What is trichotillomania?

Causes

The cause of trichotillomania is unclear. It is likely that it is caused by both environmental (learned) and biological factors. One possibility is that hair pulling is a learned response to increasing stress and that the act relieves that stress. Biological explanations are neurological in nature and focus mainly on an imbalance of neurotransmitters.

Risk Factors

Some indication exists that there may be a family history of trichotillomania. The disorder begins most commonly between the ages of six and thirteen years and is four times more likely to affect women than men. It typically appears in persons who are depressed, anxious, or stressed.

Symptoms

Persons with trichotillomania generally show signs of depression, anxiety, or increasing stress. The obvious symptoms of trichotillomania involve pulling hair from the head, eyelashes, eyebrows, beard, or other area of the body.

The disorder is characterized by areas of baldness or by patches of hair just starting to grow. Persons with trichotillomania may play with their pulled hair or even eat it. In cases where enough hair is ingested, an intestinal obstruction may develop.

Screening and Diagnosis

A person with trichotillomania presents with hair loss. Differential diagnosis involves ruling out other causes of hair loss, including both congenital and acquired causes. When hair loss cannot be attributed to any other medical condition in a person who exhibits high levels of stress or anxiety, that person is evaluated to determine if he or she exhibits hair-pulling behavior on a regular basis. Such an individual is likely to be diagnosed with trichotillomania.

Treatment and Therapy

Because the causes of trichotillomania are not clearly understood, treatment can often be complicated. All treatments generally involve attempts at decreasing or managing stress, anxiety, and depression, which can affect trichotillomania. Specific treatments for trichotillomania can be either psychological or pharmacological in nature.

Psychological treatment involving cognitive behavior therapy (CBT) seems to be most effective, although hypnosis and biofeedback have also been used. The most common type of CBT used is habit reversal, in which the person is taught to attend to hair-pulling desires and to engage in a behavior that prevents the hair pulling.

Most of the medications that are used to treat trichotillomania block noradrenalin and serotonin reuptake in the brain. Effexor (venlafaxine) has been found most effective in treatment. Selective serotonin reuptake inhibitors and dopamine-blocking medications also have been investigated as treatment modalities. All of these potential pharmacological treatments deal with the regulation of neurotransmitters.

Prevention

The only real means of prevention involves diagnosing anxiety, stress, or depression prior to the onset of hair-pulling behavior. Treating the underlying condition may prevent this physical manifestation.

Bibliography

Keuthen, Nancy J., Dan J. Stein, and Gary A. Christenson. Help for Hair Pullers: Understanding and Coping with Trichotillomania. Oakland: New Harbinger, 2001. Print.

Penzel, Fred. The Hair-Pulling Problem: A Complete Guide to Trichotillomania. New York: Oxford UP, 2003. Print.

"Trichotillomania." Upd. Timothy Rogge. Rev. David Zieve, Isla Ogilvie, and ADAM editorial team. MedlinePlus. Natl. Lib. of Medicine, 10 Mar. 2014. Web. 6 Nov. 2015.

Walther, Michael R., et al. “Recent Advances in the Understanding and Treatment of Trichotillomania.” Journal of Cognitive Psychotherapy 24.1 (2010): 46–64. Print.