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If you have a compulsion to pull your own hair, resulting in hair loss, you may suffer from trichotillomania. Here we explain what it is and how it can be treated.

What is trichotillomania?

Trichotillomania involves repeated hair pulling resulting in hair loss. The hair pulling can be done from all parts of the body but the most common areas are the eyebrows, eyelashes, scalp, and genitals. Often people look for hairs that stick out but they can also pull hair from other people or objects such as clothes or toys. They may watch, play and/or swallow hairs. Adults and children can be affected but for children it is particularly important to seek help as swallowing hair can be dangerous.

The cause of trichotillomania is a combination of genetic and environmental factors. Often people try to stop the behaviour without success and may feel bad about it. It can affect the way they function at school and work. Trichotillomania can co-exist with other mental health problems such as anxiety, depression, dysmorphophobia, obsessive-compulsive disorder (OCD) and autism spectrum disorder. Self-harm is usually intended to harm oneself, so it is different from trichotillomania.

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How common is trichotillomania?

Studies of adults have shown that between 0.6% and 3.4% of people suffer from it. Trichotillomania is ten times more common in women than men. There are currently no studies on how common it is in children and adolescents, but the problem does exist.

Trichotillomania in ADHD

Studies have shown that trichotillomania is more common in people who have ADHD and ADD. People with neuropsychiatric problems and trichotillomania have been found to be more impulsive. If you suffer from this, it is important to seek separate help for trichotillomania, as the diagnosis does not improve with treatment for ADHD alone.

Symptoms of trichotillomania

If you suffer from trichotillomania, you might have often tried to stop the behaviour, and noticed that it affects your school or work, causing distress. About 80% experience an inner tension that is released with the pulling. Here are some more symptoms:

  • Before beginning the act of hair pulling, you may experience feelings of anxiety or restlessness, among others.
  • Twitching can be done both consciously and unconsciously. It usually occurs in front of family members but not in front of strangers.
  • Hair is most commonly pulled from the scalp, eyebrows, eyelashes, and genitals, but can also be pulled from toys or other people.
  • People look for a particular hair to pull and may examine, play with, or swallow the hair.

If you recognise the symptoms of trichotillomania, you may want to seek help. For milder symptoms, we have psychologists at Lavendla who can help you. If you have more severe problems, it is good to seek help via specialist psychiatry. Below you can read more about what treatment can involve.

Treatment of trichotillomania

The most effective treatment for trichotillomania is Cognitive Behavioural Therapy (CBT). Treatment can be combined with stimulus control and Habit Reversal Training (HRT). HRT can be combined with Acceptance and commitment therapy (ACT) or Dialectical behavioural therapy (DBT) which studies show is helpful. Follow-ups are important after treatment to ensure that the effect is maintained over time.

HRT treatment consists of three parts:

  1. Mindfulness training
  2. Countermovement training
  3. Social support

Work is also done on stimulus control, which means dealing with situations where hair pulling often occurs. To reduce twitching, you can cover mirrors, change to dimmer light bulbs, avoid chairs with armrests, or use gloves in certain situations. Trichotillomania is a condition that varies in severity from mild to severe. For milder problems without great suffering and/or reduced function, you can go into treatment with a licensed psychologist or CBT therapist at Lavendla. If you have more severe problems, you should contact your GP for a referral to psychiatric care. In terms of medical treatment with drugs, not enough research has been done to recommend this.

Seeking help can change your life

Trichotillomania is not something you have to deal with on your own. Talking to a licensed psychologist can help you understand your condition better and offer effective ways to deal with it. You are not alone and it is okay to ask for help. Lavendla has qualified therapists and psychologists available to help you escape these behaviours.

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Common misconceptions about therapy

Many people believe that therapy is only for ‘serious’ cases or that seeking help is a weakness. These are misconceptions as therapy is a step toward improvement. Lavendla makes the difficult easier by connecting you with qualified therapists and psychologists through our website.

