Trichotillomania Explained Medical Course
How to Diagnose Trichotillomania
Trichotillomania is a hair pulling disorder. While some people bite their nails, twirl their hair, or pick at their skin, trichotillomania is a more extreme body focused repetitive condition that can interfere with one’s social, professional, or personal life.Trichotillomania is an impulse control disorder in which the urge to pull hair overrides any negative feelings associated with pulling hair or after effects, such as bald patches.It is especially common among children and teenagers, but can affect adults as well. If you believe you or your child or teen has trichotillomania, visit a medical doctor and mental health practitioner to receive a proper diagnosis.
Determining Physical Symptoms
Notice hair pulling locations.Trichotillomania is characterized by a persistent urge to pull out one’s body hair. Trichotillomania involves pulling out hair, yet is not exclusive to the hair on one’s head. You may notice the person pulling out eyelashes, eyebrows, pubic hair, or other body hair.
- Do notice the person pulling at body hair? Do you notice times when the person pulls all the hair from his eyebrows or eyelashes?
Observe patchy areas or bald spots.If the person pulls hair from the scalp, she may develop patchy areas or bald spots.This may lead to going to great lengths to hide or cover these areas, such as wearing hats or headbands or a bandana to cover the hair loss.
- The person may mindlessly pull her hair, then later realize large patches of hair are missing.
- Does the person often cover her head with hats or scarves and avoid taking her head coverings off?
Identify pulling patterns.Some people pull hair to relieve tension or distress. On the other hand, some people show automatic behavior, meaning they pull the hair without realizing what they are doing. This may happen when bored or preoccupied.
- Do you notice the person pulling his hair out while working, watching tv, or reading? Or does the behavior appear to have specific intent?
- Keep in mind that it doesn't have to be one or the other. Some people do both automatic and focused pulling, depending on the situation or their mood.
Look for the emergence of trichophagia.Trichophagia involves ingesting the hair and occurs in many people with trichotillomania. The person may chew or swallow the hair. This condition can have medical side effects, such as creating hair casts in the stomach or small intestine. These hair casts can cause problems such as anemia, bowel obstruction, GI bleeding, and other problems.
- People with trichotillomania and trichophagia may also play with the hair once it is pulled out, such as rubbing it on the face or across the lips.
Identifying Emotional Symptoms
Ask the person if she feels tense around pulling.A person with trichotillomania may feel tense before pulling her hair, or she may experience tension when she tries to resist pulling her hair.The feelings of tension may be related to another event or situation, or may arise from noticing the presence of the hair. Once fixated on the hair, the person may feel an intense urge to remove it.
- Does the person experience feelings of great tension before she pulls her hair? Once experienced, is it difficult to resist the urge?
- Watch the person in stressful situations and notice if she begins pulling her hair.
Observe relief or pleasure.Once the person has plucked the hairs, he may experience a release of tension, a sense of relief, or feelings of pleasure.The act of plucking or pulling the hair creates immense relief for a person with trichotillomania.
- Ask the person what feelings occur after he pulls his hair.
Assess for feelings of distress around hair pulling.The hair pulling behavior likely causes distress. The person may feel guilty or ashamed of pulling her hair, or want to hide the pulling behaviors or thinning hair. The person may fear how the trichotillomania interferes with work, school, social relationships, or other situations.
- Does the person often wear hats or other head coverings that hide bald spots?
- Does the person fear people finding out or discovering her secret and always hide her hair?
- Notice any guilt, distress, or shame around hair activities.
Note efforts to stop.Often people feel ashamed or guilty when pulling out the hair. People make efforts to stop pulling out the hair. Yet, the attempts are short-lived or the person may go back to pulling out the hair.Despite the efforts, people find it difficult to stop pulling out the hair.
- Ask the person if he has made promises to himself to stop, only to find himself pulling again. Has he tried try to deter himself from pulling or plucking with no luck?
Pinpointing Causes and Complications
Determine emotional triggers.For many people, trichotillomania is a way to deal with unpleasant or negative emotions. The person may pull her hair when she is stressed, frustrated, exhausted, lonely, or tense.
- Ask the person to notice when she pulls her hair. Does it often occur in tandem with a stressful event or unpleasant emotion? Does the hair pulling seem to be the way she deals with these emotions?
Observe family history.Sometimes, trichotillomania can show a genetic link in family members. If you suspect you or your child or teen has trichotillomania, try to think if you have a close relative with trichotillomania. This can sometimes be tricky if there is shame or guilt around the trichotillomania. You may be unaware if the person often covers up the evidence of trichotillomania.
- Reflect on the person's family members. Have you noticed any siblings, aunts, uncles, or cousins that show symptoms of trichotillomania?
Identify age of onset.It’s common for trichotillomania to onset in the child and teen years, most often between the ages of four and 17.However, trichotillomania has been observed in infants and adults.
- Although the condition can be long-term or lifelong, trichotillomania is seven times more common in children than adults.
- Ask yourself when you started noticing the symptoms.
Assess life impacts.If trichotillomania may cause the person to feel embarrassed or ashamed, and he may avoid social functions or activities. People hide the trichotillomania by wearing a wig, penciling in eyebrows, or wearing false eyelashes and fear being discovered. This can lead to social isolation and social distress in relationships.
Consulting with Professionals
Consult with a medical doctor.A medical doctor may evaluate the person to assess her symptoms and behaviors. The physician may look for causes, such as infection, or look for effects of the hair pulling, such as skin irritation or alopecia.
- The physician may run various tests to rule out medical causes, such as a dermatologic condition.
Have the person see a therapist.A therapist can assess and diagnose any mental or emotional causes to the hair pulling, specifically, trichotillomania. Once properly diagnosed, a therapist can support the person in working through the thoughts and emotions that accompany trichotillomania. The therapist and patient may discuss triggers, ways to cope with negative emotions, and finding more productive coping strategies.
- Therapy can be one way to examine a person's life and make changes. It can be encouraging to have a therapist alongside to support and encourage these changes.
Assess anxiety.Trichotillomania has been associated with feelings of anxiety. The person may feel tension or anxiety prior to hair pulling, then feel relief once he has pulled.Ask the person about how he handles stress and anxiety, and whether he relies on hair pulling to relieve feelings of anxiety. Are there other ways he handles anxiety? How effective are they compared to hair pulling?
Rule out body dysmorphic disorder.Body dysmorphic disorder involves thinking about one’s perceived flaws persistently, with intrusive thoughts about one’s body. The thoughts may become obsessive, and the person may seek extreme measures to “fix” the problem.If the person feels something is “wrong” with her hair, eyebrows, eyelashes, or other body hair, she may go to extreme measures to “correct” this perceived problem.
- When making a diagnosis, a mental health practitioner may rule out body dysmorphic disorder if the behavior is related to a perceived flaw.
QuestionI am at school and have this problem. If I am asked if I have cancer, what do I do?Top AnswererYou could explain what is happening, wear garments that cover your head, pretend you indeed have cancer to get some sympathy, get help treating the trichotillomania or ignore anyone who asks. Talking about what's on your mind is always a good idea. You can safely ignore anyone who is not respectful to you.Thanks!
Video: What is Trichotillomania (hair pulling disorder) & how do we deal with it? Mental Health with Kati
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