By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.
Hair-Pulling Disorder – Trichotillomania.
Yes Hair-Pulling Disorder, the repetitive uncontrolled kind of hair pulling is a mental health issue. Humans are not the only creatures who resort to this kind of self-mutilation when under stress. Caged animals, especially birds do this when stressed also.
Hair-pulling Disorder sounds like an odd problem to have at first glance unless you or someone you know has had this disorder and then it takes on huge importance.
The way we understand this one has been changing. This is in flux and will take some time to sort out.
In the past, as reflected in the DSM-4 this was seen as a form of impulse control disorder. Much of the way it was treated in the past was behavioral. The focus was on the behavior and not the meaning or function it had for the person pulling the hair.
As an impulse control disorder, it was in with Pathological Gambling and Intermittent Explosive Disorder. Hair pulling was for sure different than compulsive gambling but most people who had to treat clients with this problem didn’t know what else to do with it.
In the new DSM-5, when all the professionals switch to the DSM-5, this disorder will move to the section on Obsessive-Compulsive Disorders. This will put it more in the class of disorders with Hoarding and Body Dysmorphic Disorder. We are seeing that obsessions and compulsions are more driven than chosen behaviors.
This change in thinking makes a whole lot of difference in how it might get treated and it makes even more of a change in how the person who has the problem might react to that treatment.
Behavioral treatment is focused on the behavior and interrupting that behavior. So grandma might have used a treatment that consisted of slapping that hand each time the young person reached for the hair. The idea was that stop the behavior and you had the problem cured.
If we see this as OCD behavior, then this is not something the person is consciously doing. The behavior is functioning to reduce tension and there is this overwhelming need to do it. This would not be something that the person thought about beforehand and no amount of slaps or yells will change anything.
You might as well yell at someone for yawning. Once they yawn it is over. Besides we think yawning is about physical sensations, not inappropriate behavior. Despite that feeling, we still can get annoyed at people who yawn and we all try to stifle the yawn from time to time.
But if you got smacked for each and every yawn eventually you might give up and just avoid the person slapping you or you might feel that you were a bad person for not being able to control this sensation and you could punish yourself in some way.
So if this is a form of OCD we would want to know what the function of the behavior was. What anxiety or tension is the person trying to relieve by hair pulling? Reduce that tension; treat the anxiety and the hair-pulling stops on its own.
Young women are ten times more likely to get this diagnosis than young men. We do not mind seeing young men with very little hair but a young girl with bald spots, that gets noticed.
People who have Hair-Pulling Disorder (Trichotillomania) are also at higher than average risk to do other self-injurious behaviors. Someone with the hair-pulling disorder might also pick at their skin excessively, technically called excoriation, or they might nail-bite excessively.
There are also likely to become depressed and or develop another anxiety disorder.
So if you or someone you know is finding their life messed up because they are constantly pulling out hair, they develop bald spots for which there is no known medical cause and when they try to stop find they can’t, consider professional treatment.
Yes, absolutely Hair-Pulling Disorder (Trichotillomania) is a real mental illness of the obsessive-compulsive disorder type.
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As a kid, I had a pet chook (chicken/hen/whatever you want to call it) who went through a phase of trichotillomania when I went away to my grandparents’ place. She recovered quickly upon my return. I also had a sister who suffered trichotillomania. I believe she also developed an eating disorder not long afterwards. Both seem to be under control now: she went to university overseas, and did a lot of therapy there. She certainly has OCD/anxiety tendencies, so it’s interesting to read about how the DSM-5 categorizes trichotillomania. Thank you.