The nosological location of this particular condition has always created problems for the community of scientists and doctors who have been involved in studying and describing it. Contrary to when it happened in the past, when trichotillomania (or hair pulling disorder) was considered a disorder related to impulse discontrol, nowadays it is believed that trichotillomania brings with it some characteristics typically observable and attributable to the sphere of obsessive manifestations -compulsive. Although there are no real obsessions, it is believed that the behavioral manifestations of trichotillomania can be considered and treated as real compulsions.
What are the distinguishing features of this condition and how does it manifest itself?
According to the APA, the individuals who suffer from it are characterized mainly by the use of hair pulling behavior and by repeated attempts to reduce or prevent such behaviors. This is often combined with a sense of discomfort that accompanies this condition both for the awareness of suffering from it and for the negative effects and limitations it entails on a functional level and in daily actions. The areas most frequently affected by tearing behaviors include the scalp, eyebrows, eyelashes, but also all kinds of hair from different parts of the body: for example, from the limbs, chest, pubis, beard or mustache. Some people can pull whole handfuls of hair, while others pull out one hair at a time. Moreover, after plucking the hair many people can take pleasure in inspecting the hair and its root, spending time playing with it, smoothing it or holding it between their lips or teeth. Sometimes the plucked hair and hairs are carefully stored in safe places, or stuck to the mirror. An important aspect concerns the fact that more than half of these people exhibit oral behaviors following the tearing, which may also include chewing and ingestion, with consequent medical complications related to the formation of trichobezoars, clusters of hair that must be removed. surgically from the digestive system. While some individuals engage in such behaviors consciously, a large proportion of individuals tend to do so without noticing what they are doing. often while doing other particularly absorbent or boring activities, such as studying, reading or talking on the phone. Some people with trichotillomania report particular sensations in their scalp. One of the most frequent is the tingling sensation, which can only be relieved by pulling out the hair, similar to when it comes to the relief of scratching the itch. Rarely, however, those suffering from trichotillomania report pain sensations associated with the tear. similar to when it comes to the relief of scratching the itch. Rarely, however, those suffering from trichotillomania report pain sensations associated with the tear. similar to when it comes to the relief of scratching the itch. Rarely, however, those suffering from trichotillomania report pain sensations associated with the tear.
What negative consequences can this have?
As for the physical consequences they can have:
- bleeding and infections of the scalp or skin;
- difficulty in regrowing hair;
- damage to the dental apparatus and formation of trocobezoars in us manifested oral behaviors associated with the tear, resulting in nausea, abdominal pain, obstruction and possible perforation of the intestinal walls;
As for the psychosocial consequences, individuals suffering from trichotillomania may be forced to avoid situations and activities related to public places where the physical signs of the disorder may be more evident or difficult to conceal. This leads to a progressive avoidance of situations in the sports, occupational / school and relational fields, with a consequent deterioration in the quality of life.
How common is trichotillomania?
Trichotillomania has often been considered a rare condition and there are relatively few studies that have investigated this phenomenon. However, reality is changing thanks to a better understanding of the phenomenon and an increase in requests for help from those who suffer from it. Prevalence within the general population is still not fully understood. The percentages vary around 0.6 up to 1-2% if the characteristics proposed in the DSM are considered for diagnostic purposes, up to percentages of 10-15% if the inclusion criteria become less restrictive and individuals who manifest only the main characteristics of the disorder.
What appears clearer, however, is the male and female ratio, for which a strong imbalance (1: 7, approximately 1:10) was found to the disadvantage of the latter. This is especially true for adolescents and adults, while for children the trend seems to reverse, with a higher prevalence in males than females.
Trichotillomania is often found associated with other disorders such as excoriation disorder and depression . Sometimes the clinical picture may merit further diagnosis of obsessive compulsive disorder .
At what age can trichotillomania arise?
Trichotillomania generally begins in adolescence or childhood. In the latter case, some hair pulling or manipulation behaviors may be frequent, but tend to be transient. Should they persist, the advice is to seek the advice of an expert. The introduction of small precautions in the child’s daily life and the application of simple principles of behavior modification can be sufficient in itself to quickly extinguish these bad habits, avoiding the risk that they can turn into a serious problem.
Why do people start pulling their hair out and can’t stop anymore?
It is quite difficult to understand why people, at some point, start pulling their hair and fail to stop despite the undesirable aesthetic consequences and repercussions in daily life. Those who deal with trichotillomania do not yet know for sure what can cause it. The most plausible hypothesis is a learning story about a biological vulnerability. Beyond the possible causes, what we do know is that over time these people become particularly sensitive to particular stimuli (eg mirrors, tweezers or particular emotions) that trigger tear-off behavior. We also know that there are specific maintenance factors (eg the sensation of relief following tearing) that interact in a complex way, favoring the repetition of these behaviors. Such factors,
What can be done to solve the problem?
Trichotillomania is a problem that most people cannot overcome simply by forcing themselves to stop. They usually need the help of medical specialists and behavioral therapists before they can stop the ripping behavior. With expert help, however, the odds of success are high. Treatments usually involve cognitive and behavioral therapy, medication, or a combination of both. In cognitive and behavioral therapy, after a thorough initial evaluation, the first step is to help the person acquire a greater awareness of the stimuli, events and situations that trigger the jerk behavior. Once these elements have been identified, the person learns how to modify or delete them, for example, making objects used for tearing, such as tweezers and mirrors, less accessible and available, or employing distraction techniques. This means that the opportunities for environmental stimulation and induction are reduced, favoring and facilitating attempts to resist tearing behaviors. In order for these elements to be collected, the person may be asked to fill in a sort of diary of the tear episodes. In the event that the episodes are triggered by intense emotions, the therapist will train the person to use relaxation or self-regulation techniques that have the purpose of reducing tension. In the more automated forms, on the other hand, tasks to be carried out that keep the hands busy, or actions incompatible with ripping may become useful.
How to deal with relapses
As can happen with many ailments, a person can experience relapses after a treatment and must therefore be prepared for the eventuality of this happening. Being prepared means being trained to recognize the early signs of a relapse in order to be able to avert any crisis in the bud. It is of fundamental importance that the person knows how to assume an honest and accepting attitude in the face of what is, in fact, a normal occurrence; thus avoiding falling into total despair. A relapse does not at all indicate that the previously obtained results are completely lost, nor that the disorder has returned to threaten one’s well-being. In reverse, it represents an opportunity for testing in which the person can put into practice everything he has learned during therapy. The relapse prevention program is a fundamental and integral part of the treatment of trichotillomania. In case of difficulty in managing the situation, the person can still count on the help and support of the therapist, who will evaluate together with the person whether to resort to a short cycle of additional sessions.