Trichotillomania is characterised by an overpowering desire to pull one’s own hair out repeatedly, resulting in repetitive hair pulling and hair loss. The scalp hair is the most commonly affected. Eyelashes, brows, and even the beard might be affected. Trichophagy occurs when people chew and/or swallow (ingest) the hair they’ve pulled out, which can cause gastrointestinal difficulties.


Trichotillomania causes severe mental discomfort and frequently hinders social and vocational functioning. The precise cause of the illness is unknown.


Trichotillomania was previously classified as an impulse control disorder, but in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders Version 5, it is now classed as an obsessive-compulsive linked condition (DS-5, American Psychiatric Association).



What is Trichotillomania?


Trichotillomania is a type of impulse control problem that is sometimes known as “hair-pulling disease.” Trichotillomania is an illness in which sufferers have an uncontrollable urge to pluck their hair from their head, eyelashes, and brows. They are fully aware of their capacity to inflict damage, yet they typically lack the ability to control their emotions. When they’re nervous, they may pull out their hair in an attempt to relax.


Trichotillomania is an impulsive behaviour condition. People with these diseases are aware that acting on their urges can cause harm, but they are unable to stop themselves. When they’re stressed, they may rip their hair out in an attempt to calm down.



Causes of Trichotillomania



The specific causes of trichotillomania are unknown and poorly understood. Several causes, including hereditary and environmental influences, are most likely to blame, for trichotillomania.


Some people may have a genetic susceptibility to develop trichotillomania, according to an available twin research in people with the disorder. It’s worth noting that, while first-degree relatives of someone with trichotillomania are at a higher risk of having the condition themselves, the majority of them do not. Anxiety and arousal levels can play a role in trichotillomania.


Some people with the condition say they pull their hair out more while they’re relaxing (like watching TV) or when they’re stressed (such as when work is stressful). Anxiety plays a different role in different people. Early research claimed that early trauma could predispose people to trichotillomania, but there isn’t much data to back this up.


The development of trichotillomania may be influenced by structural or functional abnormalities of the brain, according to researchers. Subtle changes in the putamen, cerebellum, and cortical regions such as the anterior cingulate and right inferior frontal gyri were discovered (when compared to ‘control’ groups of patients without trichotillomania).


These brain areas play a role in how prone we are to develop habitual behaviours, as well as our ability to suppress incorrect or unpleasant habits once they form.  Because the findings differ between studies, more study is needed to understand the specific anatomical or functional brain abnormalities linked with trichotillomania and the role they play in the development of trichotillomania.


Some researchers believe that trichotillomania is a type of obsessive compulsive disorder (OCD) caused by chemical imbalances in the brain.More research is needed to establish the actual cause(s) of trichotillomania and the underlying mechanisms that cause it.


Symptoms of Trichotillomania


Trichotillomania is characterised by the repetitive pulling out of one’s own hair, which results in hair loss and substantial distress/impairment. At some time, the person has usually tried to reduce or stop tugging their hair. ‘Noticeable hair loss’ and ‘tension and subsequent alleviation from hair pulling’ were previously included in the diagnostic criteria (in version IV of the Diagnostic and Statistical Manual), however these two criteria are no longer required for a diagnosis to be made.


The intensity of the condition, as well as the precise areas of the body afflicted, can vary widely from one person to the other. Trichotillomania can be minor and tolerable for some people, but it can also be severe and debilitating for others. Trichotillomania can be chronic, continuous, or transient, meaning it might arise and then fade for months or years before reappearing.


In trichotillomania, the scalp is the most usually affected location. Affected people may pull out complete strands of hair or break off bits of hair. Bald patches usually appear on the scalp. The majority of people find one or two spots, though there may be more. The most typical location of involvement is the scalp, but the beard, eyelashes, and eyebrows may also be implicated. Hair can also be pulled from the armpits, trunk, and pubic areas.


There may be generalised tingling or itching (pruritus) in the afflicted areas, but most people do not suffer discomfort after plucking their hair at least once. It’s possible that the affected areas would irritate your skin. Affected people also have an irrepressible impulse to twist their hair or engage in other ritualistic habits like counting hair, ordering it, or fiddling with bulb roots.v


Trichophagia  is a condition in which some people chew or swallow (ingest) their own hair. Ingestion of hair can cause a hairball to form in the stomach (trichobezoar), which can cause abdominal pain, nausea and vomiting, anaemia, and/or intestinal obstruction.


Individuals with trichotillomania may deny that they have a hair-pulling problem and may try to disguise it by wearing wigs, fake eyelashes, and adopting other measures to cover hair loss. Affected persons are frequently secretive about their behaviour and may not disclose it to others.


Other activities associated with trichotillomania include abrading or wearing off the skin (excoriation), scratching, nibbling, biting their nails, cracking their knuckles, and toying with pulled hair. As a result, some experts consider trichotillomania to be a “body centred repetitive activity.”


Trichotillomania can develop in the context of depression, anxiety disorders, obsessive compulsive disorder (OCD), or attention deficit hyperactivity disorder (ADHD) (ADHD).


Diagnosis of Trichotillomania


If indications of trichotillomania, such as patches of hair loss, are present, a diagnosis of trichotillomania may be suspected. A thorough clinical evaluation, a complete patient history, and a number of tests that can rule out other reasons for hair loss can all help to make a diagnosis. As many people are ashamed or embarrassed to tell about their hair pulling habits, a diagnosis is sometimes neglected.


Treatment of Trichotillomania


Psychotherapy and medication are the two most common treatments for trichotillomania. There is no one-size-fits-all treatment that works in every situation.


Psychotherapy is the use of psychological techniques to treat a disorder. Cognitive behaviour therapy, which aims to identify and change the beliefs and feelings that lead to trichotillomania, is one type of psychotherapy for trichotillomania.


Habit reversal, awareness training, and stimulus control are some types of cognitive behaviour therapy used to treat trichotillomania.


The use of pharmaceuticals to treat sickness is referred to as pharmacotherapy. Patients with trichotillomania have been treated with a number of drugs, although there have been few well-designed clinical trials. Preliminary data suggests that clomipramine (a tricyclic drug with serotonergic effects), n-acetyl cysteine (an amino acid molecule suspected to impact glutamate transmission), and olanzapine are effective treatments for trichotillomania, according to a recent Cochrane Systematic Review (an antipsychotic medication primarily acting on the dopamine system). In general, n-acetyl cysteine appears to be the most tolerating of these alternatives (the one least likely to cause significant side effects).


In certain cases, trichotillomania is treated with a combination of behaviour modification and medication. More research is needed to discover which specific medicines, alone or in combination, provide efficacy and long-term safety for the treatment of trichotillomania patients.

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