Understanding Trichotillomania: A Guide for Patients

Trichotillomania, often called "trich," is a mental health condition characterised by an uncontrollable urge to pull out one's own hair. This condition can affect various parts of the body, such as the scalp, eyebrows, eyelashes, and sometimes other body areas. Trichotillomania typically starts during childhood or adolescence, most commonly between ages 10 and 13, but it can begin at any age.

What Is Trichotillomania?

Trichotillomania is classified as an impulse control disorder. People with this condition experience repeated urges or tension that build up until they pull out hair, followed by a feeling of relief or pleasure after pulling. Although it may seem like a harmless habit, trich can cause noticeable hair loss, bald patches, and emotional distress, affecting social, school, or work life.

Signs and Symptoms to Recognise

The main sign of trichotillomania is repetitive hair pulling. Symptoms may include:

• Pulling hair from the scalp, eyebrows, eyelashes, or other body parts.

• Visible hair loss or bald spots that may be uneven or patchy.

• Hair of various lengths due to pulling, breaking, or regrowth.

• Playing with, biting, or occasionally eating pulled-out hair (trichophagy).

• Feeling a rising tension or urge to pull hair and relief after pulling.

• Hair pulling often occurs in private and can last seconds to hours.

• Emotional symptoms such as shame, anxiety, or low self-esteem due to the behaviour.

  
  

Some people may not even realise they are pulling their hair, while others do it consciously to cope with emotions like stress, boredom, anxiety, or frustration. The behaviour may increase during stressful or anxious periods.

Causes and Risk Factors

The exact cause of trichotillomania is not fully understood, but it likely involves a mix of genetic, biological, and environmental factors. These include:

• A genetic predisposition, as trich can run in families.

• Brain chemistry and function differences affect impulse control.

• Hormonal changes during puberty.

• Psychological factors such as stress, anxiety, or trauma.

• It may sometimes be linked with other mental health issues like anxiety, depression, obsessive-compulsive disorder (OCD), autism, or ADHD.

  
  

How Is Trichotillomania Diagnosed?

Diagnosis is primarily clinical, based on the pattern of hair pulling and symptoms described by the patient. Healthcare providers look for:

• Repeated hair pulling causing hair loss.

• Attempts to decrease or stop hair-pulling.

• Distress or impairment caused by hair-pulling.

• Absence of other medical conditions causing hair loss.

  
  

Treatment Options

While trichotillomania can be challenging, several treatments have been shown to help reduce or stop hair pulling:

Therapies

• Habit Reversal Training (HRT): A behavioural therapy where patients learn to recognise hair-pulling triggers and replace pulling with other actions, such as clenching fists or squeezing a stress ball.

• Acceptance and Commitment Therapy (ACT): Helps patients accept urges without acting on them.

• Cognitive Behavioural Therapy (CBT): Works on changing unhelpful thoughts related to hair pulling and managing associated emotions.

• Therapy also addresses related conditions like anxiety or depression.

• Medications

• Medication should be tailored and monitored by a healthcare provider.

Coping Strategies and Support

Living with trichotillomania can be difficult, but some strategies may improve symptoms and quality of life:

• Identify and track triggers that lead to hair-pulling.

• Use fidget toys or wear jewellery to keep hands busy.

• Practice stress-reduction techniques, such as mindfulness, meditation, or deep breathing exercises.

• Create awareness by taking pictures of progress or bald spots.

• Seek support from friends, family, or support groups to reduce shame and isolation.

• Be patient and celebrate small successes.

• Professional therapy and support groups can provide encouragement and accountability.

How can family provide support without increasing shame or enabling behaviours

Family members can provide support for a loved one with trichotillomania by focusing on understanding, encouragement, and practical help, while avoiding shame or enabling the hair-pulling behaviour. Key ways include:

• Avoid shaming or criticism: Never blame or scold for hair pulling, as this increases shame and guilt, which can worsen the behaviour. Instead, show empathy and unconditional acceptance regardless of setbacks.

• Ask how to support: Encourage the person to share how family members can best help. Respect their wishes, especially around whether or not to draw attention to the hair pulling or attempt to stop it in the moment.

• Help identify triggers and patterns: Gently assist by observing and helping recognise situations, emotions, or environments that increase urges to pull. This can empower the person to avoid or cope better with triggers.

• Encourage replacement behaviours: Support healthier alternatives like using fidget toys, stress balls, or other tactile activities to occupy the hands when the urge arises.

• Modify the environment: Help make changes that reduce hair-pulling opportunities, such as removing magnifying mirrors, covering mirrors, or using gloves or bandages on fingertips.

• Promote healthy outlets for emotions: Encourage engaging in exercise, journaling, relaxation techniques, or other stress-reduction methods to address emotions that may fuel pulling urges.

• Be a patient listener: Sometimes the best support is simply listening without judgment or trying to fix the problem instantly.

• Support professional treatment: Encourage and help facilitate access to therapy or support groups, and provide reassurance that the person’s trichotillomania does not define them.

• Avoid enabling: Do not inadvertently reinforce pulling by giving excessive attention to the pulling behaviour or covering affected areas in a way that condones the behaviour without working toward change.

Final Thoughts

Trichotillomania is a real and challenging condition, but understanding it and seeking the proper treatment can bring relief and healing. It is important for patients to know they are not alone and help is available. Early diagnosis and intervention can improve outcomes, reduce distress, and help regain control over impulses.

At Blue Fig Clinic, we’re here to help you every step of the way. Dr Sangeetha Makielan at Blue Fig Clinic provides compassionate, personalised care designed to support patients and families living with trichotillomania.

Request an appointment today.