Trichotillomania is a disorder characterised by an irresistible and recurrent urge to pull out one's own hair, often leading to significant hair loss and distress. Linked to anxiety and stress, it oscillates between a sporadic gesture and a constant struggle against compulsive urges. Let's explore the multifactorial origins of trichotillomania, and the effectiveness of the various treatment methods.
What is trichotillomania?
Trichotillomania also known as hair-pulling disorder, is a psychiatric disorder characterised by a recurrent, hard-to-control impulse to pull out one's own hair or eyelashes.
This compulsive behaviour can lead to visible hair loss or body hair loss, often accompanied by bald spots, scars and a change in physical appearance.
Impulse control disorder
Trichotillomania is classified as an impulse control disorder. in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR, revised by the American Psychiatric Association (APA)). It can have a significant impact on the quality of life of sufferers, affecting their self-esteem, body image and social interactions.
It is estimated that trichotillomania affects approximately 1 to 2 % of the French population. However, it is important to note that many cases remain undiagnosed due to the stigma associated with the disorder and the fact that sufferers may conceal their behaviour. Approximately 90 % of adults with the disease are women.
Good to know: Trichotillomania can occur at any age, but often begins in adolescence.
Trichotillomania can occur as early as adolescence
What are the symptoms of trichotillomania?
Trichotillomania is characterised by a set of symptoms and specific behaviours:
- Recurrent pulling out of hair or body hair: hair pulling: the main symptom of this disorder is the repetitive and compulsive pulling out of hair or eyelashes. People with this disorder find it hard to resist the irresistible urge to pull at their hair.
- Growing tension: before engaging in tear-out, individuals often experience growing tension or anxiety. This tension is temporarily relieved by the act of plucking.
- Temporary relief: pulling out hair or body hair provides temporary relief from the tension or emotional discomfort felt by the individual. However, this relief is often followed by guilt, shame or remorse.
- A loss of control: people with trichotillomania find it hard to control their snatching impulses, even if they want to stop. They often feel powerless in the face of this compulsive behaviour.
- A preference for certain areas: affected individuals often have favourite areas where they pull out hair. This may include the scalp, eyebrows, eyelashes, facial hair or other parts of the body.
- Changes in appearance: repeated plucking can lead to bald patches, scarring and a change in physical appearance, which can have an impact on self-esteem.
- The impact on daily life: Trichotillomania: trichotillomania can disrupt people's daily lives because of the obsession and time devoted to pulling, as well as the physical and emotional consequences.
Trichotillomania is often accompanied by other disorders, such as anxiety, depression or other impulse control disorders.
How is trichotillomania diagnosed?
The diagnosis is usually made by a mental health professional, such as a psychiatrist, clinical psychologist or general practitioner.
It is based on the diagnostic criteria defined in the classification manuals for mental disorders.
According to the DSM-5-TR, to be diagnosed with trichotillomania, a person must meet specific criteria, including recurrent pulling out of hair or body hair, unsuccessful attempts to stop the behaviour, and significant associated distress.
The healthcare professional must ensure that the symptoms are not due to other medical conditions, such as dermatological problems or medical disorders, which could explain the hair loss.
In some cases, it may be necessary to work with other health professionals, such as dermatologists, to assess the physical consequences of pulling out hair.
Once a diagnosis has been made, the healthcare professional can draw up a treatment plan. adapted to the individual's situation.
What are the known risk factors for the development of trichotillomania?
The development of trichotillomania is influenced by several known risk factors.
- Genetics: studies have shown that there is a genetic component to the development of this disorder. Individuals with a family history of impulse control disorders are more likely to develop this disorder.
- Anxiety: certain personality traits, such as anxiety, perfectionism, obsessiveness and a tendency to rumination, are associated with an increased risk of developing trichotillomania.
- Environmental influences : chronic stress and major life changes, social pressure or family conflicts can contribute to the development of this disorder.
- Trauma: traumatic or stressful events in childhood or adulthood can trigger trichotillomania in some people. The disorder can sometimes be a way of coping with difficult experiences.
Good to know: abnormalities in brain function, particularly in reward and impulse control circuits, may also contribute to trichotillomania. Variations in neurotransmitters, such as serotonin, have also been studied in this context.
What are the consequences of trichotillomania for hair?
The effects on the hair can vary depending on the intensity and duration of the behaviour. Repeated hair-pulling can lead to sparse areas or bald patches on the scalp.
If the hair is constantly pulled with force, this can damage the hair follicle and, in extreme cases, lead to a permanent hair loss.
The act of pulling out your hair can lead to infections and skin disorders, including scars or changes in the texture of the skin on the scalp.
Trichotillomania: does hair grow back?
Hair can grow back if the follicle is not severely damaged, but this can be a slow process and the new hair may be finer or of a different texture.
In cases of severe and chronic trichotillomania, the follicles may be so badly damaged that regrowth is impossible.
How is trichotillomania treated?
Different methods can be adopted to treat this disorder, depending on individual needs.
Behavioural and cognitive therapy (CBT)
Cognitive behaviour therapy is a form of psychotherapy that aims to help people understand and change negative or destructive patterns of thought and behaviour. In the context of trichotillomania, CBT is often considered to be one of the most effective treatment methods.
Patients are gradually exposed to the triggers of hair pulling in a safe and controlled environment, while learning to resist the urge to pull their hair out.
CBT sessions are generally structured and take place over a set period of time. They can be conducted individually or in groups.
Medicines
Certain medications may be prescribed to help manage the symptoms of trichotillomania. Selective serotonin reuptake inhibitors (SSRIs) are often used to treat the symptoms of anxiety and depression associated with this disorder.
The use of medicines must be supervised by a qualified healthcare professional who can assess the potential benefits and risks for each patient.
Relaxation techniques
Activities such as meditation, yoga or deep breathing are often recommended as part of the treatment for trichotillomania, as they help to reduce the stress and anxiety that can trigger the urge to pull out hair.
The effectiveness of these techniques can vary from person to person, and it can be useful to try them out with the help of a health professional to determine which are most beneficial.
Trichotillomania is a complex disorder requiring a diversified and individualised treatment strategy. Combined approaches, including cognitive behavioural therapy, appropriate drug treatments and relaxation techniques, are crucial in helping individuals to combat the urge to pull out their hair.
Several methods can be used to treat trichotillomania: relaxation and medication, for example.
Finally, a hair diagnosis can provide valuable information on the condition of the hair follicles and point the way towards measures to encourage hair regrowth in people with trichotillomania.
Jean-François Cabos is the creator of a unique hair care method based on the research he coordinated, which led to the publication of the book Hair, Roots of Life with Hélène Clauderer published by Robert Laffont (Collection "Réponses/ Santé").