Your next step

If you or someone you know is struggling with trichotillomania, it’s a good idea to talk to a professional therapist or psychologist. Lavendla’s therapists and psychologists are qualified and your conversations are always strictly confidential. Don’t be afraid to take that first step.

Living with trichotillomania can be a daily struggle but there is help available. With the right support and tools, you can significantly improve your quality of life. If you are ready to take the plunge, we are here to support you. Book your first session today and start your journey towards a better future.

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12 frequently asked questions about trichotillomania

What is trichotillomania?

Trichotillomania is described by repeated hair pulling resulting in hair loss. Hair can be pulled from all over the body, but the most common areas are the eyebrows, eyelashes, scalp, and genitals.

How is trichotillomania diagnosed?

A diagnosis of trichotillomania is usually made by a psychologist or psychiatrist through various tests and assessments. This may include questionnaires and clinical interviews.

Is trichotillomania hereditary?

Research shows that trichotillomania may have a genetic component but it is not the only factor. Environmental factors also play a role.

What are the symptoms of trichotillomania?

Symptoms are hair pulling from all over the body, the most common body parts are eyebrows, eyelashes, scalp, and genitals. People often look for hairs that stick out, but they can also pull hair from other people or things such as clothes or toys. They often watch, play and/or swallow hairs.

How is trichotillomania treated?

Treatment can include Cognitive Behavioural Therapy (CBT) with a specific habit reversal training (HRT) and stimulus control which is particularly effective. It can be helpful to combine treatment with Acceptance and commitment therapy (ACT) or Dialectical behavioural therapy (DBT).

Is there a cure for trichotillomania?

With proper treatment, symptoms can improve significantly but it is important to monitor results over time.

Can children get trichotillomania?

Yes, children and teenagers can also be affected. It is important to seek professional help as soon as possible for the best possible treatment outcome.

How common is trichotillomania?

Studies of adults have shown that between 0.6% and 3.4% of people suffer from the condition.

Does trichotillomania affect the ability to work?

In severe cases, trichotillomania can lead to work disability. However, it is possible to return to normal function with proper treatment.

Is trichotillomania more common among women or men?

Trichotillomania is ten times more common in women than men, according to research.

Can you have other problems at the same time as trichotillomania?

It is common to have other psychological conditions such as anxiety, depression, dysmorphophobia, obsessive-compulsive disorder, autism, and ADHD. It is important to get an assessment by a licensed professional.

How do I get help with my trichotillomania?

Lavendla has experienced psychologists and therapists working with CBT who can help you feel better if you have mild symptoms. If you have more severe symptoms, you can contact your GP for a referral to a specialist psychiatrist. In an acute mental health crisis, call 111 or visit 111.nhs.uk immediately.

What does treatment for trichotillomania involve?

Seeking help is a big step towards better health, it’s a positive thing to decide to take control of how you feel. Here is an overview of the steps typically involved in treatment for trichotillomania.

Step 1: An initial assessment session

The first meeting with your psychologist or therapist is an assessment of your mental and physical health. You may be asked questions about your life situation, feelings, thoughts and behaviours. You may also be asked to complete assessment forms.

Step 2: Goal setting

This is where you and your therapist set concrete goals for the therapy, both short- and long-term.
It can define which areas of your life are most affected by your well-being and how you would like to change them.

Step 4: Treatment with different techniques and tools

This is the actual treatment phase, which involves exercises aimed at giving you tools to overcome your problem. Habitual reversal training (HRT) and stimulus control are often used.

Step 5: Monitoring and evaluation

Treatment is monitored regularly to see how well the therapy is working. If necessary, the treatment plan can be adjusted or renewed.

Step 6: Ending and looking ahead

As the therapy comes to an end, it is time to reflect on the progress made. You will also receive a maintenance plan for how to use the tools and strategies you have learned. It is important to monitor the results over time.

If you or someone close to you is looking for professional help, don’t hesitate to book a session with one of our licensed psychologists or therapists.

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Written by dominic

Dominic is a Cape Town-based copywriter and editor with a background in psychology.