Trichotillomania: the Hair-Pulling Mental Health Condition

In high school, I developed a condition that drives me to subconsciously, compulsively, and certainly at times, incessantly pull my hair out, creating large and scattered bald spots and thinning throughout my scalp. For a while, I didn’t know why I was doing it. I thought I was the only person in the world who would ever seemingly hurt themselves on purpose. The first realization I had to come to was that I was not doing this on purpose, but as a response. The second realization I had was that I was very far from alone in this struggle. 

I was suffering from trichotillomania. The period before I started coping with and investigating my hair-pulling brings back moments of intense isolation, insecurity, and pain. I would like to see knowledge pushed further into the mainstream to give help and resources to others struggling, validating people in their feelings to reach out for help sooner. Though I haven’t overcome my hair-pulling, I have learned to manage the condition and come to terms with my behaviors. 

Mental health advocate Aneela Idnani claims in her TedTalk on her experiences with trichotillomania, “Body-focused repetitive behaviors are the most common disorder you have never heard of” which is very true to me. Have you ever compulsively bit at your nails, picked at scabs, or chewed the inside of your cheeks? These actions, as well as many other similar behaviors, are considered Body-Focused Repetitive Behaviors (BFRBs), which is the larger classification of trichotillomania, but also includes dermatillomania (skin picking), onychophagia (nail biting), and others. Many studies coincide with the claim that about 5% of people have a body-focused repetitive behavior, with estimates of 1 to 2% of people having trichotillomania. However, these figures might not accurately represent the truth.

The Mayo Clinic helps us to understand the struggle with trichotillomania. The act of hair pulling for people with trichotillomania falls into two categories or modes, automatic and focused. ‘Automatic pulling’ is when the condition is driven by a sort of tunnel vision, where the individual is not able to realize they are pulling their hair. ‘Focused pulling’, on the other hand, is when the individual is aware of their actions but is still unable to stop the compulsions. In any case, the pulling leads to the neurochemical reaction of dopamine and glutamate release 1, leading to the formation of habit. Trichotillomania is largely characterized by repeated hair pulling, tension before pulling, then pleasure/relief after pulling, and varying levels of hair loss based on severity and management. The symptoms can also be severe, where symptoms might be repeated attempts to help the pulling are consistently unsuccessful or extend to feelings of distress in work, school, and social scenes.

There are many ways that culture can hurt people who are trying to overcome disorders like trichotillomania, or other BFRBs. It is therefore vital to recognize the potential for high levels of underdiagnosis due to social interpretations of the condition. The paper by Hande Günal Okumuş and Devrim Akdemir in the Turkish Journal of Psychiatry, shares that while BFRBs are largely viewed as “harmless” both generally and by the medical community, and the number of sufferers seeking help is generally low, it should be duly noted that the condition can lead to intensive functionality impairments, individual social withdrawal, and permanent bodily damages.  

While trichotillomania and other BFRBs are still widely misunderstood on both a social and a medical scale, especially as the classification for BFRBs has changed several times recently in the Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatric Association 1, research from late 2019 in the Brain and Behavior Journal sought to learn more by correlating trichotillomania with other psychiatric conditions. They showed there is evidence of comorbidity with other psychiatric conditions, notably 62% with major depressive disorder, 36% with OCD, and 22% with anxiety. Diagnoses like trichotillomania should certainly be treated through the same lens, both socially and medically as other urgent and serious diagnoses in the medical and psychiatric realm. 

One thing that has comforted me, in dealing with and learning about my hair-pulling, along with my other mental health problems, is that they are just a label of feelings in my mental state - and that they should not define or obstruct me in my intentions. In my experience with mental health, for a while, it felt like I was developing mental health conditions as if I was collecting Pokemon. After years of facing new and wilder diagnoses’, I learned more about my management strategy and what helps me cope. It was not benefiting me to identify with mental health problems but with my feelings.

Instead of diagnoses overwhelming me, categorizing me, or isolating me from society, I found the position that these diagnoses’ were merely a period of my mental state and that they could not even begin to define me. I’ve become more interested in answering why I might be depressed, or anxious, or the third to try to face my problems head-on. There is not a one-size-shoe-fits-all approach to mental health, or basically any other human problem. It is important to be dynamic in helping your mental health - in seeing what works and what doesn’t. 

Works Cited

1    Günal Okumuş, Hande, and Devrim Akdemir. “Body focused repetitive behavior disorders: Behavioral models and neurobiological mechanisms.” Turkish Journal of Psychiatry, 2022, https://doi.org/10.5080/u26213. 

2    Idnani, Aneela. “Overcoming Trichotillomania: The Power of Awareness.” Aneela Idnani: Overcoming Trichotillomania: The Power of Awareness | TED Talk, www.ted.com/talks/aneela_idnani_overcoming_trichotillomania_the_power_of_awareness?subtitle=en. Accessed 11 Oct. 2024. 

3    Lochner, Christine, et al. “Comorbidity in Trichotillomania (hair‐pulling disorder): A cluster analytical approach.” Brain and Behavior, vol. 9, no. 12, 6 Nov. 2019, https://doi.org/10.1002/brb3.1456. 

4    “Trichotillomania (Hair-Pulling Disorder).” Mayo Clinic, Mayo Foundation for Medical Education and Research, 22 Nov. 2023, www.mayoclinic.org/diseases-conditions/trichotillomania/symptoms-causes/syc-20355188#:~:text=Genetics%20may%20play%20a%20role,skin%20conditions%20that%20feel%20uncomfortable.