Living with Trichotillomania : Understanding Body-Focused Repetitive Behaviors (BFRB's)

Trichotillomania is part of a group of mental health conditions known as Body-Focused Repetitive Behaviors (BFRB). These involve repetitive self-grooming behaviors that can harm the body. Often dismissed as mere bad habits, they can lead to physical and mental health issues.

Manisha is a 49-year-old female.

Manisha’s Trichotillomania began when she was 15

“That’s when I started pulling her hair and trying to come up with rational reasons as to why I did it. I thought I was rooting out uneven hair growth. I also thought I was trying to match my root colors and weed out the blonde ones, and, obviously, I was enjoying the classic “trich-jerk” from pulling a copulating urge, followed by instant relief when I had completed the pull.  It was hard for me to identify that I had the compulsion to pull; I didn’t understand it. I remember the first bald patch that appeared, it was on my crown and rather easy to hide at this point, but it wasn’t long before it spread. I started coming up with creative ways not to have a parting and to hide the ever-growing bald patch. Over the years, I was given many suggestions, one of which was to shave my hair off and start again.

“Just stop, “ people will tell me. I did not want to be bald, but I could not stop.

When I started, Trichotillomania was not a widely known condition. There was no internet, so seeking understanding and comfort was not easy. I have become older now and have found help for my anxiety issues and have worked on my mental health. But pulling hair has not stopped, though it has become less. This is something I need to do to be able to stop one day. An easy way of coping I learned when I felt stressed or anxious, so breaking the cycle that started so young will always be an ongoing battle. Perhaps if I had stopped early, it would have been easy to give up this habit. "

Manisha, 49-year-old female 

What is Trichotillomania (TTM)?

This consists of compulsive urges to pull one’s hair, resulting in noticeable hair loss. Hair-pulling can affect any part of the body, such as the arms, pubic hair, eyelashes, and legs. Trichotillomania is a complex condition that affects individuals differently. It can range from mild hair or eyelash pulling to more severe issues like baldness, disfigurement, and persistent skin problems.

How common is TTM?

 Trichotillomania may manifest during childhood or adolescence and is frequently associated with other conditions such as obsessive-compulsive disorder (OCD) and anxiety. Its estimated lifetime prevalence ranges from 1% to 3.5% of the general population. The disorder predominantly affects females, with clinical studies indicating a female-to-male ratio of approximately 9:1. Typically, onset occurs around age 13 and is characterized by persistent, repetitive hair pulling that results in hair loss and psychological distress. It is estimated that between 5 million and 10 million Americans are affected by trichotillomania. A study conducted among college students suggests that approximately 6 out of every 1,000 individuals may develop TTM at some point in their lives. However, these figures are often underestimated due to individuals hiding their symptoms or healthcare professionals not routinely inquiring about the condition. 

Who is affected by TTM?

It can start as early as 22 months old, which is earlier than many other disorders. Typically, it begins at ages 9 to 13, emerging during preteen years. About 2-5% of teenagers experience skin picking, while approximately 45% may develop nail biting.

What causes TTM?

TTM often begins in childhood/adolescence during stress or tension. The pulling is not painful, but soothing or pleasurable, which might explain the maladaptive impulses to continue. Reportedly, there is mild trance/altered awareness when pulling, and an unawareness of their actions. This is usually followed by negative feelings of guilt and remorse, further adding to stress and tension.

Trichotillomania risk factors can vary. Often, the condition is more common for those with obsessive-compulsive disorder (OCD)or other anxiety-based disorders. While there is no specific cause for trichotillomania, increases in stress can worsen symptoms and cause more flare-ups in the behavior.

While social media doesn't play a major role, being aware of the condition through these platforms can help teens recognize symptoms and seek professional support. A combination of genetic factors, brain chemistry imbalances, and environmental stressors. There are rtiological theories that cite reasons like: parental bonding, psychosexual development, dysregulation of grooming, or ‘bad habits.’

Effective treatment for TTM

1.    Evaluation by a professional familiar with TTM

2.   Screen for other conditions that affect hair loss

3.    Behavioral treatment involving awareness of hair pulling, stimuli, or triggers, including ‘habit reversal’ to practice other behavior and control urges

4.    Medications have reduced the severity of TTM in controlled studies, eg, antidepressants

5.    Self-esteem, personal and social functioning exercises.

If you or someone you know lives with co-occurring trichotillomania and anxiety disorder, specialized care can help. Contact mylifenwellness today for more information. The longer trichotillomania is present, the more challenging it is to treat, so early intervention is best.