What is trichotillomania?
Trichotillomania (ICD-10 F63.3) is a psychological disorder of obsessive behavior , in which patients pull the hair strands from their own bodies.
These strands can be from any area of the body such as eyelashes, eyebrows, beards, armpits, abdomen and pubic hair. However, it is more common for patients to pull the strands from the scalp.
It is more common in women and manifests itself more frequently during early adolescence. The most frequently used treatments involve cognitive-behavioral therapy and the use of medications.
In some cases, the damage caused is so great that it is necessary to resort to aesthetic treatments such as implant or capillary prosthesis .
It may also happen that some patients with this condition also develop the habit of swallowing the threads, which is called trichotillophagy. It is common for these patients to have other repetitive habits, such as biting nails or biting their lips.
Trichotillophagia is also a compulsive psychiatric disorder . In this disease, the patient has the habit of eating his own hair and / or nails. When discussing trichotillomania, it is necessary to talk about this condition as well.
This is because many patients who suffer from trichotillomania also have trichotillophagia, an issue considered to be a serious complication.
The problems, physical and psychological, that pulling out their own hair cause patients to be considered serious. When we talk about trichotillophagy, it becomes even more worrying.
Trichotillophagy triggers are similar to trichotillomania. Situations stress , cases of depression and anxiety, trauma, family problems, changes or any similar psychic factor may be the cause.
In the same way, the patient feels a tension when swallowing the threads, but then the feeling of shame and retaliation fills him.
Trichotillophagy is considered a serious condition, as the swallowed threads can form hair bunches (bezoars) in the digestive system. In the long run, these people may have to undergo surgery to remove these bezoars.
In addition, it causes various symptoms such as vomiting, intestinal obstruction, weight gain and can even lead to death.
It is not yet known what the exact cause of trichotillomania is, this disease that causes an uncontrollable need to pull hairs from the body. However, it is believed that it may be the result of genetic and environmental factors .
The possible causes are related to psychological disorders responsible for emotional functions, movement, impulse control and the formation of habits.
Many patients in this condition also present with generalized anxiety, depression and obsessive-compulsive disorder (OCD) and autism spectrum disorder, such as Asperger’s syndrome.
What actually causes trichotillomania is still an open question, but there are many risk factors that contribute to this pathology developing. It is common for patients to present this pathology under the following conditions:
Our body, in certain situations, responds with physical and psychological symptoms of stress. This is a natural response of the human body, but in some people, the effects can be more severe or mild.
In people with trichotillomania, this is one of the risk factors, which can contribute to the disorder developing or becoming even more serious.
Although patients with trichotillomania have the highest cause of association with anxiety disorders, depression is also one of the risk factors. The dysthymia , a form of depression lighter, can also trigger the condition.
Obsessive-Compulsive Disorder (OCD)
OCD is a psychiatric disorder in which patients have compulsive “manias”. These obsessions become very harmful and are always negative, disrupting the lives of those who suffer from the condition.
In addition to compulsive behaviors, people who suffer from OCD also have obsessive thoughts and, in an attempt to relieve those thoughts, they may begin to develop new rituals, such as locking the door several times, compulsively washing their hands, mania for organization, cleanliness, among others. many others.
Trichotillomania, although not considered an OCD, can be a greater risk for these patients, as the symptoms and signs that precede the compulsion are similar.
Generalized anxiety disorder (GAD)
In this disorder, people suffer from excessive and continuous anxiety. For them to face crises, it is not necessary to be in specific situations, as the context does not interfere with the symptoms. The person is anxious all the time and has no power over that feeling.
It is a condition that interferes negatively in the life of those who suffer it, preventing even from being able to perform simple daily activities.
Trichotillomania can occur more frequently for people who suffer from this disorder.
There are no conclusive studies on its cause, however, trichotillomania is a higher risk for people who have some case of the disease in their family history.
Be between 11 and 13 years old
Trichotillomania, in general, begins to manifest itself during childhood and early adolescence, being more common among girls .
