Trichotillomania, hair pulling, anxious hair pulling, bald patchesTrichotillomania is quite literally when you pull your hair out: a condition where someone will compulsively pull out hair – mostly from the scalp, eyelashes or eyebrows.

Although fairly rare trichotillomania is thought to be on the increase and currently it is believed to affect between 1% and 3% of the population.

During the last 20 years in private practice I have only worked with 4 people with this condition. Indeed many therapists may never work with a single case.

There is no single cause of trichotillomania, but there are a number of theories about why it may occur. However a person will often pull their hair out as a way of relieving feelings of stress and anxiety, or other negative emotional states.

Links with OCD

The habit of pulling out hair involves compulsive behaviour, and it is likely that trichotillomania is closely related to obsessive compulsive disorder (OCD).

OCD is a condition that tends to run in families. It is thought to be caused by both biological and environmental factors.

A tendency to pull hair out may be inherited as can other OCD patterns of thought and behaviour. Like OCD trichotillomania involves obsessive thoughts (which are usually anxiety provoking) and the compulsive behaviour of pulling out hair.

Self-harm related to hair pulling

Trichotillomania could be seen as a type of self harm where a person deliberately injures themselves to seek temporary relief from emotional distress.

The pain associated with self-harm makes the brain release endorphins (natural painkilling chemicals), which cause a short-lived sense of well-being.

Self-harm is often accompanied by feelings such as:

  • guilt
  • self-loathing
  • low self-esteem
  • low mood state/depression
  • anxiety

As well as pulling hair out, some people may also self-harm in other ways such as cutting themselves.

Individuals may start self-harming as a way to cope with a traumatic experience, such as sexual, physical or emotional abuse. If sexual abuse has occurred, trichotillomania may be seen as a way of becoming less attractive, or less feminine in the case of a female. Making oneself less attractive confirms the negative view and the cycle of self-loathing and self-harm continues.

Changes in hormone levels can also be a contributing factor, so trichotillomania is more common around ages when hormone levels change, such as during puberty.

Treatment for Trichotillomania

This type of hair pulling is often linked with a lack of serotonin (the ‘feel-good’ chemical in the brain).

Treatment with a selective serotonin reuptake inhibitor (SSRI) type anti-depressant will boost serotonin levels, and has been effective for some people with trichotillomania. The low mood state as a result of, or contributing to this condition will likewise benefit from anti-depressants.

Therapy to change the hair-pulling behaviour is the most effective method of treating trichotillomania, combined with emotional support.

There are a number of other possible therapies for trichotillomania, such as psychotherapy, which is a talking therapy often used to treat emotional problems and mental health conditions

Cognitive behavioural therapy (CBT) is a type of psychotherapy that may be recommended. It can help individuals address their thoughts about themselves, relationships with others, and how they relate to the world around them. CBT may also involve behavioural therapy that aims to help change behaviour.

Hypnotherapy is an effective way of dealing with trichotillomania. I use a combination of hypnosis, psychotherapy, and behavioural therapy.

I treat trichotillomania in much the same way as OCD. First looking for the underlying anxieties and negative beliefs and feelings that trigger the behaviour. I work with the client to make them aware of their own patterns of behaviour and to recognise those thoughts and feelings that will trigger a bout of hair pulling. This is done in tandem with strategies to help the client relax and let go of negative thoughts and feelings, and to stay positive and resourceful.

I have found strategies that include helping the client relax can be extremely useful. They allow the client to stay in control and to accept responsibility for their own recovery and well-being. They may include deep breathing exercises, PMR type relaxation exercises, meditation or self-hypnosis.

There is usually some emotional distress associated with trichotillomania, such as feelings of low self-esteem, even self-loathing and guilt. Therefore emotional support is important to help the client cope with these feelings. This may be from family, friends, or a self-help group.

Trichotillomania can be particularly distressing for families of children and young adults who pull their hair out.

Hair pulling may be a way of communicating distress to one’s family, but they may feel powerless to help. In this situation family therapy may be suggested.

Although several different medications have been used to treat trichotillomania I prefer to keep this option as a last resort, if at all possible. In my experience two to three months of therapy is usually enough to make significant differences to this condition without resorting to chemical solutions. However other healthcare professionals may not agree with this view.

If you or your child are experiencing difficulties with trichotillomania, anxiety related compulsive behaviours, OCD or any other anxiety related conditions please feel free to contact me.