Introduction
The irresistible and recurring urge to pull out one’s own hair or the hairs in different areas of the body is called Trichotillomania. It tends to manifest as compulsive hair pulling, which can cause anything from small hair loss to baldness.
It is an impulse control disorder that occurs in people under states of anxiety and that in the latest diagnostic classification of the DSM5 has been linked to obsessive-compulsive disorder as a related disorder. It may also be related to other disorders such as trichophagia, which consists of chewing or ingesting hair, which can cause severe problems in the digestive system.
It can begin in childhood between ages 9 and 13 as a response to stress. It tends to occur mainly on the head, although it can also occur on other parts of the body such as the eyebrows, beard, eyelashes, armpits or pubic hair. It is difficult to really know its prevalence, since the social stigma it entails can lead to its concealment.
DSM-5 Diagnostic Criteria
A. Recurrent hair pulling, resulting in hair loss
B. Repeated attempts to reduce or stop pulling out hair.
C. Hair pulling causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. Hair pulling or hair loss cannot be attributed to another medical condition (e.g., a dermatological condition).
E. Hair pulling is not better explained by symptoms of another mental disorder (e.g., attempts to improve a perceived defect or imperfection in appearance as in body dysmorphic disorder).
Causes
This disorder is closely related to anxiety, as a compulsive act that the person can suffer in three ways:
- Children’s episode: Where it is necessary to determine if it is a specific act, pulling out one’s hair, or if it becomes a repeated act, which must be supervised so that it does not continue until adulthood.
- Automatic: Where the person tends to do it when they concentrate on activities such as studying, reflecting, browsing the Internet, … being similar to what happens with the Onychophagia disorder (nail biting).
- Aware: The person carries out the act of pulling out hair inevitably but consciously, with great tension at first and even pain, but then feeling a lot of relief or gratification.
It has also been linked to post-traumatic stress disorder, as an unsuccessful emotional regulation system.
It also appears in depressive disorders. And it can generate low self-esteem, since, especially in adolescence, it can cause a great deterioration of the image (especially in women) which can lead to attempts at concealment to avoid jokes or ridicule for part of the others.
Treatment
For automatic type trichotillomania, behavior modification perspectives such as the habit reversal technique of Azrin and Nunn are recommended.
For the conscious, it is necessary to develop a more ambitious therapeutic plan that consists of:
- Problem assessment: with recording of the intensity, frequency and duration of compulsions.
- Awareness of the problem: The person must understand when and how the need to carry out the compulsion arises, in order to understand why, they can begin their attempts at self-control.
- Emotional regulation strategies: Emotion regulation techniques need to be learned that the person can gradually use as substitutes for compulsion, leading to its automatic use with repetition and the consequent increase in the feeling of control.
- Motivation and self-esteem: If the person has been suffering from the problem for too long, it is very important to help them improve their self-talk to improve the treatment they provide, and positively reinforce each attempt at improvement that the person makes in their behavior. To do this, records of the intervention can be used to show the person their progress.
- Coping of the most complicated situations: Once the person has developed a good strategy and already has it as part of their resources, we must prepare for the person to face any situation that they previously avoided to reinforce their self-confidence and reduce the negative influence of anxiety .