For the majority of people, a full head of hair is something to be prized, an indication of beauty and health. For others, hair is to be sacrificed, to maintain a humble spirit and balanced soul. However, for millions of men and women suffering from trichotillomania, otherwise known as “trich” (“trick”), hair can cause real anguish, as – regardless of their attitude toward their locks – these people suffer from an uncontrollable urge to pull their hair out by the root. It is estimated that between 2 and 4 percent of Americans suffer from this disease, and yet there is little public awareness of trich or how it works.
What is Trichotillomania?
Trichotillomania (pronounced "TRICK-oh-TILL-oh-MANE-ee-ah") is a scientifically-recognized psychological disorder that leaves its sufferers routinely compelled to pluck out their hair, either strand by strand, or in clumps. Hair pulling may be done on purpose and involve many complex rituals, or unconsciously, with the hands or tools like tweezers or hairbrushes. Some trichotillomania sufferers pull out their eyebrows, eyelashes, leg, arm, or other body hair, although the vast majority focuses on the crown area of the head, leaving “Friar Tuck”-like bald patches surrounded by hair.
While doctors have not pinpointed any exact causes of trichotillomania, it is believe that genetics and neurological imbalances play strong roles in developing the disease; a handful of studies seem to indicate that the same genes and brain chemicals that mutate or get out of balance to cause depression, Alzheimer’s disease, Tourette’s syndrome, and Parkinson’s may be involved in bringing about trich, too. Other risk factors are family history, stress, and mental illness, as many trich patients report pulling their hair to relieve stress or anxiety, or to cope with depression. In adults, women seek help for this disorder more often than men, but young boys and girls appear to develop it at the same rate. This leads many researchers to believe that trichotillomania strikes men and women equally as often, but that women may simply seek treatment more.
How TTM Effects Its Victims
Many trichotillomania patients already suffer from low self-esteem, depression, or anxiety disorders; stressful events like the death of a loved one, job loss, or recent move have been noted to trigger trich, as has puberty. The loss of a person’s hair – unexplainable to those who do not actually realize they are pulling it out - is often a source of further shame and distress, as victims feel powerless to stop what they may see as unwarranted balding. They may also feel under siege by troubles, and are often quite embarrassed about being seen in public without a wig, hat, or concealing makeup. Without a proper understanding of what’s happening, the condition can worsen, as the added stress leads to more hair pulling, just for the sense of relief, and the cycle begins all over again.
Still other victims can spiral into secretive and almost obsessive-compulsive patterns of behavior, just to hide their hair pulling from others. Compulsive plucking can lead to baldness, destroying hair follicles at the root and preventing new growth, and can also cause or aggravate carpal tunnel disease. For sufferers who eat their pulled hair, digestive blockages, weight loss, and severe illnesses can occur because of internal hair balls.
Diagnosing the Disease
Some possible signs of trichotillomania are:
- bald patches on the head, face, or body,
- missing, or unnaturally or unevenly thinned eyelashes or eyebrows,
- routinely pulling out hair, and
- chewing, eating, playing with, or rubbing removed hair across the lips or face.
If you suspect that you or a loved one might suffer from this disorder, a visit to the doctor can help confirm or disprove your thoughts. During this visit, the physician will ask several questions about the frequency and circumstances of the hair pulling, as well as the emotions that surround this behavior. Beforehand, it helps to gather as much evidence as possible about how the patient sees themselves and their hair, and how they feel before, after, and during the pulling, so that the doctor can gain a clear picture of the condition. Many doctors will also request a skin or hair sample for biopsy, just to rule out any other causes of the hair loss.
Treatment for TTM
Right now, the most common treatment for trichotillomania is psychotherapy. As this is a compulsive disorder, most doctors refer patients to psychologists or emotional therapists who use a combination of approaches to help victims become more aware of the situations and feelings that lead to the pulling, as well as techniques for stopping it. Cognitive behavior therapy (CBT) is often used for just this purpose, while alternative medicine practices like hypnosis and biofeedback offer promise, too. Antidepression drugs are used in some cases, but often have side effects and cannot be taken by all patients, so the best course of treatment is counseling and mental or emotional therapy.
As a stop-gap between diagnosis and treatment cycles, many victims find it helpful to identify the times when they are most likely to pluck, and then cover or busy their hands. Others opt to keep short hair cuts, invest in wigs or hats, or join support groups.
For more information on trichotillomania, talk to your physician or mental health specialist, and be proactive about seeking help for yourself or others. There’s no need to keep this disease in the shadows anymore.