Is your hair loss caused by trichotillomania — the hair plucking disorder?

hair pullingPrajakta (name changed), a 21-year-old student, was suffering from severe hair loss for almost a year. A detailed analysis of her case with video microscopy suggested the condition was caused by trichotillomania, the obsessive urge some people develop to pull out their own hair. This not only leads to hair loss, but it also leads to social embarrassment because patients often become the butt of ridicule.

Trichotillomania, or the irresistible urge to pull out one’s own hair, affects 4 out of every 100 people. But the condition can be cured with a holistic combination of homeopathic treatment and behavioural therapy. 

When does it start?

Trichotillomania usually begins in early childhood or adolescence, but most patients do not seek treatment until 17 years of age, as they remain unaware of the problem. Interestingly, about 70-90% of patients approaching doctors for a cure are women. Though the exact prevalence of trichotillomania is unknown because of the secretive intent of patients, 4 out of every 100 people in the world are estimated to suffer from it.

What triggers  trichotillomania?

Trichotillomania is not as uncommon as one tends to think. ‘Tricho’ means hair and ‘mania’ means an illness related to the mind. The disorder arises in the mind, but it manifests itself as hair loss induced by the patient. It is officially classified as an impulse control disorder in which there is an impaired ability to resist one’s own impulses — this may result in a self-harming behaviour. Other examples of such a mental disorder include pyromania (setting things on fire), kleptomania (stealing), pathological gambling, compulsive shopping, and so on.

There is no definite cause of trichotillomania, but a combination of factors may be behind it, such as a genetic predisposition or aggravating stress or circumstance. There can also be underlying depression or anxiety which a person is unable to express or cope with. Stress is known to trigger trichotillomania and make it worse. The triggers can be negative – a pending exam, financial problems, strained relationships, or tensions at workplace – as well as positive, such as getting married, buying a home or car, or planning a vacation. These situations can cause anxiety and stress, resulting in the urge to pull out one’s own hair.

In Prajakta’s case, she was undergoing a lot of stress and discontent at home with her parents because of her impending marriage, much against her wishes. She wanted to study further but her parents were adamant. It was under such tremendous pressure that Prajakta reluctantly agreed to marry. In the process, she developed the habit of pulling out strands of her hair and even eating them — to get over her profound stress and disappointment. She claimed this gave her emotional relief.

The condition is also usually a result of some kind of anxiety; most patients claim the practice of pulling out their own hair soothes them. There is also an increasing sense of tension in them when this behaviour is resisted, followed by satisfaction or a sense of relief when the hair gets pulled out. Hair pulling is often resorted to automatically (usually in children) or absent-mindedly, such as while reading or watching TV.

It can also be focused, or done deliberately with full concentration. Many ‘hair pullers’ may play with their hair in some way after taking it out. Some even eat it, accumulating it in their stomach — such hair balls may require surgical removal. While it is common to pull hair from the head, other areas to indulge in the habit may include eyelashes, beard, eyebrows, chest, legs or even pubic hair.

Complications of trichotillomania

Several complications may arise in severe cases of trichotillomania. Repeated trauma to the scalp skin can lead to permanent damage of the hair follicle. If hair is eaten after pulling, it can lead to abdominal pain. This is something that has been documented in children as young as four years. There is also social discomfort. According to one study, about 20% of trichotillomania patients tend to avoid vacations, 23% find the habit interfering with their job duties, and 24% children tend to miss school often.

Treatment of trichotillomania

No FDA-approved allopathic treatment currently exists for trichotillomania. However, homeopathy has proven to be a safe and clinically effective line of treatment, with up to 90% patient recovery. Homeopathy works through controlling the underlying impulse to pull hair.

Besides, since trichotillomania is an often uncontrollable habit, behavioural therapy, as an adjuvant, has also found to be effective. Patients are made to keep a track of their behaviour and trained to develop an increased awareness of pulling hair. This self-monitoring helps in reversing the habit. In case of child patients, parent counselling is important. Parents are asked not to use guilt to try and control their child’s hair-pulling habit as it is the result of an impulse they just cannot control.

For Prajakta, a combination of therapies worked. She underwent homoeopathic treatment at Dr Batra’s homeopathy clinic. A remedy called Kali phosphoricum proved effective in her case. The doctors also used an imported hair growth treatment to restore hair in bald patches, or areas, of her head. After ten treatment and counselling sessions, Prajakta not only got her hair back, but also her self-confidence. She’s married and is happy — more so, because her husband is fully supportive of her academic dreams and to studying further.

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