Trichotillomannia: The Disease of Hair Pulling 
  Vijai P. Sharma, Ph.D
Last couple patients I saw with the problem of hair pulling had no idea that any one else on this planet had the problem of compulsive hair pulling.  

The problem of compulsive hair pulling is as old as human hair.  In the Book of Ezra in the old Testament of the Bible, Ezra describes hair pulling in the verse 9:3 "and when I heard this thing, I rent my garment and my mantle, and plucked off the hair of my head and of my beard."  In India, we have an age-old expression which translates as, "I got so frustrated, I plucked the hair of my head."  

Hair plays an important role in the expression of our emotion.  Take for example, the positive emotions: in love and friendship human beings touch and comb each other's hair, a universal behavior which anthropologists call as "grooming."  Monkeys and apes spend a lot of time in grooming one another's hair.  Nowadays people use hair spray and other devices to set their hair, so, grooming is confined to admiring one another's hairdos or, in some cases brushing and combing the hair of the person you love. Sometimes we are just content with brushing aside hair we see on each other's jackets.  

In anger and frustration, one either wants to pull and pluck the hair of the person one is angry with or if that option is not available for fear or other considerations, one wants to pull and pluck the hair of one's own.  Either way, it appears that hair pulling is an instinctive behavior that we normally learn to control and suppress as we mature.  However, there are many life circumstances that may interfere with the development of such a control in the case of many individuals.  

The term "Trichotillomania" is derived from two Greek words, trix meaning "hair" and "tillien" meaning to "pull out."  The term was invented in 1989 by a French dermatologist who came across a patient with skin complications basically due to the habit of hair pulling.  People who suffer from this disorder are so ashamed of their condition that they become an expert in hiding it from others.  Many sufferers wear wigs, hairpieces, and eyelashes and can successfully avoid the public scrutiny.  

It is for this reason that we do not have any hard data regarding the incidence of this disorder in the U.S.A. However, experts estimate that about six to eight million Americans suffer form trichotillomania.  A vast number of them cannot swim, bike, run, or dance because of the fear of detection.  Many children who suffer from trichotillomania would not dare to ride a roller coaster because of the fear of wind.  They don't want to go to school as other children may ridicule them.  Parents can't provide much help or understanding because they don't know any better about the problem.  

When these children grow older, they become more and more isolated.  As teens and adults, they avoid forming intimate relationships lest they horrify their potential partner with their "shameful" secret. Their doctors don't understand about this problem due to the lack of scientific information and education on this subject.  Many patients who consult skin doctors can't bring themselves to share that they are causing their own hair loss.  

Many experts believe that trichotillomania is a form of obsessive-compulsive behavior in so far as patients do not have adequate control over their behavior.  Patients experience an increasing sense of tension immediately before pulling out their hair.  They are often frustrated in their efforts to suppress this behavior because they experience significant tension when they try to resist pulling their hair.  Many describe that they experience some degree of relief, pleasure, or gratification when pulling out their hair.  

Often an episode of hair pulling is followed by guilt, shame or fear of losing control and becoming completely bald.  These emotions only intensify the anxiety even more.  Some pull their hair absentmindedly, that is, that they are not fully consciously aware at the time or, they go into a "trance," a dream like state without being asleep.  Other times, they pull their hair with great concentration.   

Behavior therapy and medications both are found to be effective in controlling the problem behavior.  However, if the problem is severe, best treatment approach is to combine behavior therapy with medication.  It is so because the symptoms are likely to return when stopping the medication unless one also uses behavior therapy.  Medication is particularly helpful when trichotillomania is accompanied with other emotional disorders, such as severe depression, anxiety, or other obsessive-compulsive behaviors.  

Behavior therapy is the treatment of choice at least in cases of mild to moderate severity.  In behavior therapy, hair-pulling behavior is viewed as a learned behavior that has become a long standing "habit."  After a careful analysis, specific behavioral techniques selected to reverse such a habit.   Several weeks of trial may be required before the effectiveness of the treatment can be meaningfully evaluated.    
For more articles on Mind Publications about Trichotillomania, please visit Hair Pulling.


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