Symptoms & Treatment for Trichotillomania (Hair Pulling)
What is Trichotillomania?
If you have ever wondered, “What is Trichotillomania?” or “Why do I pull my hair out?” you are not alone. In fact, many of our patients have spent many years pulling their eyebrows, eyelashes, arm and leg hairs, or pubic hairs before even knowing it is a mental health condition that many people have. Our hope is to help you feel less alone and direct you towards the correct treatment for hair pulling.
The definition of Trichotillomania (TTM), also called Compulsive Hair Pulling, involves repetitive urges to pull out or tug on ones’ hair, often resulting in small to large bald spots and, in some cases, complete baldness.
People with Trichotillomania may pull hair from their eyelashes, eyebrows, underarms, chest, legs, pubic area, or anywhere where hair grows. It is important to note that some people with symptoms of trichotillomania also have body-focused repetitive behaviors such as skin picking and nail-biting.
Symptoms of Trichotillomania
Trichotillomania symptoms include:
- Hyperawareness of hair, the texture of hair, hair imperfections.
- Experiencing a “trance” like state during pulling
- Distress about the inability to stop pulling hair, despite desire and willingness to do so.
- Significant anxiety and depression.
- Possible injestion of hair or of hair follicles.
- Gathering and preservation of pulled hairs.
- Social Anxiety and Social isolation
- Impairment of daily functioning
- Excessive attempts to cover up bald spots or hair loss by using scarves, hats, wigs, and/or makeup.
- Trichotillomania causes some to experience low self-esteem, depression, social anxiety, body dysmorphia, and other mental health struggles.
- Some people with TTM are aware of their hair pulling, while others have little awareness of their pulling. TTM may occur in any setting but commonly occurs while reading, writing, watching TV, studying, driving, working on a computer, while grooming, or while falling asleep.
Types of Trichotillomania
- Sensory Sensitive Pullers- High sensory sensitivity, low urges to pull, low levels of pulling. This is commonly the smallest category of hair pulling
- Low Awareness Pullers- High levels of automatic (unaware) pulling, high levels of impulsivity, and commonly have symptoms or diagnosis of ADHD. This is the largest category of hair-pulling.
- Impulsive/Perfectionistic Pullers- High levels of impulsivity and perfectionism, often accompanied with low mood, low emotional regulation, and highly focused pulling.
Research has identified three subtypes of hair-pulling.
Trichotillomania Causes
The cause of Trichotillomania is still not certain. However, we do know that there are genetic and environmental components that cause trichotillomania.
Common causes of trichotillomania include:
- Having one or more family members who pull their hair, pick their skin or bite their nails.
- Have other disorders, such as Obsessive-Compulsive Disorder, ADHD, or co-existing anxiety disorder.
- Stress- Stress may increase hair pulling or the onset of TTM.
- Some ADHD prescribed medications
- Age- commonly between 9-13 yrs old
While these factors are taken into consideration, the trichotillomania cause is not the primary focus of treatment. Instead, the patient is considered a part of the treatment team, and together, the patient and the therapist create a treatment plan to manage their hair-pulling symptoms and promote overall well-being.
How to Stop Trichotillomania?
Trichotillomania treatment is not as easy as “just stopping” and is not just a matter of willpower. In fact, we know that “just stopping trichotillomania” can cause significant distress. Attempts to go “cold turkey” on hair pulling often causes trichotillomania symptoms to increase. In many cases, the more one tries to stop trichotillomania behaviors without the correct training and support, the more trapped and out of control they feel.
Trichotillomania Treatment
Trichotillomania treatment involves first understanding what triggers these urges. Similar to any problem, we must first understand the emotions, thoughts, and actions contributing to the urges and other symptoms of trichotillomania. Once a thorough inventory is done on these triggers, the person with TTM will be trained using compassionate, strategic skills to manage the strong urges to pull one’s hair.
There are multiple treatments for Trichotillomania involving a combination of several gold-standard treatment modalities. Our therapists are highly trained at treating Trichotillomania using the below treatment modalities.
Trichotillomania Treatments:
- Cognitive Behavioral Therapy
- Habit Reversal Training (or Habit Reversal Therapy)
- Mindfulness Training
- Acceptance and Commitment Therapy
- Mindful Self-Compassion
- The use of Cognitive Behavioral Therapy (CBT) can be a very successful way to manage Trichotillomania. Cognitive Therapy teaches people how to identify urges and triggers and how to restructure their
- distorted thoughts into more reasonable and rational thoughts.
The use of Cognitive Behavioral Therapy (CBT) can be a very successful way to manage Trichotillomania. Cognitive Therapy teaches people how to identify urges and triggers and how to restructure their distorted thoughts into more reasonable and rational thoughts.
Behavioral Therapy involves making small but significant behavioral changes to reduce hair-pulling and to manage life stressors.
Habit Reversal Training (HRT) is the gold-standard treatment of Trichotillomania and is a type of behavioral therapy that has been highly successful at managing one’s urges. Habit Reversal Training strategically targets specific triggers and events that can increase the likelihood of hair-pulling. HRT also teaches the person with trichotillomania how to manage these urges and reduce or eliminate hair pulling.
Mindfulness training can be an incredibly beneficial tool when considering how to stop trichotillomania behaviors. Mindfulness training helps one become more aware of the urges they experience. Mindfulness also helps us manage our uncomfortable thoughts, feelings, and sensations that often cause one to pull out their hair. (Read more about Mindfulness here)
Self-Compassion is also an important part of recovery. People who pull their hair are often very hard on themselves and engage in painful self-criticism and self-punishment. Self-Compassion is a highly effective tool that can not only reduce these painful behaviors but can also be used when managing strong urges to pull or eat one’s hair.
