Trichotillomania (hair-pulling disorder)
Trichotillomania (hair-pulling disorder)
Trichotillomania (trik-o-til-o-MAY-ne-uh) is an irresistible urge to pull out hair from your scalp, eyebrows or other areas of your body. Hair pulling from the scalp often leaves patchy bald spots, which people with trichotillomania may go to great lengths to disguise.
For some people, trichotillomania may be mild and generally manageable. For others, the urge to pull hair is overwhelming and can be accompanied by considerable distress. Some treatment options have helped many people reduce their hair pulling or stop entirely.
Signs and symptoms of trichotillomania often include:
Most people with trichotillomania pull hair in private and generally try to hide the disorder from others.
For some people, hair pulling is intentional and focused. They're aware that they're pulling their hair out and may even develop elaborate rituals for doing so. Other people pull their hair unconsciously. The same person may also do both, depending on the situation and mood. For example, focused hair pulling may occur when you're frustrated in the car. Or you may unconsciously pull hair when you're bored. Certain positions or rituals may trigger hair pulling, such as resting your head on your hand or brushing your hair.
The cause of trichotillomania is unclear. But like many complex disorders, trichotillomania probably results from a combination of genetic and environmental factors. Also, abnormalities in the natural brain chemicals serotonin and dopamine may play a role in trichotillomania.
These factors tend to be associated with trichotillomania:
Although it may not seem particularly serious, trichotillomania can have a great impact on your life. Complications include:
Preparing for your appointment
Seeking help is the first step in treating trichotillomania. At first you may see your primary care doctor or a dermatologist. He or she may then refer you to a mental health provider.
These suggestions may help make your appointment easier:
Create a list of questions ahead of your appointment so that you can make the most of your time with your doctor. For example:
In addition to your prepared questions, don't hesitate to ask questions during your appointment.
Tests and diagnosis
Your doctor will perform a thorough evaluation to determine if you have trichotillomania, which may include examining how much hair loss you have, having you fill out a questionnaire and eliminating other possible causes of hair pulling or hair loss. In some cases, your doctor may also take a biopsy of your hair or skin to try to pinpoint the problem.
To be diagnosed with trichotillomania, you must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association.
DSM criteria for the diagnosis of trichotillomania include:
There is some debate among mental health providers — and people with trichotillomania — about these criteria, and they may change in the future.
Treatments and drugs
Research on treatment of trichotillomania is limited. Current approaches focus on:
Some complementary therapies to psychotherapy and medications that may help trichotillomania include:
Coping and support
Many people with trichotillomania report feeling alone in their experience of hair pulling. It may help to join a support group for people with trichotillomania so that you can meet others with similar experiences and who can relate to your feelings. You might ask your doctor for a recommendation or visit the Trichotillomania Learning Center's website to find a support group.
Family and friends of people with trichotillomania also may benefit from group therapy.
Last Updated: 2011-01-19
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