Trichotillomania

Trichotillomania is a disorder that causes people to pull out the hair from their scalp, eyelashes, eyebrows, pubic area, underarms, beard, chest, legs or other parts of the body resulting in noticeable bald patches.  While for some trichotillomania is mild and can be stopped with extra awareness, for others the urge is strong and makes thinking of anything else almost impossible.  Hair pulling varies greatly in severity, location on the body, and response to treatment. The impulses to pull are so strong.  The body requires a sensation that is satisfied with the hair pulling.

Trichotillomania is a series of complex behaviors, not always easy to understand.  In order to treat trichotillomania, the treatment plan has to meet the complexity of the behavior to meet the complexity of the pulling.  One may wonder, “Why do people have the urge to pull their hair?”  There are several components that contribute to hair pulling including sensory, motor, environment, emotions, and cognitive.

Sensory
Some people pull their hair because they like the sensation they get from the skin or the scalp.  Some people like the itch or tingle they feel before the pull.   The pull site is not the only sensation individuals feel, as they also have sensations on their fingers.  The physical sensation is not the only sensory fulfillment.  Some individuals enjoy the sound of the snap of their hair the the look of a specific hair that seems out of place from the rest.

Motor
Many people find that they pull their hair automatically, without even thinking about it.  These individuals report that their hands have a mind of their own.  Some are aware of the pulling episode, but they can’t seem to stop.  It is very common for people to experience a combination of both awareness and automatic pulling episodes.

Environment
For some, there are places or rooms that they are more likely to pull.  For others they will pull anytime, anywhere.  Environments can include rooms in the house, school or workplace, and the car to name a few.  There seems to be something about those environments that trigger the pull.

Emotions
At one time, people believe that people engaged in hair pulling behavior because they felt anxious.  It is now known that people pull their hair when they feel a variety of emotions, and those emotion.  Some pull when they are bored, depressed, anxious, hungry, frustrated, relaxed, and excited to name a few.  The pull relieves the tension the individual is feeling.

Cognitive
Every day we have a variety of thoughts.  Our thoughts, feelings, and behaviors are all connected.   When pulling, individuals have thoughts before, during, or after an episode.  Hair pulling can lead to frustration, disappointment, humiliation, and shame.  The thoughts related to these feelings play a role in the hair pulling cycle.

Trichotillomania can wax and wane over time.  When working with a trained therapist, individuals with trichotillomania can learn strategies to make it impact their lives less over time.  No two treatment plans are alike for individuals with trichotillomania.  Addressing only one of the components (sensory, motor, environment, emotions, and cognitive) does not help the whole issue.  Individuals need to address the different components simultaneously to meet the complexity of the behavior.