Hair pulling syndrome: Causes and solutions

Trichotillomania is a type of impulse control disorder characterized by an irresistible urge to pull your hair out despite knowing it could hurt. People with trichotillomania may deny that they have a problem and then try to hide their hair loss.

Hair pulling syndrome can cause serious problems if not treated early

What is hair pulling syndrome?

Trichotillomania is also known as hair pulling syndrome or hair pulling disorder. This is a chronic impulse control disorder, characterized by the pulling of one’s own hair, resulting in significant hair loss. The most common areas for hair pulling are the scalp, eyebrows, and eyelashes. However, the patient can pull out the hair anywhere on the body.

Although large-scale and comprehensive epidemiological studies have yet to be performed, smaller studies estimate trichotillomania to affect approximately 1 to 3.5% of adolescents and early adulthood. Some people may struggle with the condition continuously or intermittently throughout adulthood.

Some women report that they tend to pull their hair out more at the start of their menstrual cycle. Research in 2018 found that hormonal changes that occur in women’s bodies at the start of their menstrual cycle have an impact on trichotillomania symptoms. In addition, another study in 2013 also showed that the symptoms of trichotillomania can be influenced by hormonal changes during pregnancy.

People with hair pulling syndrome often know that damage can be caused by their pulling behavior, but they can’t stop themselves. They may pull their hair out when stressed as a way to try to soothe themselves. Depending on the individual, symptoms and effects will be variable, manageable or severe.

Causes of hair pulling syndrome

The exact cause of hair pulling syndrome is still unknown. It may be related to changes in brain pathways associated with areas involved in how you manage emotions, movement, habits, and impulse control.

In addition, several factors are thought to increase the risk of this disorder. Consists of:

• Age: Trichotillomania tends to start in adolescence, between the ages of 10 and 13. It can last a lifetime. However, symptoms can come and go from time to time.
• Genetic factors: In a family, the tendency to have hair pulling syndrome can be passed down. Although specific genes have not been detected, genetic factors are thought to play a role.
• Other mental health disorders: If you live with hair pulling syndrome, you may also have other mental health problems. Such as depression, anxiety, or obsessive-compulsive disorder (OCD).
• Stress: Prolonged excessive stress can increase the risk of developing hair pulling syndrome in some people. Stress can be triggered by situations such as abuse, family conflict, the death of a family member or a close friend.

Prolonged extreme stress can trigger the development of Trichotillomania symptoms as a way of relief

In fact, more women than men receive treatment for hair loss disorder. This can often be because women tend to seek medical advice more. During childhood, girls and boys appear to be equally affected.

Signs of hair pulling addiction

People with hair pulling syndrome often feel a strong urge to pull their hair out. At the same time, they will also feel the growing tension until they act. After pulling their hair, they usually feel more relieved.

A person may pull their hair out in response to a stressful situation. Or the action can be taken without them really thinking about it. Most people with addiction pull hair out of the scalp. However, some pull hair from other areas, such as eyelashes, eyebrows, beard or genital area.

Signs and symptoms of Trichotillomania may include:

• Continuously pull your hair out, usually from your scalp, eyelashes, or eyebrows. However, sometimes it is from other body areas and the locations may change over time.
• Feeling of increasing tension before pulling or when you are trying to resist the pull.
• Feeling of relief or refreshment after pulling hair.
• Noticeable hair loss. For example, short hair, thinning, bald areas on the scalp or in other areas of the body. Includes sparse, missing eyebrows or eyelashes.
• Preference is given to specific hair types, rituals associated with hair pulling or hair pulling patterns.
• Bite, chew or eat the plucked hair.
• Play with pulled hair or rub it on your lips or face.
• Constantly trying to stop pulling hair or trying to do it less often without success.
• Suffering or serious problems at school, work, or in social situations are associated with hair pulling.

People with Trichotillomania not only pull out the hair on the scalp, but also pull out the eyebrows, eyelashes, etc.

Many people with hair pulling syndrome also have a tendency to scratch their skin, bite their nails, or bite their lips. Sometimes plucking hair from pets, dolls, or objects, such as clothing or blankets, can also be a sign. Most people with trichotillomania pull their hair out in their private parts, but often try to hide the disorder from others.

For people with trichotillomania, hair pulling can take two forms:

• Focus: Some people intentionally pull their hair to relieve stress or distress. For example, they pull their hair out to reduce the urge to pull the hair too much. A person may perform elaborate rituals to pull out the hair, for example finding the right hair type or biting the plucked hairs.
• Automatic: Some people pull their hair without even realizing they are doing it. For example, when they are bored, watching TV or reading a book. The act of pulling hair can happen unconsciously.

