In episode 322, I received an interesting question from a listener living with Trichotillomania. In this post, I dive into more detail and offer advice on how to manage living with this disorder.
Hey Duff! Got an easy one for the podcast. Can you discuss trichotillomania and any tips you may have for living with it? Thanks!
Good one! I don’t believe I’ve covered this on the podcast before. Trichotillomania is also called hair-pulling disorder and it’s actually pretty straightforward. In the current classification, it is part of a group of disorders called obsessive-compulsive and related disorders, which also includes OCD, hoarding, and body dysmorphia. Trichotillomania is characterized by recurrent pulling out of one’s hair, resulting in hair loss. This persists despite repeated attempts to decrease or stop the hair-pulling. Importantly, this can’t be due to another medical condition or mental disorder – so for instance, if someone is deliberately trying to change their appearance because they don’t like the way they look, that would fall more under the body dysmorphia category.
People might pull from any area with hair. Common areas are the scalp, the eye brows, and the eye lashes. There are also sometimes behaviors that go along with the pulling, which is why this is within that OCD related disorders category. People might have a specific way that they pull out the hair or certain rituals they do with it. Some people eat the hair or the hair follicle. There are basically two broad types of the hair pulling behavior. For some it’s automatic and they don’t even know it’s going on. For others, it’s preceded or accompanied by an emotional state like anxiety or tension. For many people they have this build up of tension while they try to resist the urge to pull hair, which is only resolved (temporarily) by engaging in the pulling behavior. There is often a lot of personal shame that accompanies the disorder as well as the feeling of loss of control and distress or impairment in important areas of the person’s life like work or relationships. In general, this is an easy thing to diagnose since it’s so based on the behavior of pulling hair.
Managing Trichotillomania: Treatment Options
When it comes to treatment, there are options. First off, it’s important to recognize that while it’s not exactly an anxiety disorder, anxiety is often something that goes hand in hand with trichotillomania. People with it might find that they are more inclined to hair pull when they are experiencing significant stress or anxiety. Treatment can sometimes be focused on the underlying issues like anxiety or trauma and when those are resolved, the maladaptive coping strategy of hair-pulling fades as well. In other cases, behavior modification is necessary. Habit reversal training is something that a lot of people use to reduce the impact of trichotillomania. This focuses on identifying the situations and circumstances that lead to hair-pulling. After you build the awareness of your patterns, you use that information to instead engage in an alternate behavior. There is another approach, which is basically to redirect your hand to a different location or activity.
For those who are more on the automatic side, there are actually wearables that are being made now that can help learn your body language and give you a gentle alert when you are probably hair pulling. There are also simple modifications like wearing a hat at times that you are likely to hair pull or reducing the time that you spend alone during your most at-risk periods. Other people might get really nice nails or invest in nice makeup that they don’t want to mess up, which is another detractor from pulling.
There is a pretty high rate of relapse for this disorder and the symptoms themselves tend to wax and wane. Luckily, aside from hair loss and possible complications from eating hair. It’s not a super dangerous disorder and it’s okay if you have an on and off battle with it. Help is available and there is also a lot of awareness-building that you can do on your own. What I would say is that if you are looking for professional treatment from someone, make sure they have experience in dealing with the disorder.
If this applies to anyone out there, best of luck!
You can listen to this on Episode 322 of the podcast!
Thank you for the great question!
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