What is Trichotillomania (Hair Pulling Disorder)?

Trichotillomania, commonly known as the habit of pulling hair, is a mental health disorder. This health issue, which requires treatment, typically occurs between adolescence and adulthood. It is known that individuals with trichotillomania pull their hair in response to stress, anxiety, and worry. As a result, it can have a serious negative impact on a person's quality of life.

What is Trichotillomania (Hair Pulling Disorder)?

Trichotillomania is known as hair pulling disorder. It is a type of psychological disorder that falls under the category of obsessive-compulsive disorder (OCD). Individuals tend to pull out their hair, eyebrows, and eyelashes as a coping mechanism for anxiety, stress, and worry. Over time, this behavior can cause damage to hair follicles and the individual themselves. When this disorder becomes severe, it can have a serious negative impact on a person's quality of life and well-being.

What Are the Differences Between Trichotillomania and Obsessive-Compulsive Disorder?

Trichotillomania and obsessive-compulsive disorder (OCD) are both types of psychological disorders that fall into the same category. Despite being in the same category, there are important features that distinguish these two disorders:

Obsessive-compulsive disorder includes uncontrollable obsessions (such as a compulsion for order). This does not occur in trichotillomania.
In trichotillomania, individuals engage in hair pulling, eyebrow plucking, and eyelash pulling as a response to stress. This action provides relief and happiness. Such relief is not observed in obsessive-compulsive disorder.

What Are the Causes of Trichotillomania (Hair Pulling Disorder)?

The exact causes of trichotillomania are not yet fully understood. However, some research has identified several factors that may contribute to the disorder. These factors include:

The habit of hair pulling or breaking can be learned by observing others.
When individuals cannot cope with stress, anxiety, or worry, a defense mechanism may develop for the body to relax. Hair pulling is one such mechanism.
Attempting to stop the habit of hair pulling or reducing its frequency without seeking help can exacerbate the behavior.
It may be observed as a result of genetic factors, particularly in cases related to DNA mutations. This requires extensive research on the patient.
Various psychological disorders, such as hyperactivity, eating disorders, obsessive-compulsive disorder, substance abuse, and major depressive disorder, can trigger trichotillomania. Individuals with these disorders have a higher likelihood of experiencing hair pulling disorder.

What Are the Symptoms of Trichotillomania (Hair Pulling Disorder)?

To be diagnosed with trichotillomania, five essential criteria must be present. The criteria used to differentiate this disorder from other psychological conditions include:

Repeatedly pulling hair despite knowing it causes hair loss.
Concluding that hair pulling negatively affects social life, such as work and friendships.
Intentionally pulling hair due to the belief that one is different from others.
Unconsciously engaging in hair pulling while thinking about another subject.
Symptoms such as bald patches in areas where hair should be present.

Individuals exhibiting the above symptoms are advised to seek examination at a healthcare facility as soon as possible, before the condition reaches a serious level.

How Does Trichotillomania (Hair Pulling Disorder) Affect Individuals?

Individuals who have this disorder during childhood generally find it easier to recover. The disease does not leave many negative psychological or social effects during childhood. However, adolescents and adults with trichotillomania tend to experience much more serious issues. The psychological and social effects of trichotillomania on individuals are as follows:

Psychological Effects of Trichotillomania (Hair Pulling Disorder):

People with hair pulling disorder often feel ashamed of their condition. Many individuals do not seek treatment due to feelings of shame, which leads to the worsening of the disorder over time. This can adversely affect a person's work and social life.

Approximately 20% of those with this disorder have a tendency to eat their hair after pulling it out, a behavior known as trichophagia.

Ingested hair can form a hairball that leads to blockages in the digestive tract. This situation is quite risky and may require surgery for many individuals.

Social Effects of Trichotillomania (Hair Pulling Disorder):

In advanced stages of hair pulling disorder, patients can cause damage to their skin and subcutaneous tissues. In some cases, skin grafts may be needed to repair the damaged skin tissue. As a result, permanent losses can occur in the hair follicles, potentially leading to baldness and causing the individual to feel isolated from society.

How is Trichotillomania (Hair Pulling Disorder) Diagnosed?

If symptoms of trichotillomania are observed, it is recommended that the individual consult a nearby healthcare facility. The physician at the healthcare facility should examine the symptoms of trichotillomania through a physical examination.

While it is relatively easy to diagnose, individuals may try to conceal the disorder due to feelings of shame. In response to health professionals' questions, they may hide this condition or refuse physical examinations. In such cases, it is also possible to diagnose the disorder through specific skin tests.

One of the skin tests used for diagnosis is the "punch biopsy," which involves taking a sample of skin for laboratory testing. This test enables a definitive diagnosis, distinguishing trichotillomania from other causes of hair loss.

If there is suspicion that the individual has swallowed the pulled-out hair, imaging tests such as computed tomography (CT) may be requested to check for blockages. In addition to these tests, necessary blood tests may also be conducted during the diagnostic process.

What is the Treatment for Trichotillomania (Hair Pulling Disorder)?

Trichotillomania typically arises from psychological factors, which is why there is no one-size-fits-all treatment. A combination of therapy and medication is usually recommended for patients. The dosage of medication and the duration of therapy may vary depending on the severity of the condition.

During the therapy process, the first step is to identify the root cause of the problem. Events that cause stress and anxiety for the individual are openly discussed. The patient and physician should collaborate to address the factors contributing to the disorder. Close observation is crucial during periods of heightened symptoms, allowing for the identification of behaviors and thoughts that may trigger the disorder.

In medication treatments, factors such as the severity of the disorder, the patient's other chronic conditions, and the patient's age are important for treatment. The dosage and duration of the medication may vary based on these factors. Therefore, it is essential to undergo a medical examination by a physician before using any medication, which will be prescribed accordingly. The following medications may be used in treatment:

Antidepressant Medications: Known for treating depression, these medications can help reduce the urge to pull hair in some individuals.
Antipsychotic Medications: Used in the treatment of psychological disorders, these medications help balance brain chemistry and are also utilized for treating trichotillomania.
Anticonvulsant Medications: These medications are used for disorders affecting muscle movements and seizures and can also be prescribed for trichotillomania in some cases.
Nutraceuticals: Dietary products such as amino acid supplements that can aid in the treatment of the disorder.

Frequently Asked Questions About Trichotillomania

Hair pulling disorder generally presents similarly in many individuals, which can lead to confusion with hair loss from other causes. Therefore, there are several frequently asked questions regarding this condition:

Is Trichotillomania Contagious?

No, this disorder is not contagious. It is a type of condition that arises from genetic predisposition and psychological factors.

Will Hair Grow Back After Trichotillomania?

If diagnosed and treated early, there is a high likelihood that hair will regrow after being pulled out in trichotillomania. However, if the disorder is left untreated and the individual begins to damage the underlying skin tissue, the chances of hair regrowth in that area become very low.