Blogathon Kick-Off: What the heck is Trichotillomania?
Trichotillomania = Compulsive Hair Pulling
ABC News deemed Tricholtillomania “A True Medical Mystery”, a disorder that researcher’s can't seem to place, approximating it somewhere between Obsessive Compulsive, Body Image and Impulse Control.
I'll never forget my first trip to the psychologist about this. She barely knew how to say the disorder, let alone what it really was. I remember seeing her frantically leaf through her disorder books, thumbing from one categorization to another until landing on impulse-control disorder. She read aloud, " ...An inability to resist the impulse to perform an action that is harmful to one's self or others. Like... kleptomania, pyromania, compulsive gambling. Et Cetera."
I think we’re all familiar with the image of a crazy woman, pale as a sheet, eyes sunken in, ripping out her hair in a frenzy. While it has never been given as much attention as other mental illnesses like anorexia or depression, it makes its cameo in bits and pieces, the occasional song lyrics, the occasional novel. I was surprised to find a reference in the Bright Eyes Song, Haligh Haligh a Lie Haligh:
Aside from being a particularly dismal song, the lyrics say, "As you tear and tear your hair from roots / From that same head that you have twice removed."
Beyond it's representation in history and culture, the actual disorder itself occurs in a very different context, one that is daily, rhythmic and generally unstoppable. In its essence, hair pulling resembles any nervous habits like nail biting or cracking one's knuckles (See: Trichotillomania's relationship to nail biting and other disorders). But I for one, do all of these things, and Trichotillomania is by far the most devastating.
Each hair-puller's story is slightly different. Some people begin pulling as children, some as teenagers, some as adults. Some people pull only the hair on their heads, others pull eye lashes, eyebrows and pubic hair. It's common to cast the hair away after pulling while others examine the roots, place the roots into their mouths and eat them, and some people eat the entire hair, another related disorder called trichophagia (See: BBC Special on Trichotillomania). At times, people pull hair out in a trance-like state, others stand in front of the mirror and inspect for hairs to pull out with tweezers. The most logical, physical result of this compulsion leads to noticeable hair loss. Other results include dangerous hair balls that clog the intestinal tract (See: Surgeons Remove Ten-Pound Hairball From Teen Girl's Stomach), tendinitis caused by repetitive motion, and sometimes wearing away of the enamel of the teeth.
The disorder ranges in severity, as well. Some people can't stop pulling, their compulsion is so intense that they pull every single hair off of their heads. Others produce small bald spots, others pull from all over and can better hide the condition. Those who are in the middle may have enough hair to cover up the bald spots or be able to find styles that look relatively normal.
For me, at least, the compulsion stems from a desire to "get rid of bad hairs," only pulling hairs that feel shorter, thicker, curlier or different from the others. This selective behavior aligns mostly with the of Obsessive Compulsive Disorder categorization. It is thought that Trichotillomania is a grooming mechanism gone awry, but it's not that simple, either. A puller may do it because he or she is bored, tired, stressed, depressed, pre-menstrual, angry... the list goes on. While there's no exact formula for hair pulling, clinicians have seen that pullers feel that they release a tension with their habit, that they use it as a coping mechanism.
When you go beyond the physical implications of the disorder, a hair-puller is left with feelings of guilt, frustration and isolation for something they cannot control. Many sufferers feel intense shame about the condition, hiding it from their families, friends and partners. It's often co-morbid with other factors such as depression, anxiety and high-levels of stress.
In the last few years, Duke released a study that linked Trichotillomania to a faulty gene, once linked to Tourette's Syndrome (See: Duke Study). While I have encountered different statistics, it is thought one to two percent of the population is affected, equaling about "four to eleven million Americans" (TLC, see link below).
There's no simple cure for the disorder. Antidepressants, anti-obsession and anti-anxiety medications have been helpful to some, but don't stop many from pulling. Others have suggested treatments like hypnosis, acupuncture, special diets and vitamins, but results have been mixed.
The reality is that not everyone who reads this article has Trichotillomania. But I'll put it this way: If you're reading this you probably knew me and that means that now you know someone. My poor college roommate had a roommate in boarding school who had Trichotillomania, and then a few years later ended up with me, too, so it's a lot more common than you'd expect. The thing about Trichotillomania is that people are so ashamed they do their best to cover it up, to "sweep it under the rug" both literally and figuratively.
It's been very difficult synthesizing all of this information into one entry. It's an incredibly complex disorder with many factors going into it. I've left out a lot of information in this first post because I feel like I could go on for days. If you have any questions, please ask me. My upcoming posts are going to take a more personal focus, but I wanted to set an introduction for anyone who isn't familiar with Trichotillomania.
If you'd like to learn more about this disorder, in addition to the links I've included in the body of this article, I highly suggest checking out The Trichotillomania Learning Center. It boasts a plethora of information, it's the most comprehensive website I've found.
Update 1/19/09: Please check out my post with Austin Trichotillomania Resources.
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