Julie Miller's Mental Health Blog

Archive for the ‘“T” is for Trichotillomania’ Category

“Trichotilomania” is recurrent pulling out of one’s own hair that results in noticeable hair loss.

Trich (for short) is classified under “Impulse Control Disorders,” which I translate as a process addiction.  Pathological gambling is classified in the same way, as is pyromania, kleptomania, and intermittent explosive disorder (failure to resist aggressive impulses).

Many of us play with or twist our hair (if it’s long enough!) out of anxiety, a behavior that can restore regulation to the central nervous system if agitated.  The hair damage from this  “habit” is minimal, if any.  It probably also does not cause significant distress to the individual.

Distress is significant for an individual with trich.  Damage from trich includes patches of baldness and damaged hair.

Imagine being a girl with trich which began in about 4th grade.  The girl may have significant patches of baldness in her hair, and so wears a wig (yes, this does happen in youngsters).  In junior high, for the first time, she must take off all her clothes in front of her peers, get in a bathing suit, swim, and shower in the same room as her classmates.

How will she navigate that without the class and teacher finding out that she wears a wig?  How will she explain the hair loss?  Teasing and stigma are sure to follow.

How will she keep her wig in place on a windy day?  How will she handle slumber parties?  Will she wake up in a room full of girls with her wig twisted to the side, or laying on the floor next to her pillow?

If she chooses to go without the wig, will she shave her hair close to her head so she is not tempted to pull (can’t pull the hair if it’s only 1/4″ long)?

If she goes without a wig and leaves her hair long, will she increase the size of the bald spot with continued pulling?  Long hair is a powerful trigger for trich.  The shame and hiding that comes with trich in our society is enormous.

Triching (the act of pulling)  is a CNS regulating behavior.  It is especially notable in individuals with anxiety, and acts to soothe the individual.  The individual may also be dissociated while triching.  Like any other negative regulating behavior, it can become deeply ingrained in an individual’s regulation repertoire.

Treatment may include such things as medication (SSRIs, etc.), cognitive behavioral therapy, motivational interviewing, 12-step, DBT.

The individual you see in front of you at the supermarket with bald patches on their head may well suffer from this illness.  Your compassion, kindness, and a warm smile, not staring, may be the best gift you can give them.