A hair-pulling disorder

Sometimes we get so worried and stressed that we joke we want to tear our hair out. But for people with trichotillomania, the urge is literal.

A mental health condition characterized by the frequent, irresistible impulse to yank hair from the scalp, eyebrows, eyelashes, or anywhere else on the body, trichotillomania often results in patchy bald spots. It’s one of a group of disorders known as body-focused repetitive behaviors, which also include skin picking and nail biting.

For some, trichotillomania is mild; for others, it’s all-encompassing, disrupting their jobs, social lives, and relationships. And for women, especially, furtive efforts to conceal the lost hair with creative hairstyles, wigs, hair extensions, false eyelashes, or makeup to draw in missing eyebrows is part of the picture.

“Because of the embarrassment, some people won’t socialize or take promotions at work because they don’t want to be in front of people,” says psychologist Nancy Keuthen, director of the Trichotillomania and Excoriation Disorder Program at Harvard-affiliated Massachusetts General Hospital.

“People cope differently,” she adds. “But more often than not, for females in our society, their hair is their crowning glory, so they don’t want it to be thin or coarse or have uneven lengths.”

Who’s most affected?

Chronic hair-pulling has been a phenomenon since ancient times, though its current name wasn’t coined until the latter part of the 18th century.

But while it’s surprisingly common, there’s still limited awareness of the condition, Keuthen notes. About one in every 50 to 100 people has trichotillomania, which was once estimated to occur far more often in women than in men. But its true incidence is difficult to pinpoint since those affected often hide it, Keuthen says, and recent re-search suggests women and men are equally affected.

Women are certainly diagnosed and treated more often, she says. “Even if it’s occurring almost equivalently in women and men, the shame and isolation among women is probably greater,” says Keuthen, also an associate professor of psychology at Harvard Medical School.

Other mental health challenges may accompany trichotillomania, such as anxiety, depression, or obsessive-compulsive disorder (OCD), attention deficit disorder, or substance abuse. “It’s called an OCD spectrum disorder — a kissing cousin, if you will,” Keuthen says.

Typical triggers

What drives persistent hair-pulling? People with trichotillomania may resort to the behavior when faced with specific stressors such as tension, loneliness, or fatigue. They might also tug their hair out absent-mindedly during humdrum daily activities. Some can feel an increasing sense of tension that builds until they pull the hair, then a feeling of re-lief.

“It can be done to regulate anxiety and anger as well as other emotions, like boredom,” Keuthen says. “And if you’re anxious, it can calm and soothe you.”

Specific types of hair may also be targeted, such as unruly strands on the crown, arm hair, or even pubic hair. People with trichotillomania may tug it out in certain patterns or in step-by-step fashion. After pulling, some of them bite, chew, or eat the strands or rub them across their face or lips. “Some are looking for an intact hair root to pull, almost like pulling the weeds in gardening,” Keuthen says.

Long-term effects

But trichotillomania doesn’t necessarily affect only hair growth. Repeated pulling can lead to scarring, infections, and other damage to skin and hair follicles. Some people develop carpal tunnel syndrome, a painful condition in the hands and fingers, from repeatedly using their hands to pluck; others develop neck and back muscle problems from constantly twisting themselves into unusual positions. Itchy skin is common.

People who eat their torn-out hair can develop large, matted hairballs that get stuck in the digestive tract — a potentially serious issue. “Hairballs can be fatal if they’re blocking the gut,” Keuthen says.

If you happen to tear your hair out, when is it time to see a doctor? Once you feel you can’t control the action, Keuthen says. Use a paper notebook or an app to log when it happens, what you’re thinking about, and how you feel in that moment. Then share this information with your doctor.

Various treatment approaches can hinder the hair-pulling urge or stop it completely. Cognitive behavioral therapy (CBT) is considered essential to combat the condition, and medications may also help.

“If it’s happening repeatedly and you can’t control it — if it’s taking a bite out of your life, physically or emotionally — it’s worthwhile to get it evaluated,” Keuthen says.

Image: © Ekaterina Demidova/Getty Images