Understanding Trichotillomania
Trichotillomania, also known as hair-pulling disorder, is a mental health condition characterized by a compulsive urge to pull out one’s hair. It can affect people of all ages and often leads to noticeable hair loss and distress. This article delves into the various aspects of trichotillomania, providing a comprehensive overview of its causes, treatments, and prognosis.
What is the Main Cause of Trichotillomania?
The exact cause of trichotillomania remains unknown, but it is believed to be influenced by a combination of genetic, environmental, and psychological factors. Some key factors include:
Genetics:
Family history of trichotillomania or related disorders suggests a hereditary component.
Brain Chemistry:
Imbalances in neurotransmitters, such as serotonin and dopamine, may play a role.
Stress and Anxiety:
High levels of stress, anxiety, or emotional trauma can trigger or worsen the condition.
Behavioral Factors:
Repetitive behaviors may develop as a coping mechanism for dealing with negative emotions.
How Do I Get Rid of Trichotillomania Permanently?
While there is no guaranteed permanent cure for trichotillomania, long-term management is possible through a combination of treatments. Key strategies include:
Therapy:
Cognitive-behavioral therapy (CBT) and habit reversal training (HRT) are effective in changing the thought patterns and behaviors associated with hair-pulling.
Medication:
Certain medications can help manage symptoms, especially when combined with therapy.
Support Groups:
Connecting with others who share similar experiences can provide emotional support and practical advice.
Stress Management:
Techniques such as mindfulness, meditation, and exercise can help reduce stress levels, which may, in turn, reduce hair-pulling urges.
Mandy Robertson, Trichologist
"I am seeing this condition on an increasing basis at my clinic. Many people who pull their hair or scratch/rub their scalp are not aware that there is a name for the condition or that there are evidence based treatments to manage it. Since some people with trichotillomania have scalp symptoms (itching, burning, pain) that can worsen urges to pull, it can be helpful to visit a trichologist or dermatologist to ensure that any underlying scalp conditions are treated. I often recommend that people also visit their family doctor for follow-up treatment of any underlying mental health issue. Seeing a therapist can also be very helpful for many people with trichotillomania".
Consult With MandyWhat is a Good Treatment for Trichotillomania?
The most effective treatments for trichotillomania typically involve a combination of therapy and medication. Specific treatments include:
> Cognitive-Behavioral Therapy (CBT): Focuses on identifying and changing negative thought patterns and behaviors.
> Habit Reversal Training (HRT): Teaches individuals to recognize hair-pulling triggers and develop alternative, less harmful behaviors.
> Medications: Selective serotonin reuptake inhibitors (SSRIs) and other medications may be prescribed to help control urges.
> Mindfulness-Based Therapies: Techniques such as mindfulness-based stress reduction (MBSR) can help increase awareness and control over the impulses to pull hair.
Does Trichotillomania Get Worse With Age?
Trichotillomania can vary significantly from person to person. In some individuals, the condition may worsen with age, while in others, it may improve or remain stable. Factors influencing the progression include:
> Severity of Symptoms: More severe cases may be harder to manage over time.
> Treatment Adherence: Consistent and effective treatment can help prevent worsening symptoms.
> Life Stressors: Increased stress or life changes can exacerbate the condition
Will Hair Grow Back After Trichotillomania?
Hair regrowth is possible after trichotillomania, but it depends on the extent and duration of the hair-pulling. Key points to consider:
> Short-Term Pulling: Hair often regrows if the pulling has been infrequent and of short duration.
> Long-Term Pulling: Prolonged and severe pulling can damage hair follicles, potentially leading to permanent hair loss.
> Treatment Impact: Effective treatment and cessation of hair-pulling can improve the chances of hair regrowth.
What Does Trichotillomania Look Like?
The following images were provided by Vancouver Trichologist, Mandy Robertson. This was a 30 year old female with trichotillomania Mandy explains. Her microscopic photos show irregularly broken hairs, redness/inflammation, and “v-sign” hairs. The “v sign” represents two hairs that were pulled at the same time and snapped off at the surface. They are found in over 50 % of patients with trichotillomania.
1. Shampoo: I would recommend washing your hair every other day. In areas where your scalp is more irritated/itchy, you can use an anti-dandruff shampoo, such as Nizoral or Vichy Dercos Anti-Dandruff Shampoo. To use, massage the shampoo into the affected areas and leave on for 2-3 minutes before rinsing. You can follow with a shampoo and conditioner of your choice. Once symptoms subside, you can reduce your use of the anti-dandruff shampoo to twice a week and eventually once per week.
2. Topical steroid cream: You can speak with your doctor about getting a prescription for a topical steroid cream, such as betamethasone. A thin layer of betamethasone can be applied to affected areas once per day. Topical steroids should only be used regularly for short periods of time (e.g. less than 4 weeks unless otherwise directed by your doctor).
3. Supplements: You can talk to your doctor about the possibility of taking n-acetylcysteine (NAC) supplements to help reduce urges to pull. Doses of NAC for trichotillomania in adults range from 1,200 to 2,400 mg/day. You can read more about using n-acetylcysteine for trichotillomania here: https://www.ncbi.nlm.nih.gov/pmc/
associated with trichotillomania.
4. Low-level-laser-therapy (LLLT): You can also consider using a LLLT device. When the scalp is illuminated by red laser, light energy is absorbed by the hair follicles, which increases their activity. As a result, the hair follicle spends a greater amount of time in the growth phase of the hair cycle, thereby slowing or reversing miniaturization and the progression of thinning. LLLT devices are also helpful at reducing inflammation in the scalp, which may be helpful for reducing scalp irritation/itching. Wearing the device at times when you would typically pull (e.g. while watching TV) may also be helpful.
5. Meditation/breathing: You may also find it helpful to incorporate a breathing or meditation practice into your daily routine. I have found the Insight Timer App to be helpful for guided breathing and meditation. You can also try Reveri, which is a self-hypnosis App.
6. Habit replacement therapy (HRT): Habit replacement has also been found to be helpful in reducing body-focused-repetitive-behaviours (BFRBs). You can read more about HRT here: https://clinical-neuropsychology.de/habit-replacement-en/#sthash.J6iQiYRi.dpuf, https://donovanmedical.com/hair-blog/habit-replacement-therapy.
7. Topical or low dose oral minoxidil: You can also talk to your doctor about the possibility of trying topical or low dose oral minoxidil to help stimulate hair growth.
Trichotillomania Summary
In conclusion, trichotillomania is a complex condition that can be managed with the right combination of therapy, medication, and support. Understanding the underlying causes and effective treatments can significantly improve the quality of life for those affected by this disorder.
References:
Mandy Robertson, Vancouver Trichologist
Dr. Blake Bloxham, New York Hair Transplant Surgeon