In addition, the same person can perform both focused and automatic hair pulling actions. This depends on the mood and the situation. Certain positions or rituals can trigger hair pulling behavior, such as combing your hair or resting your head on your hands.

Trichotillomania can also be related to emotions:

• Negative Emotions: For many people with hair pulling syndrome, hair pulling is a way of dealing with uncomfortable and negative feelings. Such as anxiety, stress, boredom, fatigue, loneliness or frustration.
• Positive emotions: People with hair pulling disorder often find that pulling their hair gives them a sense of satisfaction. Moreover, it also helps them to reduce the feeling of fatigue. As a result, they will continue to pull their hair out to maintain these positive emotions.

Hair pulling syndrome is a disorder that tends to be chronic. Without early treatment, symptoms can vary in severity over time.

Hormonal changes can worsen trichotillomania symptoms in women. For some people, if left untreated, symptoms can come and go for weeks, months, or years. Rarely, trichotillomania ends within a few years of its onset.

What are the effects of hair pulling syndrome?

Hair pulling may not seem particularly serious, but the disorder can have a huge negative impact on your life. Affective issues may include:

Hair pulling syndrome can cause baldness and permanently affect hair growth

• Emotional distress: Many people with trichotillomania report feeling very embarrassed and humiliated. They often have low self-esteem, depression and anxiety. Many people also turn to alcohol and drugs to relieve negative emotions.
• Problems with social and work functioning: Shame about hair loss can make people want to avoid social activities and turn down job opportunities. People with Trichotillomania may wear wigs, style their hair to cover bald patches, or apply false eyelashes. Some people may avoid intimacy for fear that their condition will be discovered.
• Damaged skin and hair: Repeated plucking can cause scarring along with other damage, including infection of the skin on your head or the specific areas where you pull the hair. This can also permanently affect hair growth.
• Rapunzel Syndrome: People with persistent trichotillomania may develop Rapunzel syndrome. Because a person with hair pulling syndrome can eat their own hair. The accumulation of hair in the stomach and digestive tract can cause abdominal pain, vomiting, chest discomfort, digestive disorders, etc. Surgery is the preferred treatment option in this case.
• Diagnosis of hair pulling addiction syndrome

To determine if you have hair pulling syndrome, your doctor may need:

• Check your hair loss
• Ask questions and discuss your hair loss
• Rule out other possible causes of hair pulling or hair loss through a doctor-ordered test
• Identify any physical or mental health problems that may be related to hair pulling

In addition, to make a definitive diagnosis, the doctor will use the diagnostic criteria weighted in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. Ky. DSM-5 criteria for hair pulling disorder include:

• Pulling hair many times, leading to hair loss
• Repeated attempts to reduce or stop pulling hair
• Hair pulling cannot be better explained by symptoms of a mental disorder or other medical condition
• Hair pulling causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

Hair pulling syndrome is often misdiagnosed as obsessive-compulsive disorder (OCD). Although the repetitive and compulsive actions of Trichotillomania look similar to those in OCD, they are actually different.

When differentiating hair pulling disorder from obsessive-compulsive disorder (OCD), your doctor will screen for repetitive hair pulling behavior that accompanies any other repetitive habits. Along with that will be screened for OCD.

Questions commonly used to screen for OCD include:

• Do you clean or do a lot of laundry?
• Do you check things a lot?
• Is there a thought that bothers you and you want to get rid of it but can’t?
• Do your daily activities take a long time to complete?
• Are you worried about order or symmetry in general?

Hair pulling syndrome is often misdiagnosed with obsessive-compulsive disorder

In addition, doctors will distinguish hair pulling syndrome from alopecia areata. This is a medical condition that causes hair to fall out in small patches. Some ways to distinguish these two syndromes are endoscopy, scalp biopsy, and medical history examination. With an open and honest dialogue, diagnosing trichotillomania becomes simpler.

Methods to overcome the syndrome of hair pulling addiction

If you can’t stop pulling your hair or you feel embarrassed about your appearance after pulling it out, see your doctor soon. Hair pulling is not only a bad habit, it is also a mental health disorder. This condition is unlikely to get better without treatment.

To date, studies on the treatment of trichotillomania are limited. However, some treatments have helped many patients reduce or stop their hair pulling.