During this phase of changes, it is observed that it is more frequent that they start pulling the hair strands.
The girls, specifically, show a greater discontent with the possible appearance of thicker wires, of different colors, more wavy etc.
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The main symptom of trichotillomania is the impulsive action of pulling hairs from the body. However, there are other implicit signs. Thus, patients follow a certain pattern of behavior, demonstrating the following feelings and actions:
- Repeatedly plucking hairs from the head, eyebrows, eyelashes and, in some cases, from other parts of the body. Depending on the stage of the disease, the patient may start by pulling the hair strands out and “advancing” to other areas of the body;
- Feeling of tension before pulling the wire or while trying to resist the act;
- Feeling of pleasure or relief after pulling the wires;
- Perceptible losses such as areas of the scalp showing or with shorter hair. It is also possible that these patients’ eyebrows and eyelashes will look more flawed;
- Patterns of hair strands, such as only pulling out curly hair and white hair;
- Patients may show as a sign that they are always chewing or putting hair in their mouths;
- Playing with the hair, passing strands across the face or putting them in the mouth;
- Patients with this pathology can demonstrate that they are constantly trying to avoid pulling their hair out, venting frustrations that cannot stop touching their hair or trying to slap their own hands;
- Feeling of stress or nervousness in situations where your hair will show, such as hairdressers;
- Itching or tingling sensation on the scalp, which is only relieved by pulling the strands.
Trichotillomania can also happen together with other manias, such as biting your lips or biting your nails, these details are important signs to be observed, whether the patient or someone close.
Many patients, out of shame, try to hide the problem. For this reason, they may prefer to always be wearing caps, caps, hats, false eyelashes, scarves and painting their eyebrows.
The symptoms within this pathology are similar to those of an addiction like any other, where the patient feels tension before pulling the threads, pleasure or relief when performing the act and shame or regret for continuing with the mania.
There are two very common forms within the behavior of patients with this pathology, in which the act of pulling the hair is preceded by two different situations.
In one of them, there is a great tension, causing greater anxiety and nervousness. It is more frequent in situations of great stress.
The other, occurs in quiet and contemplative situations, in which the patient plucks the threads unconsciously, when he is not doing any activity or is not worried about any problem.
Thus, he begins to pull his hair absently, while performing other activities such as reading, watching television, while on the cell phone and other tasks in which they focus.
In some cases, patients adopt the habit of swallowing the threads, a condition identified as trichotillophagy , a variation of this pathology.
From this behavior, some symptoms appear. Are they:
- Lack of appetite;
- Nausea and vomiting;
- Gastrointestinal block;
- Internal bleeding;
- Abdominal pain;
- Accumulation of hair in the stomach.
Patients who believe they suffer from trichotillomania can turn to general practitioners, dermatologists and psychiatrists to make a diagnosis.
However, there are no specific tests to confirm trichotillomania. Unlike other diseases, it is not possible to diagnose with CT scans or blood tests, for example.
Therefore, the physician must rely on the analysis of physical symptoms and the patient’s report. From there, you should assess the amount of hair loss and investigate whether there is another physical disease involved in hair loss.
Some criteria are used to confirm the diagnosis. They are described in the Diagnostic and Statistical Manual of Mental Disorders (DSM).
- Pluck the hair repeatedly (whether from the head, eyebrow or eyelashes), causing loss;
- Numerous attempts to reduce or curb behavior;
- When the act ends up causing clinically significant suffering or causes damage to the patient’s social routine;
- When the obsession to pull the strands has no relation explained by symptoms of any other type of mental disorder;
- When the loss of hair or the act of pulling it out has nothing to do with another medical condition, such as a dermatological problem, for example;
- Attempt to hide or repair the flaws caused by the act of pulling the hair out;
- Pull the strands of hair out when in stressful situations at school, at work, in other social circles and conflicts.
