truly be one of the medical mysteries of our time because there is really no
deciding factor in why it exists to begin with. Unquestionably doctors and
scientists know what it is and in many cases can control it with behavior
therapy or medications but why the repetitive activity occurs is quite
perplexing. The disorder may have its anchors in genetics or some neurological
disorder yet unexplained. If anything it has similarities to Tourette’s
syndrome but the explanations for that have been studied for many years. Plus
with trichotillomania there is some degree of self-control involved because the
individual will often engage in the behavior only when alone as compared to
other neurological tics. On the other hand though the individual is seemingly
quite powerless to stop it which may arise from a conditioned response or
repetitive brain signals. Regardless of this many medical abnormalities can only
be treated by focusing on symptom reduction to control the disorder.
What is Trichotillomania?
Well it’s essentially classified as an impulse
control disorder or tic where the individual has an irresistible urge to engage
in the pulling or plucking of hair on the scalp but can involve hair anywhere on
the body. Even though it has been associated with obsessive compulsive disorders
(OCD) where there is a rise in psychological tension prior to the behavior and a
reduction in this tension after the plucking there are many cases that
completely defy this theory. The simple reason why is some people are totally
unaware they are even engaged in the behavior similar to those who chew their
fingernails. What’s even more baffling is the disorder can occur in any age
group but is most controllable in young adults or children.
The term trichotillomania was first coined in 1889
by the French dermatologist Francois Henri Hallopeau and essentially means “hair
pulling mania.” There are records of this hair plucking behavior dating back
to the ancient Greek physician Hypocrites.
Causes of Trichotillomania
Theories and research as to what triggers this
disorder are abundant and in many cases the origin might be found in multiple
disciplines. What is clear though is many individuals suffering from this
disorder often experience anxiety, depression, and other obsessive-compulsive
behaviors. Some of this could result from the individuals’ fear of being
discovered or the belief that it is not an appropriate activity to engage in to
begin with. Other theories range from stress triggering the hair pulling to the
idea it is just another form of addiction. Even though trichotillomania has
similarities to some neurological orders it equally expresses itself as being
atypical. Plus even though some theories espouse this disorder as originating
from genetics or even the size of the brain none of this has ever been
scientifically proven over a large number of cases.
Trichotillomania may be difficult to diagnose
because if the individual has escaped detection through their teenage years then
they likely have established methods in adulthood for it to go undetected or
unobserved. In other words the activity has likely become entrenched. Camouflage
techniques have likely emerged ranging from hats and wigs to eyeliners that
disguise eyebrow plucking. Often times though the activity is caught in the
earlier years when the individual or parents expose the activity to a
The typical dermatologist unless they specialize in
the disorder will first rule out any other scalp disorder or infection that
might be present. This can include patchy baldness such as alopecia areata, the
telogen effluviums, traction alopecia, or infections like tinea capitis. The
distinction with these conditions can be quite evident because with
trichotillomania the hair cannot be easily pulled out as with some of these
conditions. A biopsy may be performed but usually the condition exhibits itself
with dried blood, redness of the scalp from recently pulled hair, empty follicle
openings, malformed hair from the twisting, or just the typical uneven hair
growth. All of this is readily observable to the trained eyes of a doctor with
an overhead lamp and magnifying platform.
Symptoms of Trichotillomania
· An overwhelming urge to pluck or
pull hair from any part of the body.
· Patchy bald spots or uneven hair
growth exhibited mainly on the scalp or eyebrows.
· Camouflaging of the affected areas
with hats and wigs.
· A tremendous sense of relief or
fulfillment once the hair is plucked.
· Continually playing with, chewing,
or even swallowing of the hair that has been plucked.
· Bowel blockage if the individual
is swallowing the hair.
The chief complication to the physical body tends to
be infection that is rooted in the hair pulling. The psychological and social
impact of the disorder can be immense with lowered self-esteem and withdrawal
from normal activities. That alone may result in the sufferer harming themselves
because of their inability to control the situation. Also quite a few
individuals who pull their hair and chew on it have a tendency to eventually
swallow it. This can lead to serious intestinal blockage which requires
admission to a hospital.
Trichotillomania can affect any age group or sex but
after young adulthood ninety percent of the sufferers are likely to be women. If
caught in the early childhood years the affliction tends to be self-limiting.
The cure at that point seems to be parental discipline or the proper referral to
medical specialists. It goes without saying that most habits, if it is just
that, can be trained out of an individual in the formative years or in the early
stages of developing a repetitive routine. Unfortunately with most patients over
the age of thirty this disorder tends to be a lifelong event.
Treatment for Trichotillomania
Treatment approaches for this disorder can involve a
variety of methods ranging from support groups to behavior modification and
medications. Alternative therapies can encompass yoga, hypnosis, prayer,
meditation, herbs and vitamins, and nutritional changes. In regard to
medications the drug of choice among physicians is Anafranil (clomipramine)
which is one of the older anti-depressants in the tricyclic group. None of the
Serotonin Reuptake Inhibitors have shown themselves to be as effective as the
mentioned. The problem with the drug route is many times it seems to work
initially but the gains tend to be temporary though some do experience a long
term cure. Because of this specialists feel a combination of medications and
behavioral therapies is the best answer. Habit reversal training has shown great
promise if the symptoms are caught early enough. N-Acetylcysteine has shown
promise as a dietary substance for control of the symptoms and opens the door to
many possibilities for natural treatments that have not been pursued.
Trichotillomania will likely remain a baffling
medical anomaly in the foreseeable future and remain categorized among the many
obsessive-compulsive disorders. Even among the many people who suffer from
trichotillomania it is generally recognized that without widespread exposure
research funding for a cure will likely remain limited. Plus due to the fact
many choose to conceal the symptoms we would tend to agree. Without a doubt the
emotional, mental, and physical strains of this condition are immense.
MALE AND FEMALE THINNING HAIR