Trichotillomania (TTM), also known as hair-pulling disorder, is a complex mental health condition characterised by the compulsive urge to pull out one’s own hair. This often leads to noticeable hair loss, distress, and difficulties in daily life. The condition is classified as an obsessive-compulsive and related disorder (OCRD) and can affect individuals of all ages.

Many people with TTM feel a sense of relief or satisfaction after pulling hair, but this is often followed by feelings of shame, guilt, or frustration. As a result, some individuals attempt to hide their hair loss or avoid social situations, which can significantly impact their self-esteem and overall mental well-being.

At Chase Lodge Hospital, we recognise the challenges faced by individuals with TTM and offer comprehensive assessment, diagnosis, and tailored treatment plans to support long-term recovery.

What Causes Trichotillomania?

The exact cause of Trichotillomania is not fully understood, but research suggests that it develops due to a combination of genetic, neurological, psychological, and environmental factors. Some of the key contributors include:

1. Neurological Factors

• TTM has been linked to irregularities in brain function, particularly in areas responsible for impulse control and emotional regulation.
• Abnormalities in neurotransmitters, such as dopamine and serotonin, may contribute to compulsive hair-pulling behaviours.

2. Genetic Influences

• Research indicates that TTM may run in families, suggesting a genetic predisposition.
• Studies have found that individuals with close relatives who have obsessive-compulsive disorder (OCD), anxiety disorders, or TTM may be at higher risk.

3. Psychological and Emotional Triggers

• Many people with TTM report hair-pulling as a coping mechanism to deal with stress, anxiety, or boredom.
• Trauma, emotional distress, or unresolved psychological issues may increase the likelihood of developing TTM.

4. Habitual and Sensory Aspects

• Some individuals engage in hair-pulling due to sensory gratification, finding the sensation of pulling or playing with the hair soothing.
• Over time, hair-pulling can become a deeply ingrained habit, making it difficult to stop without professional intervention.

Recognising the Symptoms of Trichotillomania

Common Signs and Symptoms:

• Recurrent urges to pull out hair, leading to noticeable hair loss.
• Hair pulling from various areas, including the scalp, eyebrows, eyelashes, beard, or pubic region.
• Feeling a growing tension or anxiety before pulling hair, followed by a sense of relief or pleasure after doing so.
• Repeated unsuccessful attempts to stop hair-pulling, despite knowing the negative consequences.
• Hiding hair loss or bald patches by wearing hats, scarves, or using makeup.
• Feelings of shame, guilt, or embarrassment, leading to avoidance of social situations.

Some individuals may not even be fully aware of their hair-pulling behaviour, especially if it occurs during moments of deep thought, boredom, or stress.

How is Trichotillomania Diagnosed?

Assessment at Chase Lodge Hospital

At Chase Lodge Hospital, diagnosis is carried out by expert mental health professionals, including psychiatrists, psychologists, and therapists, who specialise in obsessive-compulsive and related disorders. The diagnostic process typically includes:

• A detailed clinical interview to understand the nature and impact of the symptoms.
• A review of medical and psychological history to rule out other causes of hair loss (e.g., alopecia areata, skin conditions, or medication side effects).
• Psychological assessments to evaluate any co-existing conditions, such as anxiety, depression, or OCD.

Since TTM can significantly impact an individual’s quality of life, an early and accurate diagnosis is crucial to ensure the most effective treatment.

Treatment Options at Chase Lodge Hospital

At Chase Lodge Hospital, we provide a holistic, evidence-based approach to treating Trichotillomania, with treatment plans tailored to each individual’s specific needs.

1. Cognitive-Behavioural Therapy (CBT)

CBT is widely regarded as the gold standard treatment for TTM. It helps individuals:

• Identify and understand triggers that lead to hair-pulling.
• Develop alternative coping mechanisms to manage urges.
• Challenge negative thought patterns associated with hair-pulling.

2. Habit Reversal Therapy (HRT)

HRT is a specialised type of CBT designed specifically for compulsive behaviours like hair-pulling. It involves:

• Recognising warning signs before an urge to pull occurs.
• Replacing hair-pulling with a competing response (e.g., squeezing a stress ball or using fidget toys).
• Building awareness and control over the behaviour.

3. Medication (When Necessary)

In some cases, medication may be recommended, particularly if TTM is accompanied by severe anxiety or depression. Possible options include:

✔ Selective serotonin reuptake inhibitors (SSRIs) – commonly used to treat anxiety and OCD-related symptoms.
✔ N-acetylcysteine (NAC) – a supplement that has shown promise in reducing compulsive behaviours in some individuals.

4. Mindfulness and Stress Management

Techniques such as mindfulness meditation, relaxation exercises, and breathing techniques can be beneficial in reducing stress and increasing awareness of hair-pulling behaviours.

5. Support Groups and Therapy

• Peer support groups can help individuals connect with others experiencing similar challenges.
• Family therapy can be beneficial for younger individuals with TTM, ensuring parents and loved ones provide the right support.