Cases in which trichotillomania is not diagnosed
In some situations, only the act of pulling out the hair means that the patient has trichotillomania. This habit, in these cases, can be a response to other stimuli. Understand some circumstances that can be confused with this disease, but that are not diagnosed:
Hair removal and handling
Some people are in the habit of curling or handling their hair constantly. In some cases, they pull out some strands so that it looks aesthetically better, according to what they think is the most beautiful.
For example, people who pull out threads that are frizz or when they find only a white thread and prefer to remove it.
There are also people who bite the threads instead of pulling them out and this is also not characterized as a diagnosis of trichotillomania.
In the long run, it can become a concern. It is important to pay attention and understand if these habits are harming your daily life and take care that they do not become an obsessive act.
Although OCD and other mental disorders are associated with risk factors, in some cases, the compulsion to pull the threads is not related to trichotillomania, being a characteristic of the mental disorder itself.
In OCD patients, who are extremely concerned with symmetry, pulling their hair out can be part of this rite. However, even in these conditions, it is not characterized as a case of trichotillomania.
Within cases of dysmorphophobia or dysmorphic disorder, in which the patient is obsessed with his appearance and the defects he believes to have, pulling the hair out can be one of the symptoms of the disease.
Because you believe they are ugly, abnormal or asymmetrical, you may end up developing this habit. Likewise, it does not fit the criteria for trichotillomania and does not receive this diagnosis.
Therefore, this behavior within another frame of repetitive disorder excludes the chances of being considered a frame of trichotillomania.
When it occurs with the use of substances
Pulling one’s hair out can be a behavior stimulated, in certain cases, by specific substances such as stimulating drugs. This does not mean that these substances are the primary cause of pulling. However, when hair pulling occurs within this condition and does not meet the diagnostic criteria, it is not considered a condition of trichotillomania.
Psychotic conditions, a pathological condition in which the patient experiences a loss of connection with reality, also do not fit into what is established as a diagnosis for trichotillomania.
Psychotic disorders can cause personality changes, delusions, hallucinations and impairments in the performance of daily activities in patients.
Neurodevelopmental disorders, according to what is established in the Diagnostic and Statistical Manual of Mental Disorders (DSM), is a term that covers several types of disorders.
This includes intellectual disabilities, attention deficit hyperactivity disorder, specific learning disorder, motor disorders, autism spectrum disorder and communication.
These disorders have a characteristic beginning even in the child’s developmental period, usually causing damage to the diagnosed patient’s personal, social, professional and academic performance.
Trichotillomania is a psychological disorder that presents symptoms similar to those of an addiction. The patient, in this condition, needs to look for ways to control these obsessive impulses to pull the threads out of the treatment.
In many cases, the disease is considered chronic, as the patient will have to learn to deal with these impulses forever. However, there are successful cases in which the patient does not have “relapses”.
To say that there is a cure is uncertain, but, yes, it is possible to treat and live with the disease . Just as it is possible to recover the damages caused by the condition.
The treatment of trichotillomania does not have a specific time and can vary for each patient.
During this process, the patient will have to learn to control his impulses, deal with negative feelings, find ways to avoid obsession and, little by little, seek a cure.
For people who have had major hair loss, they may also have to undergo physical treatments to recover the area damaged by the compulsion caused by the disease. Understand the main types of treatment:
Acceptance and Commitment Therapy
Acceptance and Commitment Therapy , in English Acceptance and Commitment Therapy (ACT), is a type of cognitive-behavioral therapy whose principle is to show the patient what is not within his personal control.
In this context, the therapist contributes by showing the patient ways to deal with his feelings and thoughts. It is a therapy that uses the practice of mindfulness.
Habit Reversal Therapy
Habit reversal therapy is a pioneering treatment to help patients with trichotillomania. It consists of the union of principles that aim to stimulate the patient to understand the triggers that make him pull the wires, to have a more preventive idea of the case and to promote self-monitoring.
