TRICHOTILLOMANIA
Trichotillomania is a disorder of impulse control that results in people pulling out the hair on their scalp or other body areas. It may have characteristics of a habit, an addiction, a tic disorder or an obsessive-compulsive disorder. It affects 1 to 2 percent of the population.
This poorly understood disorder starts most often in adolescence and affects 9 women for every man. The main sign of the problem is a bald spot on the scalp or other area of the body. Many people will go to great lengths to cover up the affected area. The general public has not known much about this problem until the 1990’s when it became publicized.
A number of treatments have been researched in the past decade but no one therapy has been found to be superior.
Cognitive-behavioral therapy seeks to alter behavior by identifying the factors that trigger hair pulling and teaching how to redirect responses to the triggers. A psychologist with training and experience in this field best does this type of therapy. An increased awareness of the times of day, emotional states and other factors that promote the hair pulling behavior is necessary. Once this is done, the person can develop strategies to change the behavior when the environmental cues happen.
Some of the SSRI antidepressants show promise in reducing the severity of the symptoms. Some people get complete relief and others find none. Combining a drug with cognitive-behavioral therapy may give improved control of symptoms.
Support groups can be very helpful in helping people deal with the frequent shame associated with this disorder. Contact www.trich.org for information about location of support groups and for further information.
Alternative therapies such as biofeedback, hypnosis, dietary changes and exercise may be beneficial in some cases. Little research has been done so far on these therapies for this disorder.
Daniel Blodgett MD