Trichotillomania is a compulsion to repetitively pull or pluck one's hair, resulting in noticeable hair loss. Many people with trichotillomania feel ashamed and embarrassed by their hair pulling, attempt to hide it from friends, co-workers and family members, and do not seek help. Many who consult their personal physician or a dermatologist because of hair loss never reveal the true cause and doctors often fail to consider this diagnosis.
Some experts feel that trichotillomania is a variant of obsessive compulsive disorder. Both conditions are characterized by compulsive behavior that is usually recognized as senseless, is difficult to resist, and is associated with anxiety. Also, treatment with medications that have similar effects on serotonin, a brain neurotransmitter, may benefit both trichotillomania and OCD. In addition, OCD is more common in people with trichotillomania than in the general population. The observation that a higher-than-expected number of relatives of trichotillomania sufferers have obsessive compulsive disorder suggests a genetic link between the two disorders.
In contrast to OCD, people with trichotillomania tend not to have obsessive thoughts, do not engage in rituals other than hair pulling, and have a different pattern of abnormal brain metabolism. Trichotillomania patients are more likely to be women while OCD has a more even gender distribution; the relationship of trichotillomania to OCD is not fully understood and currently they are thought to be related but distinct disorders.
Researchers estimate that some 1-2% of the U.S. population has trichotillomania. Although trichotillomania can begin in very young children or middle-aged adults, the most common age of onset is during early adolescence. Women seem to be affected more than men with some estimates suggesting a ratio of 3 women to every man.
Trichotillomania is currently categorized as an impulse control disorder in which the urge to pull hair is associated with an increasing sense of tension. The act of pulling itself is presumed to relieve that tension. Trichotillomania has been considered a habit, like nail biting, that can have both a soothing function and potential consequences.
While the actual cause of trichotillomania is not known for certain, several factors appear to play contributing roles:
Most people with the condition experience anxiety, embarrassment and diminished self-confidence and self-esteem. Attempts to keep the condition a secret can lead to avoidance of everyday activities such as visits to the hairdresser, sports, exercise, dancing, public showers, swimming, and being in brightly-lit rooms. Some avoid treatment for medical or dental problems because of concern that their hair pulling will be discovered. Many go to great lengths to conceal their hair pulling and try to camouflage hair loss with different hair styles, make-up, clothing, or wigs or other hair pieces. Scalp inflammation, irritation, itchiness and tenderness are common.
Some researchers have found that nearly 20% of hair pullers eat their hair or chew off and swallow the root ends. Called trichophagy, it can lead to hair being lodged between the teeth and more seriously to large accumulations of retained hairs in the stomach and digestive tract called trichobezoars (hair balls).
Symptoms of trichobezoars include abdominal pain, nausea, vomiting, and sometimes blood and/or visible hairs in the stool. Trichobezoars can also cause foul breath, poor appetite, constipation, diarrhea, excessive gas, bowel obstruction, and even bowel perforation. Liver and pancreas functions can be adversely altered. Sometimes a physician can feel a trichobezoar by gently pushing in the mid or left upper area of a patient's abdomen. Trichobezoars can be diagnosed by using special upper gastrointestinal X-rays, looking into the stomach with an endoscope, or using ultrasound. Surgical removal is the most common treatment.
Hair pulling very rarely causes irreversible baldness. However, when the behavior stops, hair occasionally grows back gray or white and it may be finer, coarser or curlier. These changes may normalize over time.
Some researchers have described early onset (childhood) and later onset (adolescent) types of trichotillomania. There is no clear evidence that children with this form of the disorder are at increased risk for developing future psychiatric problems. However, children who are four, five or six and are still pulling their hair may begin to overlap with the later onset type trichotillomania which has a less favorable prognosis.
The trauma of hair pulling also increases the risk for scalp infection. Sometimes repetitive hair pulling can cause problems such as carpal tunnel syndrome, tendonitis, and neck/back strain. Perhaps the most common serious medical complication of trichotillomania is avoiding medical care for other illnesses because of the shame associated with hair pulling and the fear of its discovery.
In 2009 it was reported that a 12-week trial with 50 patients indicated that 56% were "much or very much improved" with N-acetylcysteine use compared with only 16% of those taking placebo.
See the link between Trichotillomania and Sugar Avoidance.
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