Mindfulness is a technique that seeks to relieve unpleasant sensations by promoting greater attention and awareness of the individual’s physical sensations and surroundings. It is bringing yourself back to the here-and-now, the way it is, and disconnecting from what could be.
At first, the individual must pay attention to his own bodily sensations and accept them. In times of stress, accepting the symptoms of anxiety is just a way to combat them. Becoming aware of them and focusing on the present means that the individual is in the current experience, and not traveling in his thoughts.
In this way, the body tends to return to normal, since the mind is no longer occupied by worries, but by the present moment.
Cognitive-behavioral therapy (CBT)
Patients with trichotillomania have the psychological approach as their main form of treatment, with cognitive-behavioral therapy being the most used and with the best results.
In this therapy, the patient is encouraged to understand his patterns of thinking and behavior. In the case of trichotillomania, the patient needs to understand the moment when the act of pulling the threads takes place, how long he has lived with this habit, the feelings that precede and proceed, etc.
This analysis will help, during therapy, the patient and psychotherapist to build different ways to treat this compulsion, replacing it with healthier habits for the patient.
In CBT, unlike other types of therapy, the focus is not necessarily on why the disorder happens, but on how it happens. The intention is more objective, in order to modify these specific behaviors.
During a determined time, the patient will have to learn different techniques to be able to control his impulses.
It is necessary, at that moment, that the patients have patience, because the disease condition, even with a good treatment, can take time. The important thing is to persist and talk to the doctor about how you are feeling with the treatment.
Treatment with the use of medications
In parallel with psychological treatment, patients with trichotillomania may also need the support of medication to achieve a better prognosis.
Patients who have a psychological disorder associated with trichotillomania, such as depression and anxiety, should also seek medical advice for the treatment of these diseases.
For this, it is possible for doctors to advise patients on the use of antidepressants, anxiolytics and antipsychotics.
However, although drugs are beneficial in many cases, it is essential to have an adequate monitoring of use, in order to avoid side effects or cause addiction.
For some patients it may be interesting to have the option of participating in support groups. Although not the most effective method for reversing trichotillomania, it can be beneficial together with other treatments, simultaneously.
In cases of people who are more resistant or ashamed to admit that they are sick, hearing reports from others who are experiencing the same problem can be positive for the evolution of treatment.
Hair prosthesis and hair implant
The capillary prosthesis is a treatment used for cases of trichotillomania with great hair loss. In many people, the damage caused by pulling the strands is so great that the hair does not grow again.
To help regain self-esteem and also as an incentive for the patient not to give up on other treatments, it can be very beneficial to resort to this resource. Prostheses can be made on both men and women.
The fact of presenting several models of hair, facilitates this procedure. Thus, the patient is able, in some way, to recover the image he had of himself, before the disease reached him.
The prosthetic threads can be placed individually on the scalp or in small groups, under a screen or film that simulates human skin. The prosthesis can be used temporarily or semi-permanently.
The time of using a prosthesis can last between 6 months to 2 years . The cost may vary, according to the size, model and quality of the prosthesis, but it has a lower cost than the hair implant, a surgical treatment.
The price of the hair implant is higher because it is a plastic surgery. In this procedure, the patient receives a transplant of capillary threads from his own body.
As it is a definitive procedure, the hair implant proves to be the best option for those who had a complication of baldness.
The surgery lasts an average of 6 to 8 hours, varying according to the patient’s need for implantation. The price, not so advantageous, can vary from 7 thousand to 42 thousand.
The drugs most used to treat this disorder are antidepressants such as selective serotonin reuptake inhibitors (SSRIs). These are not specific drugs for trichotillomania, but they can help reduce symptoms and contribute to psychotherapeutic treatment.
Anxiolytics, used to treat different types of anxiety disorder, can also be used when the patient has both conditions.
Antipsychotics can be used in some cases, in combination with SSRI medications or alone.
To treat damage to the scalp or other parts of the body, it is possible that doctors prescribe medications to aid in the recovery of the strands in the affected area.
