Trichotillomania is one of five disorders classified as Obsessive Compulsive and Related Disorders in the DSM V (Diagnostics and Statistics Manual). It is a stand alone disorder that can also be found comorbid with OCD. It is commonly referred to as the hair pulling disorder and can lead to noticeable hair loss and balding, distress and social or functional impairment.
The condition is mostly found in females and usually develops at an early age, from pre-adolescence to early twenties. It can be present in infants but the peak onset age is 9 to 13.
The main symptom of Trichotillomania is the recurrent, compulsive pulling out of hair from the root from such places as eyebrows, eyelashes and the scalp. Sometimes this causes baldness. Pulling of hair can also occur from other locations including the pubic area or any other body area. Other symptoms include:
- A high level of tension and a strong urge to pull.
- Pleasure, relief or gratification when pulling out hair.
Typcially sufferers of Trichotillomania will use their fingers to pull their hair out but some sufferers will use tweezers or other instruments.
Other symptoms of the disorder include hair sucking or chewing. This can lead to the ingestion of hair, which may lead to intestinal problems requiring surgery.
People who suffer from trichotillomania often pull only one hair at a time and these hair pull episodes can last for hours at a time. Trichotillomania can go into remission-like states where the individual may not experience the urge to “pull” for days, weeks, months, and even years.
Covering up hair loss is a common reaction by those with Trichotillomania. The goal is to prevent others from noticing the hair loss and this is accomplished by wearing hats, scarves and false eyelashes.
Some sufferers of Trichotillomania lead normal lives while others become embarrassed, depressed or ashamed to the point of avoiding social situations in an effort to hide their hair loss.
Treatment of Trichotillomania includes medications and Cognitive Behavioral Therapy or a combination of both. The type of CBT most commonly carried out is Habit Reversal Training (HRT). This type of therapy was developed in the 1970s for treating nervous, automatic habits such as hair pulling, tics, skin picking and stammering. Exposure and Response Prevention may also be indicated as a therapeutic alternative.