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If you have a problem with compulsive hair pulling on different parts of your body, you may suffer from trichotillomania. This is a condition that can be helped. 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 over 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 and if you are a child 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 have tried to stop the behavior without success and may feel bad about it, which can also affect their functioning 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 often aimed at harming oneself and is therefore different from trichotillomania.

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How common is trichotillomania?

Current research estimates that 1-2pc of the population has this disorder so it affects one to two people in every 100 in Ireland.

Trichotillomania in ADHD

Studies have shown that trichotillomania is more common in people who also 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 this diagnosis did not improve with treatment for ADHD alone.

Symptoms of trichotillomania

If you suffer from trichotillomania, where you have compulsive hair pulling, you have often tried to stop the behavior. They may have noticed that it also affects their school or work, causing them distress. Around 80% experience an inner tension that is released with the pulling. Here are some more symptoms:

  • Before beginning the behavior 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.
  • It is most commonly from the scalp, eyebrows, eyelashes and genitals, but can also be 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 Behavioral Therapy (CBT). Treatment techniques have also been combined with stimulus control and Habit Reversal Training (HRT). HRT has also been studied with the addition of Acceptance and commitment therapy (ACT) or Dialectical behavioral therapy (DBT) and has been helpful. It has been found that it is important to follow up the 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.

There is also work on stimulus control, which means dealing with situations where hair pulling often occurs. To reduce twitching, you can, for example, 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 moderate to severe. For milder problems where you do not experience such great suffering and/or have reduced function, you can go into treatment with a licensed psychologist or CBT therapist at Lavendla. If you have more severe problems, you should primarily be treated in specialist psychiatric care and then you can go to your health center to get a referral. In terms of medical treatment with drugs, there is not yet enough research to be able to give a recommendation on medication.

Seeking help can change your life

Trichotillomania is not something you have to deal with on your own. Talking to a licensed psychologist can not only help you understand your condition better but also offer effective ways to deal with it. You are not alone and it is okay to ask for help. On our website, we have qualified therapists and psychologists who are happy to help you get out of these behaviors.

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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. In both cases, these are misconceptions. Rather, therapy is a step towards improvement and we make the difficult easier by connecting you with qualified therapists and psychologists online and onsite.

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. We assure you that all therapists and psychologists on our platform are qualified and that your conversation is always confidential. Don’t be afraid to take the 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 means repeated hair pulling resulting in hair loss. The hair pulling can be done 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 but the most common 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 like clothes or toys. They often watch, play and/or swallow hairs.

How is trichotillomania treated?

Treatment can include Cognitive Behavioral Therapy (CBT) with a specific Habit reversal training (HRT) and stimulus control which has been shown to be particularly effective. It may also be helpful to add Acceptance and commitment therapy (ACT) or Dialectical behavioral 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 internationally have shown that between 0.6% and 3.4% of the population are diagnosed.

Does trichotillomania affect my ability to work?

Yes, 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 also 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?

At Lavendla, we have 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 health center to get a referral to a specialist psychiatrist. If you have thoughts of self-harm or suicide, contact 112 or the nearest emergency department.

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 behaviors. 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 wellbeing and how you would like to change them.

Step 3: 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 4: 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 5: 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 in the future. It is also 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 Ellen Lindgren

Licensed psychologist

Ellen is a licensed psychologist and has experience mainly in clinical psychology where she has worked with various conditions such as stress, anxiety, depression, insomnia, crises and trauma in primary care and psychiatry. She has also worked with research while studying in the US and with affective disorders and insomnia at Karolinska Institutet, Sweden.