Here are the commonly used methods to overcome hair pulling addiction syndrome:

1. Psychotherapy

Psychotherapy has been identified as the primary treatment for trichotillomania. Depending on the individual’s condition, different therapies can provide benefits. Such as:

Habit reversal therapy (HRT):

A 2012 study found that Habit Reversal Therapy (HRT) is a type of behavioral therapy that can be effective in treating hair-pulling syndrome. HRT includes 5 main stages as follows:

• 1. Awareness training: Help the patient identify the psychological and environmental factors that may be causing the hair loss.
• 2. Competitive Response Training: The patient practices replacing the hair pulling behavior with another behavior.
• 3. Motivation and compliance:  Patients engage in activities and behaviors that remind them of the importance of sticking to habit reversal therapy. This may include receiving compliments from family and friends about the progress made in therapy.
• 4. Relaxation training: The patient practices relaxation techniques. Such as deep breathing and meditation. These will help reduce stress and limit stress-related hair pulling.
• 5. Generalized training: Patients practice their new skills in a variety of situations to help the new behavior become automatic.

Cognitive-behavioral therapy (CBT):

Cognitive-behavioral therapy (CBT) is another useful form of therapy to help treat trichotillomania. This is talk therapy widely used to treat a number of psychological difficulties.

During the CBT process, you will work through the connection between your thoughts and behaviour. CBT will help you become more aware of the unhelpful thought patterns that lead you to want to pull your hair out.

Your counselor will eventually teach you techniques to manage or even change these dysfunctional thought patterns. Thereby reducing the symptoms of Trichotillomania.

Some common techniques of CBT include:

• Discuss the factors that lead to hair pulling and the consequences
• Using HRT to promote mindfulness around hair pulling
• Identify limiting beliefs and find ways to combat them

Acceptance and commitment therapy (ACT):

Acceptance and commitment therapy (ACT) is also a type of behavioral therapy. The ACT uses mindfulness and acceptance strategies related to your behavior as part of a mental disorder to help you through.

The ACT differs from CBT in that you will learn to simply observe and accept previously unwanted symptoms and events as part of the disorder.

Group therapy:

People with trichotillomania can feel isolated. And it’s good for those experiencing this condition to know that they’re not alone. Group therapy is a great option for someone struggling to overcome their hair pulling addiction.

Group therapy sessions may include:

• Discuss openly and honestly
• Share tips and tricks
• Looking for a support system

2. Drug use

There are no FDA-approved medications to treat or cure hair pulling syndrome. However, some medications can still be prescribed by a doctor to help those affected cope with trichotillomania.

There are different interacting neurotransmitter systems involved in the pathophysiology of the disorders, Trichotillomania being one of the disorders mentioned. Therefore, drugs that can act on these transmitters will often be used to treat trichotillomania.

Commonly used drugs may be:

• Selective serotonin reuptake inhibitors
• Clomipramine
• Lamotrigine
• Inositol
• Naltrexone
• Olanzapine
• N-acetylcysteine

Your doctor may prescribe a number of medications to help control hair pulling syndrome

Talk to your doctor about any medications they prescribe. The possible benefits of drugs need to be balanced against the side effects they are likely to cause. Absolutely do not arbitrarily buy drugs to use or be careless in using drugs.

3. Other support measures

Along with medical treatment, a number of other supportive solutions can also help people with hair pulling syndrome. Here are some helpful tips:

• Keep yourself busy, having too much free time can trigger unconscious hair pulling.
• Read everything you can on the internet about trichotillomania and treatment plans for dealing with it.
• Spray perfume on your hands so you can easily tell when you’ve reached up to part your hair.
• Keep a journal of your feelings.
• Search and read books on hair anatomy.
• Wear a wig all day until you go to bed. Then put on the bandana. This should only be used for the first two weeks or so.
• Take good care of your hair. You should brush your hair daily, wash your hair at least every 2 days.
• Apply lotion or gel to your hands so you have a hard time grasping the hair you want to pull.
• Take pictures of your bald spots and stick them in places where you often go or pass by. When you see these images, you will not want to pull your hair anymore because bald patches look very scary.
• Tell your family and friends to remind you to stop when they see you pulling your hair.
• Practice stress management solutions, such as deep breathing exercises, warm baths, meditation, physical activity, etc.

People with hair pulling syndrome can feel embarrassed and out of control. Although it will take some effort, the condition is treatable. Try to get over the shame and talk openly with your doctor or psychologist to get this disorder under control early.