General Information About Trichotillomania
Disease Details and Frequently Asked Questions
It is an impulse control disorder characterized by the continuous and repetitive plucking and pulling of hair from the scalp, eyebrows, or eyelashes with one's own hands, severe enough to create bald patches (alopecia).
In dermatological conditions like Alopecia Areata (spot baldness), hair falls out 'spontaneously' in oval patches and is treated by a dermatologist.
In Trichotillomania, the HAIRS ARE HEALTHY; they do not fall out. The individual PLUCKS them out deliberately by winding them around their fingers. It is a psychiatric condition. In the plucked areas, hair follicles (broken hair shafts) of varying lengths are typically observed.
Prior to pulling, an agonizing sensation of 'itching' or tension accumulates in the brain. When the individual pulls the hair from its root (and experiences that sharp physical pain), the brain secretes 'Endorphins' (the relaxation/pleasure hormone), much like taking a narcotic. This transient relief is so addictive that whenever the patient experiences stress, they continue to pull their hair to recreate this pleasurable sensation.
A subset of Trichotillomania patients (10-20%) chew and SWALLOW the hair strands they pull, or the white membrane (bulb) at the root (Trichophagia). The human stomach cannot digest hair. Over years, these ingested hairs accumulate in the stomach and intestines, forming a massive, stone-like concretion known as a 'Trichobezoar (Hairball)'. This giant mass, which completely obstructs the stomach, must be removed via emergency open surgery.
When the individual who impulsively pulls their hair sees their bald scalp in the mirror 5 minutes later, they experience profound remorse, shame, and self-disgust (depression). To conceal the baldness, they wear hats, wigs, or beanies in both summer and winter. Fearing that people will stare at their hair (and think they are 'crazy'), they become unable to go to the hairdresser, attend school, or even step outside (especially in windy weather).
The patient must consult a PSYCHIATRIST, not a dermatologist.
1. Pharmacotherapy: High-dose Antidepressants (SSRIs), utilized in OCD treatment to suppress impulses, are prescribed to balance serotonin levels in the brain, thereby blunting the 'urge to pull'.
2. Psychotherapy (The Golden Key): Medication alone is insufficient. Habit Reversal Training (HRT) is implemented. The patient is taught that at the very first moment they feel their hand moving toward their hair (awareness), instead of pulling, they should clench their fist, squeeze a stress ball, or hide their hands between their legs (competing response). Through this, the brain discovers a new pathway for relief and breaks free from the hair-pulling addiction.
Our health library contents are prepared for informational purposes only and with scientific data available at the time of recording. For all your questions, concerns, diagnosis, or treatment regarding your health, please consult your doctor or a healthcare institution.
