Strange is human behaviour. People become
obsessed with some peculiar habits like
nail biting, repeated counting, checking
whether they have locked the house properly
or not, washing their hands frequently,
or worse, pulling their hair to such an
extent that they become bald or develop
patches on their scalp much to the embarassment
of their friends or relatives! But they
are unable to stop the urge to repeat
such kind of disgusting behaviour.
The topic aroused my interest as I too
had a habit of not pulling but rolling
locks of hair with my fingers while studying
and my mother tried hard to stop me from
doing that. I used to pull out hair one
strand at a time, then inspect the strand
after pulling it out, or play with the
hair after it’s been pulled. (But
did not take into my mouth). That is Trichotillomania.
It is a type of psychological condition
that involves strong urges to pull hair.
Doctors used to believe trichotillomania
was rare. But that concept is now changing.
Trichotillomania affects more girls than
boys. Most people develop it during adolescence.
People often start compulsive hair-pulling
around the age of 12-13; although it is
not uncommon for it to start at a much
younger or older age. Frequently,
a stressful event can be associated with
the onset, such as: change of schools,
abuse, family conflict, or the death of
a parent. The symptoms may also be triggered
by pubertal hormonal changes.
During adolescence, which is an especially
crucial time for developing self-esteem,
body image, comfort with sexuality, and
relationships with peers of both sexes,
teens may endure ridicule from family,
friends, or classmates, in addition to
feeling shame over their inability to
control the habit. Therefore, even a small
bald patch can cause devastating problems
with development that can last life-long.
Although many people with trichotillomania
get married and carry on with their lives
in a normal fashion; there are those who
have avoided intimate relationships for
fear of having their shameful secret out.
People with trichotillomania pull hair
out at the root from places like the scalp,
eyebrows, eyelashes, or pubic area. Some
people pull large handfuls of hair, which
can leave bald patches on the scalp or
eyebrows. But trichotillomania isn’t
just an ordinary habit that a person can
easily stop. It’s a medical condition.
Trichotillomania is a type of compulsive
behavior. People with the condition feel
an overwhelming urge to pull their hair.
People with trichotillomania also may
have other compulsive habits, such as
nail biting or skin picking. Some people
with trichotillomania also have problems
like depression, anxiety, or obsessive-compulsive
disorder (OCD). It can sometimes run in
families.
People with trichotillomania may feel
embarrassment, frustration, shame, or
depression about the condition. They may
feel nagged by people who don’t
understand that they’re not doing
this on purpose. They usually try to hide
the behaviour from other people, and this can
make it difficult to get help. The victims
might feel less confident about making
friends, some might feel powerless to
control the urge to pull or blame themselves
for not being able to stop.
Some think it might be related to OCD
since OCD and trichotillomania both involve
compulsions. Since compulsions arise as
an effort to reduce tension, the urges
that lead to hair pulling can be stronger
when a person is stressed out or worried.
Experts think that compulsive behaviour
like hair pulling may be caused by an
imbalance of chemicals in the brain. There
is no certain cause of trichotillomania,
but the current way of looking at trichotillomania
is as a medical state.
One theory on a biological level is that
there is some disruption in the system
involving one of the chemical messengers
between the nerve cells in parts of the
brain. There may be also a combination
of factors such as a genetic predisposition
and an aggravating stress or circumstance;
as with many other illnesses. Further,
trichotillomania could be a symptom caused
by different factors in different individuals
just as a cough can be produced by a multitude
of different medical problems. Depression
also frequently occurs in individuals
with this illness. There may be a
direct neuro-biochemical relationship
secondary to the chronic demoralization
and low self esteem attached to hair-pulling.
Some people with trichotillomania say
that they notice sensations in their scalp
or skin. For example, it may be a
tingling feeling that can only be relieved
by pulling, like the feeling of relief
that comes from scratching an itch. Some
people say that they notice a satisfying
feeling when they pull their hair. Others
don’t even notice when they
pull, and do it without thinking. Any
relief that comes with hair pulling usually
only lasts for a moment. The urge almost
always returns. That’s because when
the mind becomes used to giving in to
the powerful urges that go with compulsive
behaviours, the behaviour is reinforced.
This idea is supported by the tendency
for the two problems to run in the same
families and the fact that OCD medications
can be helpful in treating trichotillomania.
People with trichotillomania usually need
help from medical experts before they
can stop. With the right help, though,
most overcome their hair-pulling urges.
When someone is able to stop pulling,
hair usually grows back. Overcoming hair-pulling
urges may involve talk therapy, medication,
or a combination of both.
Therapists teach some special behaviour
techniques that help people with trichotillomania
recognize the urge to pull hair before
it becomes too strong to resist.
The person learns ways to resist the urge
so that it eventually grows weaker and
then goes away. A therapist can also help
a person regain confidence and self-esteem.
That’s why it helps to work with
an expert who can offer support and practical
advice about how to reverse this powerful
habit. Some doctors may prescribe medications
that can help the brain deal better with
urges, making them easier to resist.
Medication therapy can help to correct
the imbalance of chemicals in the brain.
Many people find it helpful to keep their
hands busy with a different activity (like
squeezing a stress ball or drawing) during
times when pulling is the worst.
If you’re worried about hair pulling,
talk to a parent, school counsellor, or
someone you trust about getting help overcoming
the problem. After going through various
literature I am now convinced that I too
have this problem, which my mother had
diagnosed when I was young, but never
thought of seeking medical help !
(The writer is an Associate Professor
at the Department of Pharmacology, Veterinary
College, Khanapara)
