Trichotillomania is an impulse disorder that affects about two percent of the population and is characterized by compulsive hair pulling. The areas where hair is pulled include the scalp, eyebrows and lashes, legs, arms, hands, nose and pubic areas. While it can involve multiple sites, it is most often focused on one or two areas. At times, the pulling occurs in a trance-like state and is described as automatic or unconscious; this is more often the case in younger children who have the disorder. For others, pulling can be very focused and can include rituals (i.e., playing with or eating the hair). While some people report a “pre-pulling” tension and “post-pulling” relief, others do not have this experience at all, or are not aware of it.
This condition is often chronic and difficult to treat and can result in noticeable hair loss which brings associated shame and social or functional impairment. Trichotillomania has been seen in infants, but more often manifests between the ages of nine and 13.
Typically, hair pulling is confined to one or two sites, but more sites can be involved. The more common sites are the scalp, brows and lashes, face, arms and legs; less commonly, the pubic area, underarms, beard and chest are involved. Episodes can vary in length sometimes going on for hours. The behaviour is often very secretive. When hair loss is noticeable, people often avoid socializing. Attempts to cover or conceal the hair loss can include wearing hats or wigs or using creative hair styles and using false lashes or eyebrow pencils to fill in missing hair. Stress seems to be a large component in this behaviour and when stress is reduced there is often a decrease in the pulling.
In some cases, individual eat the pulled hairs, potentially causing gastrointestinal obstruction, which could be a very serious medical complication. Other problems include infection, hair loss and repetitive strain injury such as carpal tunnel syndrome.
Several treatments have been used to treat trichotillomania, including habit reversal training (HRT), medications, cognitive behavioural therapy (CBT) and acceptance and commitment therapy (ACT). Habit reversal training focuses on helping clients to recognize their impulse to pull, to catch it early, and to implement strategies to redirect or interfere with this impulse. CBT (including HRT) has been shown to offer improvement over and above medication alone.
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