How to Stop Pulling Your Hair Out

By: Suzanne Feinstein, PhD

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While it may seem like an issue almost no one faces, around 3.5% of individuals (if not more) experience hairpulling at some point in their lives.

It is essential to raise awareness about impulse control disorders like hairpulling, as they can significantly impact an individual’s well-being. Hair pulling, also known as Trichotillomania, presents unique challenges, and seeking professional help is crucial for managing it effectively.

In this guide, we’ll go over what you need to know about trichotillomania as well as what you can do to manage it. Keep reading for some additional insights and recommendations.

Understanding Trichotillomania

Trichotillomania (sometimes called hairpulling, hairpulling disorder, trich, or TTM) involves recurrent hair pulling, leading to noticeable hair loss from the scalp, eyebrows, eyelashes, facial hair, arms, legs, pubic area or any other body part with hair.

While it’s not 100% understood, mental health professionals consider it to be a body-focused repetitive behavior (BFRB). Some other common examples of BFRBs include nail biting, lip chewing, and skin picking.

People with trichotillomania understand it’s harmful, but struggle to resist their urges. In bad cases, it can result in hair loss and bald patches. This can lead to emotional distress, shame and self-consciousness.

Why Do People Pull Their Hair Out?

Although hair pulling is generally painful to most people, those who struggle with trichotillomania find the sensation to be satisfying, gratifying or self-soothing. Regardless of its negative aesthetic consequences, most people with trichotillomania opt to engage in this repetitive behavior as a response to stress, frustration, or boredom. It allows an outlet for them to redirect their negative energy. Despite later regret, it often feels too difficult to resist the short-term relief it provides.

During the hair pulling process, the brain might start releasing dopamine. As a result, the brain makes a connection between this behavior and the good feeling it provides, increasing the urges and contributing to the difficulty people have in overcoming these hair-pulling habits.

Symptoms of Trichotillomania

Hair pulling can be an automatic behavior, in which there is little to no awareness, or a focused behavior, in which there is at least partial awarene. People can have a mixture of both automatic and focused pulling.

Hair pulling is most common with sedentary behaviors such as studying, reading, watching TV, at a computer, traveling, falling asleep, etc.

The following symptoms are common among people struggling wiht trichotillomania:

  • Feeling tense before pulling out your hair
  • Feeling satisfied, relieved, or pleased after pulling out your hair
  • Distress or problems at work or in your social life
  • Avoiding social situations where people might notice you’ve been pulling out your hair
  • Tension or conflict with friends/family in relation to hair-pulling
  • Sore or irritated skin from hair-pulling
  • Skin damage or scars from hair-pulling
  • Appearance changes due to hair loss
  • Bare patches where hair once was

As many as 20% of people who suffer from trichotillomania also have trichophagia, a disorder in which people ingest their hair after pulling it. Trichophagia can lead to further complications like stomach aches, vomiting, nausea and, if severe enough, gastrointestinal blockages.

Trichotillomania Causes

Trichotillomania is a complex condition that scientists are still trying to understand. Some believe it’s caused by differences in the parts of the brain related to impulse control, emotion, movement, and learning. It could also be caused by chemical imbalances in the brain, stress, or learned behavior.

Statistics show that serious cases often form between the ages of 10 and 13, potentially from hormonal changes prior to puberty. Research has also demonstrated that it may be passed on genetically. In addition, people who suffer from other mental health issues like depression, anxiety, or OCD may be more prone to BFRBs. Stress can be a commong trigger that leads people to self-soothe with this behavior.

It’s worth noting that while the prevalence of trichotillomania appears to be equivalent across genders among children, women are far more likely to be diagnosed as adults. This can either suggest that adult females are more likely to suffer from it, or more likely to seek out treatment, thus skewing the diagnostic statistics.

Trichotillomania Treatment Options

There are different treatment options that have been known to help people with trichotillomania:

Therapy

Cognitive-Behavioral therapy (CBT) for hair pulling, if implemented properly, has been proven quite effective in treating BFRBs. CBT helps individuals identify triggers, develop coping strategies, and challenge negative thought patterns related to hair pulling.

Acceptance and commitment therapy allows individuals to practice accepting their hair-pulling urges without acting on them.

Habit Reversal Training (HRT) is a specific CBT approach that encourages people to practice alternative, less harmful behaviors. For example, it teaches people how to clench their fist or reverse the muscle memory whenever they have the urge to pull their hair.

Stimulus Control Techniques, used in conjunction with HRT, recommends creating physical barriers or distractions to change the sensory experience of the hair pulling. Wearing hats, bandanas, bandaids on the fingers, etc. makes it harder to get to the hair, raises awareness, and acts as a buffer to the reward center of the brain.

Medication

As it stands, there aren’t any FDA-approved medications for treating trichotillomania. Despite this, the following drugs are believed to help in certain cases:

  • Antidepressants
  • Atypical antipsychotics
  • N-acetyl cysteine, an amino acid supplement

Self-Care

Numerous trichotillomania sufferers have devised other methods to help when it comes to managing hair pulling urges. Some effective self-care approaches include:

  • Distractions such as fidget toys or origami to keep the hands busy
  • Practicing new routines or rituals
  • Stress management or mindfulness
  • Wearing hats, bandanas, etc. to make it harder to get to the hair

Getting Help From a Trichotillomania Specialist

If you think you’re suffering from trichotillomania and are having trouble fighting your hair-pulling urges, don’t be afraid to seek out the help you need. A trichotillomania specialist can work with you to determine the most suitable approach to your treatment and may be able to help you eliminate the issue.

Advanced Behavioral Health specializes in the treatment of trichotillomania and other body-focused repetitive behaviors in addition to the full spectrum of anxiety and mood disorders.  We’re based in Midtown Manhattan and have been helping people since 1995. Get in touch today to book your free 15-minute consultation.

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