repetitive self-pulling of hair
repetitive self-pulling of hair (Photo credit: madamepsychosis)

By Lisa Pitts

The condition OCD is marked by its repetitive thoughts and compulsions which the sufferer needs to carry in out in order to neutralize the anxiety they are suffering from and calm their brain down. Alongside obsessive-compulsive disorder, a number of other mental illnesses can co-exist, such as Compulsive Skin Picking, which is a constant urge to pick, peel or scratch at the skin, done to neutralize bad thoughts. It is also a form of self-harm for many and something which many sufferers do as a means of trying to cope with the mental anguish they suffer. Further to CSP, there is also another less well known phenomenon which an increasing number of OCD sufferers have and often live with in silence. It is called Trichotillomania and these are the facts behind a condition which is not discussed nearly enough.

What is Trichotillomania?

Although it isn’t strictly classed as OCD, it carries many of the same characteristic urges and compulsions and there are many sufferers who have both conditions co-morbidly, finding that the obsessive-compulsive urges they have spill over into these hair related compulsions. Its main defining area is that the sufferer has an uncontrollable desire to pull their hair out – sufferers will mostly do this from the hair on their head – taking it out from the root, but it also applies to body hair, such as on the arms, legs and even from the genital region. There are also documented cases of people pulling their eyebrows and eyelashes out too. Mostly, people experiencing Trichotillomania will use their fingers to pull at or remove the hair, but also it is not uncommon for things like scissors or tweezers to be used to do the same. Every time a sufferer has a bad thought, they will try and remove more hair to relieve their stress.

It is usually found in females, but not exclusively. There are also a smaller percentage of boys and men that do it too. In older men, they may start to pick at and pull out their facial hair.

The typical age for onset of the condition will be between the ages of nine and thirteen, more often than not as adolescence occurs. It can also start up in the late teenage period and develop through the early twenties. It is believed to be triggered through anxiety, perhaps after periods of stress and also recurring bouts of depression and may also be brought on as a response to years of suffering from obsessive-compulsive disorder.

Another facet of the illness is hair sucking or chewing – this, for many, starts in youth and in severe cases can sometimes result in the sufferer ingesting a great quantity of hair over time that may need medication or surgery to remove it.

How do people with Trichotillomania manage their condition?

From an aesthetic standpoint and from the point of view of the illness being covered up, sufferers will go to great lengths. They may wear hats at all times; they may invest in a series of wigs to cover up bald patches. Some simply wear scarves around their heads for most of the time. If the hair has been pulled from the face, a sufferer might resort to using semi-permanent or permanent make up to restore things like their eyebrows, or wear false eyelashes that can be glued into place every day. Many will simply avoid social situations and may not want to talk about it if anyone notices the hair loss or bald patches.

How is it treated?

The condition is treated in a fairly similar way to OCD. However, many physicians at the present moment have very little information or knowledgeon the condition, though this is improving all the time. If you present to your physician with the symptoms of Trichotillomania, you might have to be prepared to explain how you are suffering with it and what you think it is – then ask for a referral to a psychologist. For the physical, visible symptoms of the illness, your healthcare professional might prescribe a course of genuine medication for hair loss which will encourage the hair to grow back naturally and without any noticeable balding or thinning patches. They may also advise, if you are not already, to take a suitable SSRI anti-depressant medication to help relieve the symptoms of anxiety and depression which may be causing the compulsion to pull the hair out. In terms of therapy, the most common and widely regarded method for treating Trichotillomania is something called Habit Reversal Training, which is, for the most part, pretty much the same as Cognitive Behavioral Therapy for OCD.

Habit Reversal Training

This is a theory, developed in the early 1970s, by the eminent psychologists Nathan Azrin and Gregory Nunn. Used for Trichotillomania, it is also successful in treating conditions like Tourettes and Compulsive Skin Picking too. It works on the belief that the sufferer pulls their hair out due to a conditioned response they have when confronted with certain stressful situations or triggers. More often than not, the sufferer of Trich is totally unaware of these triggers and so the first part of this type of therapy is to get them to note when they are pulling their hair out and what occurred before, or whether there are any unusual circumstances which make them do it.

It then teaches them to become aware of these situations and try to consciously find other, less harmful and destructive ways of coping with them. A good psychologist or therapist will encourage the Trichotillomania sufferer to become more aware of the emotional states, times of day and any moods which they experience that can affect whether they pull their hair or not. They will also be asked to note whether this affects their OCD and general all round anxiety. Habit Reversal Training can also be used alongside traditional Cognitive Behavioral Therapy and conventional talking therapies to fully understand and get a hold on what may be triggering both the OCD and the Trichotillomania itself. Treated appropriately it is a condition that has a high recovery rate and it is nothing to be ashamed of. Being open and honest about it is the best way forward to not only help yourself, but to raise awareness.