As you spend more time discussing goals and challenges with your Talkspace therapist, you may have questions or are interested in learning more about specific mental health topics and conditions. The Talkspace Bookshelf offers up-to-date mental health information directly from our behavioral health team to provide a better understanding of condition origins, diagnoses, various forms a condition may take, and different treatment options. Feel free to use this resource as a starting point to open up a dialogue and pose questions for your Talkspace therapist.

Trichotillomania is a rare condition that affects approximately 1% to 3.5% of young adults and late adolescents. The rates for adults are estimated around 1% of the population.

The Diagnostic and Statistical Manual of Mental Health Disorders 5 defines Trichotillomania as a primarily anxiety driven condition, along with other obsessive-compulsive disorders. Often referred to simply as “Hair Pulling Disorder,” Trichotillomania is a serious condition that can have a profound impact on a person’s appearance and sense of self.

First and foremost, this condition is characterized by the pulling out of one’s own hair. This can occur on various places on a person’s body but often manifests with removal of head hair. A condition related to Obsessive-Compulsive Disorder, the hair pulling behavior of trichotillomania is primarily thought of as a behavior that an individual engages in to cope with strong and distressing feelings. Initially, this coping might be adaptive to survive dire emotional circumstances or trauma, but may end up leaving a person dealing with negative results in the long-term.

Individuals with Trichotillomania most often experience intense urges to pull out one’s hair due to mounting tension. They most often feel great relief immediately after engaging in hair pulling.

You may be living with Trichotillomania if you:

  • Experience hair loss due to regular or recurring pulling out of one’s hair (not limited to hair on one’s head)
  • Experience hair loss that is not attributed to any other medication condition, such as a dermatological condition like alopecia
  • Have made attempts to stop or decrease the pulling
  • The hair pulling leads to dysfunction or disruption in major areas of your life such as work, school, relationships or other areas
  • The pulling behavior is not explained more accurately by the symptoms of another condition such as Body Dysmorphic Disorder


Impact & Implications

As you might imagine, living with Trichotillomania can be very difficult. What begins as a way to cope and process difficult emotions ends up turning into a maladaptive condition of its own, with its own negative consequences.

Many who live with Trichotillomania experience embarrassment due to the obvious physical changes associated with the condition. Hair pulling can result in apparent bald patches that can damage an individual’s self-esteem. This may be exacerbated by the embarrassment an individual may experience if others such as friends, family members, co-workers, classmates, or colleagues discover the bald spots.

Many living with Trichotillomania go to exhaustive lengths to prevent others from knowing the status of their condition. This may lead to extreme isolation and a preoccupation with hiding the evidence. Individuals living with hair pulling may compensate by developing and acquiring an affinity for hats, wigs, or head coverings. For other affected areas, they may choose clothing that largely covers body parts that naturally have hair. This may have a significant financial impact on the individual and his or her family.

Trichotillomania may also result in isolation and rejection from peers. This has been found to be especially true in adolescents and young adults who live with condition. They may be regularly subjected to negative scrutiny from peers.

Some individuals with Trichotillomania also ingest the hairs that they pull and may be at risk for gastrointestinal issues.


Treatment

Due to the rarity of the condition, much more research must be done to further improve the treatment of Trichotillomania. Most established research points to the effectiveness of behavior therapy and medication in the treatment of hair pulling disorder.

Medication

A variety of medications have been tried in the treatment of Trichotillomania. Further research needs to be done to find the best medication for each individual. To date, the most effective medications for the treatment of hair pulling are antidepressant medications such as fluoxetine (brand name Prozac), sertraline (brand name Zoloft) and clomipramine (brand name Anafranil).

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy is the most well-established treatment for Trichotillomania. Clients who are looking for support in this area may want to seek out a therapist who specializes in behavioral interventions for obsessive-compulsive and related disorders.

In therapy, you may work with a therapist to identify the patterns of hair pulling behavior and the cycle you experience. A therapist will work with you on understanding your cycle and breaking that cycle by a process referred to as Habit Reversal Training.

First, your therapist may spend some time educating you on the prevalence and course of the condition. You then may be asked to record your hair pulling behavior for some time to identify the conditions in which you most often pull or when there are urges to do so. You may be then encouraged to resist pulling behavior and engage in other competing responses that will help curb the reliance on hair pulling for stress relief. This is known as Habit Reversal Training.

Additionally, your therapist may incorporate certain relaxation strategies as a part of your treatment. You will be asked to practice these behaviors outside of your session time. Recovery from Trichotillomania is a very active and challenging process, but is achievable and much easier with the help of a therapist.


Therapeutic Note

Remember your therapist is here to help you figure out the best way to address your concerns. Therapy works best when it is a collaboration between you and your therapist. It is important to be open, honest, and an active participant in this process. Talk to your therapist about your goals for therapy so that together you can come up with the best plan to achieve your goals.

Questions for my therapist:

  • Can I ever be cured of Trichotillomania?
  • How do people go on to develop Trichotillomania?
  • Can I have Trichotillomania AND an anxiety condition? What about OCD?
  • How early does something like this start?
  • I’m weary of taking medication, what are some of the side effects of taking antidepressants?


Sources:

American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th edition. Washington DC: American Psychiatric Publishing, 2013. 

Franklin, M. E., Zagrabbe, K., & Benavides, K. L. (2011). Trichotillomania and its treatment: a review and recommendations. Expert Review of Neurotherapeutics, 11(8), 1165–1174. http://doi.org/10.1586/ern.11.93

Gupta, S., & Gargi, P. D. (2012). Habit Reversal Training for Trichotillomania. International Journal of Trichology, 4(1), 39–41. http://doi.org/10.4103/0974-7753.96089

McGuire, J. F., Ung, D., Selles, R. R., Rahman, O., Lewin, A. B., Murphy, T. K., & Storch, E. A. (2014). Treating Trichotillomania: A Meta-Analysis of Treatment Effects and Moderators for Behavior Therapy and Serotonin Reuptake Inhibitors. Journal of Psychiatric Research, 0, 76–83. http://doi.org/10.1016/j.jpsychires.2014.07.015

Psychological treatments for trichotillomania: Update and future directions. (n.d.). Retrieved July 12, 2017, from http://journals.sagepub.com/doi/abs/10.1177/1039856215590029#articleCitationDownloadContainer

Trichotillomania (Hair Pulling). (2017, March 29). Retrieved July 12, 2017, from http://www.mentalhealthamerica.net/conditions/trichotillomania-hair-pulling