Life Style

Trichotillomania

By Nagaland Post | Publish Date: 7/15/2019 12:23:57 PM IST

 The word ‘Trichotillomania’ is an unfamiliar one to most and may sound Greek; interestingly enough, it has origins in the Greek language. Once considered to be a rare mental illness, studies now indicate a much higher prevalence rate.  Trichotillomania is characterized by repetitive pulling out of hair on one’s body, causing hair loss and functional impairment. There may be attempts to decrease the hair pulling and the behaviour itself causes significant distress to the individual. 

The hair pulling can occur in any part of the body but is most frequently observed in the scalp region followed by the eyebrows. Thus, it is also known as hair pulling disorder. People are more likely to pull their hair when alone or engaging in sedentary activities (watching tv, reading a book or talking on the phone) while being able to avoid engaging in this behaviour is social situations. 
The illness is seen more commonly in females; onset usually occurs in adolescence. There may be certain triggers to the hair pulling behaviour such as sensory (physical sensations, thickness of the hair, and length), emotional (stress, anxious, angry, or feeling bored) or cognitive (thoughts about appearance, errors in cognition). There is also a large section of people with Trichotillomania who report that the hair pulling is more automatic in nature. In case of ‘automatic pulling’ the individual is unaware that he/she is engaging in the behaviour; in case of ‘focused pulling’ the individual reports a sense of tension which is relieved by the act of hair pulling. Some behavioural patterns may precede the behaviour such as combing through the hair, feeling the hair, play with the hair between their fingers and so on. There is also a subset of people who ingest the hair pulled, increasing the risk of gastrointestinal complications. The major focus with regard to Trichotillomania is the functional impairment it causes which leads to decreased quality of life. Adults suffering from Trichotillomania report difficulties in work as also social functioning; absence from work is also common. 
For adolescents, the illness may be very disabling and may have an adverse impact on their social and emotional development. Adolescents are often concerned about negative evaluations and peer rejection which can then impact self esteem and identity formation. The hair pulling may be so persistent that the individual has to resort to using various methods of concealment such as scarves and wigs. Often, the first point of contact for many is a dermatologist.  However, any intervention designed to help the individual needs to address underlying psychological issues.  Information concerning the cause is scarce but some studies have indicated a familial link. Multiple family studies have reported increased rates of Trichotillomania in first degree relatives. Psychological theories have suggested that the hair pulling may regulate emotional states/stressful states. 
The hair pulling behaviour may provide temporary relief from negative experiences and this relief may continue to maintain the behaviour. Anxiety as a state may play a significant role in the pathophysiology of Trichotillomania. 
Clinical intervention is essential as it can target the symptoms as also the functional impairment. Psychological therapy most commonly used is Habit Reversal Training (HRT). HRT has three major components- awareness, competing for the response, and social support. In the initial phase, the person is trained to be aware of the hair pulling behaviour as also of the triggers associated with the behaviour. 
The awareness is gradually reinforced. Following this, a competing response is introduced. A competing response is an action the individual engages in which makes it difficult for them to perform the hair pulling behaviour. Social support from family members and friends can serve as an encouragement as also a reminder. Pharmacological management is also available. 
Early intervention is the ideal, especially considering that the onset in majority of the cases occurs during adolescence. Family members ought to provide a supportive atmosphere, one that supports help seeking behaviour. Trichotillomania is a mental illness and can be treated. 
Parvathy Nair, Clinical Psychologist, nairparo@gmail.com

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