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Trichotillomania is classified as an Impulse Control Disorder and is characterized by the repeated pulling out of one's own hair or eyelashes and eyebrows. The pulling behavior may seem to be beyond the individual's control. This is a very common disorder that is often accompanied by a tremendous amount of guilt and shame; therefore it is usually very difficult for individuals struggling with this to receive treatment.
The disorder oftentimes affects people who are of high intelligence and high achieving. While outwardly they appear highly functional, sweet-natured and stress-free, they judge themselves harshly. They have a great deal of internalized anxiety that is relieved from the pulling behavior. A person with trichotillomania may exhibit some problems in focusing attention and coping effectively with stress. The pulling behavior relieves internalized stress that they may not feel free to express verbally. Symptoms of trichotillomania include:
People often start compulsive hair-pulling around the ages of 12-13; although it is not uncommon for it to start at a much younger or older age. Frequently, a stressful event can be associated with the onset, such as: change of schools, abuse, family conflict, or the death of a parent. Symptoms may also have a variable course in which the pulling behavior may stop for a period of time and re-emerge during a stressful period.
During adolescence, which is an especially crucial time for developing self-esteem, body image, comfort with sexuality, and relationships with peers of both sexes, teens may endure ridicule from family, friends, or classmates, in addition to feeling shame over their inability to control the habit. Therefore, even a small bald patch can cause devastating problems with development that can last life-long. Although many people with trichotillomania get married and carry on with their lives in a normal fashion; there are those who have avoided intimate relationships for fear of having their shameful secret exposed.
For many people with trichotillomania, there are symptoms of obsessive-compulsive disorder (OCD) such as compulsive counting, checking, or washing as well. There are so many similarities between hair pulling and other compulsive symptoms that some consider it a subtype or variant of OCD. This idea is supported by the tendency for the two problems to run in the same families and the fact that OCD medications can be helpful in treating trichotillomania.
Depression also frequently occurs in individuals with this illness. Other associated behaviors may include nail biting, thumb sucking, head banging, or compulsive scratching. Frequently, hair pullers also find they compulsively pick at their skin, which may also cause physical and emotional scarring.
The two methods of treatment that have been scientifically researched and found to be effective are behavioral therapy and medications.
In behavioral therapy, people learn a structured method of keeping track of the symptoms and associated behaviors, increasing awareness of pulling, substituting incompatible behaviors and several other techniques aimed at reversing the “habit” of pulling.
Although medications clearly help some people temporarily, symptoms are likely to return when the medication is stopped unless behavioral therapy is incorporated into treatment. Medications may help to reduce the depression and any obsessive-compulsive symptoms the person may be experiencing.
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