Trichotillomania
(Hair-pulling)
Do you or your loved one struggle with pulling out hairs on the scalp, eyebrows, eyelashes, and other areas of the body?
Have you or your loved one sought medical and mental advice and been consistently faced with a lack of understanding of professionals?
Do you feel shame about this habit?
Trichotillomania, often referred to as hair-pulling disorder, is a mental health condition characterized by an irresistible urge to pull out one's own hair. It falls under the category of body-focused repetitive behaviors (BFRBs) and is similar to skin-picking, nail-biting, and inner-cheek biting. People with trichotillomania may pull hair from the scalp, eyebrows, eyelashes, or other areas of the body.
Trichotillomania is considered a complex disorder, and its exact causes are not fully understood. However, several factors are believed to contribute to its development, including genetic predisposition, brain chemistry imbalances, and environmental factors. Stress, anxiety, and boredom can also trigger or worsen hair-pulling episodes.
Individuals with trichotillomania often experience a sense of tension or mounting anxiety before pulling out their hair, followed by relief or gratification afterward. The behavior can lead to significant distress and functional impairment, as well as physical consequences such as noticeable hair loss, bald patches, and skin damage.
Some clients with trichotillomania have no awareness of when they are engaging in this behavior, and experience the habit in an almost trance-like state. Others feel very conscious and aware of the hair pulling, but feel it is a coping mechanism or a nervous habit that they cannot shake.
What about trichophagia?
Trichotillomania can sometimes be accompanied by another behavior called trichophagia, which is the act of ingesting or eating the pulled-out hair. Trichophagia is considered a subtype or a symptom of trichotillomania. Not everyone with trichotillomania engages in trichophagia, but it can occur in some individuals.
Trichophagia can lead to various complications, such as:
Trichobezoar: When hair is consumed, it can accumulate in the stomach and form a hairball called a trichobezoar. Trichobezoars can cause gastrointestinal issues, including pain, bloating, nausea, vomiting, and in severe cases, obstruction of the digestive tract.
Nutritional Deficiencies: Consuming hair does not provide any nutritional value and can interfere with the absorption of nutrients from food. Over time, this can lead to deficiencies in essential nutrients, potentially causing health problems.
Gastrointestinal Disorders: Ingesting hair can irritate the gastrointestinal tract and contribute to the development of conditions like gastritis or gastroparesis, which affect digestion and cause symptoms like abdominal pain, indigestion, and changes in bowel movements.
Dental Problems: Chewing on hair or hairballs can damage the teeth, gums, and mouth, leading to dental issues such as tooth decay, gum disease, or oral infections.
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How are trichotillomania and trichophagia treated?
Treatment for trichotillomania and trichophagia typically involves a combination of therapeutic approaches, including:
Cognitive-Behavioral Therapy (CBT): CBT helps individuals identify and modify the thoughts, emotions, and behaviors associated with hair-pulling and hair-eating. Techniques such as habit reversal training and stimulus control can be effective in managing these behaviors.
Acceptance and Commitment Therapy (ACT): ACT focuses on accepting difficult thoughts and emotions related to hair-pulling while committing to behavior changes aligned with personal values. It helps individuals develop coping strategies and improve psychological flexibility.
Medication: In some cases, medication such as selective serotonin reuptake inhibitors (SSRIs) or other medications used for impulse control disorders may be prescribed to help manage the symptoms of trichotillomania and related behaviors.
Support Groups: Joining support groups or seeking peer support can provide a sense of understanding, shared experiences, and coping strategies for managing trichotillomania and associated behaviors.
However, the primary therapeutic technique utilized by Kairos Wellness Collective was developed by Dr. Charles Mansueto, and is known as the ComB approach. The ComB technique, also known as the "habit reversal with competing response" technique, is a behavioral intervention commonly used in the treatment of trichotillomania. It aims to replace the hair-pulling behavior with an alternative, incompatible response. Here's how the comb technique is typically implemented:
Identify Hair-Pulling Triggers: The first step is to identify the triggers or situations that commonly precede hair-pulling episodes. This may involve keeping a record of when and where the hair-pulling occurs, as well as any emotions, thoughts, or environmental factors that contribute to the behavior.
Raise Awareness: Increase the individual's awareness of their hair-pulling behavior by using techniques such as self-monitoring. Encourage the individual to pay attention to the sensations, thoughts, or urges that precede and accompany hair-pulling episodes.
Teach the Competing Response: Identify a specific behavior or action that is physically incompatible with hair-pulling. The individual is taught to perform this alternative response whenever they feel the urge to pull their hair. The most common competing response used in the ComB technique is holding a comb or other object that prevents hair-pulling. The individual uses the comb to stroke or massage their hair instead of pulling it.
Practice and Generalize the Competing Response: The individual practices the competing response (holding and using the comb) in various situations and environments where hair-pulling typically occurs. This includes practicing the technique during times of heightened stress or when they feel the urge to pull their hair.
Maintain and Reinforce: Consistency and reinforcement are crucial in the ComB technique. The individual is encouraged to continue using the competing response consistently and to reinforce their efforts through positive self-talk, self-praise, or small rewards when they successfully resist the urge to pull their hair.
Support and Relapse Prevention: Ongoing support and relapse prevention strategies are essential to maintain progress. The individual may work with a therapist or support group to address any setbacks or challenges and develop strategies to prevent relapses.
It's important to note that the ComB technique is most effective when used as part of a comprehensive treatment plan that includes other therapeutic approaches, such as cognitive-behavioral therapy (CBT) and habit reversal training. These approaches may involve addressing underlying triggers, managing stress, and developing coping strategies.
Want to learn more about how we can help trichotillomania?
If you or someone you know is struggling with trichotillomania, please reach out to Kairos Wellness Collective for support. Our specialized therapists can offer personalized guidance and support to develop an appropriate treatment plan tailored to individual needs. With a proper diagnosis and a personalized treatment plan, our team will help you reclaim your hair and your life.