- Minoxidil (to stimulate hair growth);
- Antidepressants ;
- Anxiolytics ;
- Olanzapine (antipsychotic);
- Aripiprazole (antipsychotic) .
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
In adults and adolescents, the estimated prevalence of the disease for more than 1 year is 1% to 2%, with females being more affected than males.
This difference between the number of cases of trichotillomania between the two genders, however, is also considered a reflection of a culture in which women seek more medical help than men.
When trichotillomania occurs in children, both sexes are affected equally, which reinforces the hypothesis that the numbers show only those who most seek medical help, since they are responsible for the children who take them to a specialist.
The evolution of the pathology is little known and varies for each patient. Studies carried out with trichotillomaniacs show that most of these patients have a chronic condition of the disease, thus having to live and fight with the disease every day.
A positive or negative prognosis, therefore, will depend a lot on the age at which the disease started to manifest and the associated comorbidity.
The number of existing research on trichotillomania is still relatively limited, but demonstrates a greater awareness of symptoms and occurrence, which were believed to be uncommon.
International surveys show that trichotillomania rates accounted for about 1%, which now account for between 2% and 3% of patients with the disease. In Brazil, there are records of more than 150 thousand cases per year.
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Trichotillomania is a disease that affects patients’ lives emotionally and physically. Compulsively pulling the wires can lead to a variety of aesthetic damages, in addition to health problems. Here are some common complications of the disease:
It is very common for patients with trichotillomania to have low self-esteem as a complication.
In addition to feeling ashamed of the disease and hiding the condition from people, they may feel bad about the physical damage caused by the disease, such as flaws in their eyebrows, beards and hair, even avoiding looking in the mirror for not accepting that reflection .
People with trichotillomania who have low self-esteem can avoid social interactions by leaving home. Thus, your social and professional life can be severely impaired.
It is common that they are always avoiding the exposure of physical damage caused by the disease, wearing caps, caps, painting their eyebrows, making use of false eyelashes or any other way of masking the wires pulled from the areas of the body.
Therefore, they lose interest in being in overexposure environments, such as beaches, swimming pools or any activity that flaws can be exposed to.
In extreme cases, the damage of pulling the strands reaches the point of being irreversible. Thus, the patient ends up presenting baldness as a complication, needing to resort to aesthetic treatments to recover the damaged area.
Infection and skin damage
Plucking hair strands in different areas of the body can lead to possible infections and damage to the skin.
Patients who suffer from trichotillomania accompanied by trichotillophagy, a disorder in which the person swallows hair, may have the formation of bezoars as a complication.
These bezoars are the result of years of accumulation of hair in the patient’s gastrointestinal system, which ends up forming tangles of hair in the individual’s body.
These hair balls, in the long run, bring several health damages such as weight loss, vomiting, abdominal pain, internal bleeding and intestinal obstruction.
In some cases, surgical intervention is required to remove the bezoars. When left untreated, it can lead to death.
There is no exact way to prevent trichotillomania, because even its cause is, in fact, unknown. However, some health care can be practiced.
Control everyday stress
Trichotillomania is very associated with stress, which is one of the risk factors. Although it is not directly the cause, having control over this problem is fundamental to a better quality of life.
Take care of your mental health
We are used to health recommendations with regard to our physical condition, with good food tips, quality of sleep and physical exercises.
Certainly, maintaining these recommendations is fundamental, but we cannot ignore the importance of our mental health .
If you suffer from a mental disorder, such as depression and anxiety, seek psychological help and seek appropriate treatment. Talk to people close to you and explain what you are going through.
Likewise, it must be with people who believe they are suffering from trichotillomania. There is no reason to be ashamed or to hide the problem.
Observe possible symptoms
Informing yourself is also a form of prevention, so being aware of symptoms can also be a way to avoid or diagnose early.
Often, patients begin to pull the wires unconsciously or automatically. In some cases, for those close to you, it may be easier to identify “mania” than the person who commits it.
