysmorphic disorder (BDD). Trichotillomania can also be classified as a form of body focused repetitive behavior (BFRB).
In essence, the classification of trichotillomania is a rather fluid definition; one that is generally dependent on where and whom the trichotillomania information is being ascertained.
Statistical Data Concerning Trichotillomania
Due to the negative social implications of trichotillomania, the disorder often goes unreported, which in turn hinders the accuracy of the condition’s statistical metrics related to its prevalence. However, a basic statistical profile has been built based on the cases that have been reported.
The first statistical metric that has been built around trichotillomania concerns age. While the peak age of onset has been established to range between 9 and 13, it is been determined that a notable peak within this range occurs between the ages of 12 and 13. Other sources of hair pulling information have noted that trichotillomania may be present in a person as early as the infantile stage.
The second metric regarding trichotillomania is based on gender. It has been determined that the disorder is more prominent in females than it is in males. However, this level of gender-based prominence may not necessarily be linked to the actual condition itself. Studies have shown that trichotillomania affects boys and girls equally in early childhood. This has led to the theory that the gender discrepancy is not a product of the disorder itself; rather, it is a reflection of the greater frequency in which females seek help concerning the condition in relation to their male counterparts. Statistically speaking, it is estimated that anywhere between 70% and 93% of the patients seeking treatment are female.
In terms of actual overall prevalence, it is estimated that trichotillomania affects at minimum roughly 0.6% of the population. The prevalence has been estimated to be as high as 1.5% in males, and as high as 3.4% in females. This prevalence rate translates to an estimation of about 2.5 million people in the United States suffering from trichotillomania during the course of their lifetime.
It should again be noted that these metrics are based on estimations, as there have been no broad-based population epidemiological studies that have been conducted in conjunction with the disorder.
Causes of Trich
The actual root cause of trichotillomania has yet to be determined by the medical field. However, there have been several theories that have been put forth through various forms of trichotillomania information relating to the disorder’s origin.
One of these theories links the disorder to conditions such as obsessive-compulsive disorder, depression, anxiety, and stress. This theory determines that the disorder is designated as a coping mechanism designed to alleviate the negative feelings that are associated with the aforementioned conditions. This theory can be extended by linking the condition with post-traumatic-stress-disorder. It can also be extended to link trichotillomania with self-harm; the condition in which a person deliberately injures or damages their body as a means to cope with or expressing overwhelming emotional trauma.
Another theory regarding trichotillomania ties the disorder to an imbalance within the brain’s chemistry. Basically, this theory can be traced to a disruption or interference with the brain’s neurotransmitters, which are normal parts of the brain’s communication center. In scientific terms, this theory involves an interference between the basal ganglia (a group of nuclei associated with the formation of habits) and the frontal lobes (the parts of the brain that are critical for habit inhibition).
A third theory concerning trichotillomania links a disorder to genetics and gene mutation. Scientific studies on laboratory mice with a mutation of the HOXB8 gene – a gene that is also found in humans – recorded several abnormal behaviors that included hair pulling. Similar studies on other gene mutations have also produced results that could indicate a potential link with trichotillomania. That said, the data that is being derived from this type of study is still in its preliminary stage, and further study must be done before findings can be viewed as conclusive.
Another potential cause of trichotillomania is linked to the same properties seen in addiction. The theory here is that the more a person pulls out their hair, the greater the need to repeat the process becomes.
Symptoms associated with trichotillomania manifests themselves on various levels depending on the behavior of the individual.
Obviously, the biggest symptom linked to trichotillomania is the act of repeatedly pulling hair out. However, the way this symptom presents itself is not necessarily uniform. Some people will pull out large tufts of hair, while others will pull the hair out on a strand-by-strand basis. Also, the methodology behind the hair pulling varies from individual to individual, causing the actual act of trichotillomania to be subdivided into two distinctive categories – automatic and focused. In the case of automatic hair pulling, people report that the act is done absent-mindedly, and they do the activity without thinking. Conversely, in the case of focused hair pulling, people report that they notice a tingling sensation that develops on their scalp or skin that can only be relieved by hair pulling. The result of this activity is akin to the feeling of relief that occurs when an itch is scratched. However, any relief that is associated with trichotillomania is short-lived, and the urges to repeat the process almost always return. In this case, the symptom becomes cyclical, as the mind becomes accustomed to giving into these urges, thus forming a habit.
Several other symptoms associated with trichotillomania are linked to a person’s behavior once the act of pulling hair has occurred. These symptoms include playing with the hair once it is pulled out, chewing or eating the hair, or rubbing the pulled out hair across the face and lips. Other physical-based symptoms associated with trichotillomania include the appearance of patchy bald areas on the scalp and sparse or missing eyebrows and eyelashes.
As these symptoms show, the actual act of hair pulling is not a particularly serious in terms to a person’s overall physical health, as the associated symptoms for the most part do not indicate a serious life-threatening illness. However, the negative effects of trichotillomania are potentially devastating from an emotional and psychological standpoint.
Effects of Trichotillomania
People that suffer from trichotillomania can feel a strong sense of shame, humiliation, and embarrassment over having the condition. These negative emotions can translate into other feelings that have an adverse impact on the lives of the sufferer, including depression, anxiety, and low self-esteem. These feelings can expand even further outward into the realm of social problems. These particular issues can manifest themselves in many ways, from avoiding going outside when the weather is windy to avoiding intimacy out of fear that their disorder will be exposed.
The adverse impact that trichotillomania could have on an individual could also lead a person to turning to unhealthy life choices in order to cope with the negative emotions that may develop in the wake of not being able to control the urges associated with the disorder, such as drugs or alcohol.
This is not to say that all of the issues concerning trichotillomania are merely limited to the psychological side of things. Constant hair pulling can cause a wealth of skin damage if instances of hair pulling occur in the same area over and over again. These can range from mild skin abrasions to serious infections to the skin from whatever region the hair is being pulled from.
Furthermore, if a person that suffers from trichotillomania is eating their hair as a symptom linked to the disorder, they may develop hairballs in their digestive tract. These matted balls, which are known as trichobezoars, could grow over time as the hair accumulates; eventually, the balls can cause vomiting, weight loss, intestinal obstruction, and death in some cases. If the ball gets large enough, intestinal or stomach surgery may be required in order to extricate it.
While there are a host of treatments that have become available for people looking for a way to cope with and overcome trichotillomania, there is still a lot to learn about the disorder. Its onset and causes are still in the process of being researched. Its statistical metrics are fully conclusive. And even though the disorder has an official classification, it still manages to attach itself to other classes. However, what is known is that the disorder has the potential to be a rather devastating condition for its sufferers to have, as its physical symptoms can readily be synthesized into emotional trauma that can be more scarring than the disorder’s manifestations. It is for this reason that research into trichotillomania in order to paint as complete of a picture as possible remains vital.
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