Trichotillomania Treatment for Men


Trichotillomania has been considered a disorder that primarily affects women. It is rarely reported in men. Such rarity may reflect distinct clinical features in men that call for different treatment strategies. Alternatively in may suggest that male sufferers are less likely to seek help or admit to ahving a problem. This may be because male hair loss is perceived more socially acceptable than femail balding or hair thinning. To investigate potential gender differences in trichotillomania, one study systematically assessed the descriptive characteristics as well as psychiatric comorbidity of 14 male hair pullers and compared them to 128 female hair pullers who had been similarly assessed. Although a few gender differences existed, male trichotillomania was very similar to that seen in women. These results suggest that gender-specific treatment is not justified at this time; however the effectiveness of current treatment methods for trichotillomania between male and female patients should be evaluated.

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Stress and Social Pressures

Although there is not a significant difference in the way that compulsive hair pulling presents in men and women, further investigation should be carried out into the possible causes of the onset of trichotillomania. Identifying the cause provides valuable insights into the best treatment approach. It would be important to establish if there is a difference in the predominant cause of trichotillomania in men versus women. Indeed, even if the causes are the same, the way that it manifests in males and females may be different. For example many hair pullers describe extreme stress and anxiety as one of the main triggers for the behavior. Society places great pressure on men to fulfil the traditionally patriachal role of breadwinner and provider. This can place enormous strain on men to success in their chosen careers and particularly during tough financial times. Surprisingly, hair pulling is just as often associated with under-whelming feelings such as boredom. It would be beneficial to identify if there are differences in the reasons boredom would trigger pulling in men as compared to women.

Areas of pulling

Trichotillomania occurs in people who are happy and well adjusted and it may also occur during times of anxiety, stress, trauma or other emotional disturbance. Hair pulling alone is not evidence of emotional disturbance or abuse, but it does not exclude such problems either. Depression is very common in people with trichotillomania and should always be screened for at the start of treatment for trichotillomania. Trich sufferers typically pull hair from the scalp, often the central part leaving the sides almost untouched. Some people may also pull from their eyebrows, eyelashes, arms, legs, armpits and pubic region. Men may pull facial hair and if moustaches and beards are shaved there seems to be an increased likelihood with some men to pull from the early re-growth.

Men and 'feelings'

Through the ages, men have always been socialized to be strong, solution-oriented and in control. This cliche causes men to feel disempowered and frsutrated when they are not able to 'fix' a problem. This loss of a sense of control can be a source of great emotional turmoil for most men. Unfortunately men are also socialized to 'just deal with it' and therefore perceive acknowledgement of 'feelings' as an indication of weakness. A key aspect of proven cognitive behavioral therapy (CBT) techniques with trichotillomania is the development of awareness of pulling and triggering emotions that precede the behavior. The mental block some men can have to acknowledging negative emotions can be a barrier in effective treatment.

Men and talk therapy

If acknowledging the experience of negative emotions or the loss of control over ones behavior is difficult, talking to a stranger about may seem near impossible. However a recent study showed that 70% of men actually preferred talk therapy over medication. This was attribited to the men possibly worried about side effects. The study also revealed that 90% of the men in the study also preferred individual therapy to group therapy. According to the study authors, "may be reflective of men’s presumption that individual therapy might allow them to preserve key practices of masculinity such as independence and autonomy, and minimize exposing vulnerability".

Online therapy

Another alternative to talk therapy is online text-based therapy. This makes the CBT methods of treatment available in a format that allows for anonymity. Online text-based therapy is not very common currently, but we hope that the flagship program that is now being offered here on will pave the way for more men and women to access affordable treatment for trichotillomania.


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