In such cases, it is important to talk to patients and guide them to seek help, without ridiculing the problem, but encouraging and helping them to understand that this act can be a disease.
Investigate whether there are family histories of the disease
Trichotillomania can be a more recurrent disease in people who have cases of the disease in the family. Investigating whether a case of the disease has occurred previously can be a way to prevent it.
Trichotillomania is a difficult pathology and treatment requires not only physical, but mainly emotional effort. Thus, living with the condition becomes a daily exercise. Here are some ways to deal with this disease and make everyday life more comfortable:
Identify the triggers
Some people who suffer from this disease have a pattern between the plucked strands. For not liking them, for example, they can continue to maintain this compulsion to take them out at all costs.
Among the possible patterns are the obsession with pulling white wires or wires very different from others, such as curly hair or split ends.
It is important to understand where this behavior begins, for diagnosis, treatment and also to be able to live with the disease.
Create different ways to intercept these actions
When the patient understands how his process happens, using as a strategy to follow the three principles of perceiving , interrupting and choosing a method , developing a plan to circumvent this obsession can help even more in the treatment.
Knowing the feelings that precede the need to pull the hair out, the patient can think of ways to stop those feelings, such as maintaining a repetition of positive thoughts.
Performing other activities that occupy your head and hands can help, such as developing the habit of writing in a diary, drawing, painting or doing some type of crafts.
Express your feelings and look for new distractions
During the treatment, it is important to try to express your emotions, to be able to control the obsession of pulling the hair strands.
There is no need to create big new challenges, simple activities can help like just taking a short moment to take a deep breath and empty your mind.
Other tips are to have a notebook to draw or scribble on, when you feel the urge to pull the wires is coming.
Common hobbies like listening to music that match your feelings, reading an interesting book, calling friends, doing volunteer work, organizing your room, cleaning something or playing a video game are some easy options to relieve your emotions and keep you distracted.
Get away from the triggers
It will not always be easy to eliminate or distance yourself from the triggers, but it is important, at the very least, to notice them and try to somehow reduce contact with these factors that lead you to compulsion.
Often times, stressful situations are caused by exhausting work environments, very stressful study routines, troubled and abusive relationships, family traumas, grief and many other events.
It is understandable that in many of these situations it is difficult to distance yourself from the triggers. Leaving a job or ending a relationship, for example, is not such a simple task.
In such cases, it is necessary for the patient to assess whether these relationships are paying off for their mental health. In situations where there is no possibility of moving away from the moments that trigger the triggers, the patient needs to be prepared.
Thus, it is essential that you seek psychological help, to be able to deal with these moments of stress, to improve your self-acceptance and to learn from the situations that make this disorder more difficult.
Look for ways to improve your self-esteem and self-acceptance
Learning to love and accept yourself is fundamental for patients with trichotillomania. Because it is a disease that transforms the appearance of people who suffer from the condition, it can leave them with shaken self-esteem.
It is common for these people to be ashamed to talk to other people about the problem, because they think it is an attitude that should be hidden and disapproved, not understanding that it is a disorder.
Trichotillomania is a little commented disorder and therefore raises some doubts. Check out:
Is it possible to recover the plucked wires?
Recovery depends on several factors, such as the area of the body in which the wires were pulled out and how much were pulled out.
In more advanced cases of the disease, the damage to the scalp hair (or other areas of the body) may have been so aggressive that the strands do not grow back.
Fortunately, there are aesthetic treatments and products that help to stimulate hair growth. In cases where the loss is irreversible, there is the possibility of using a prosthesis or hair implant.
Can people with trichotillomania also pluck hair from other people?
Yes, there are cases where patients with trichotillomania also feel the need to pull hairs from people close to them, such as those of their partners.
It is important that these people guide the patient to seek medical help, seeking to understand that it is a disorder. Responding in a retaliatory manner or encouraging behavior are not advised attitudes.