Hair Today Gone Tomorrow

The burden of trichotillomania

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HealthDay Reporter

SATURDAY, Nov. 3, 2001 (HealthDayNews) -- Most people feel like pulling their hair out now and then but never do it. People with trichotillomania struggle with such impulses every day and almost always act on them.

The result? Patches of hair loss, stubby or missing eyebrows, eyelashes or body hair, and even baldness, often accompanied by low self-esteem.

"If I tell people I have trichotillomania, they often take a step backward, as if it might be contagious," says Darlene Barnes, a computer programmer in Portland, Ore., who has been a compulsive hair puller for more than three decades. "The only people I've found who understand are other people who have it."

Despite Barnes' experience, the condition isn't uncommon.

"Recent surveys of college students show that about 1 to 2 percent of them have a past or current history of the condition," says Dr. Gary R. Gaffney, associate professor of psychiatry at the University of Iowa College of Medicine. "It's not a disorder that gets a lot of attention, but it's definitely one that affects many people."

Generally classified as psychological in origin, trichotillomania is described as similar to obsessive compulsive disorders -- a group of conditions characterized by persistent or repetitive thoughts or behaviors over which an individual has little conscious control.

"Compulsive hair pullers generally feel mounting tension before pulling out their hair," Gaffney says. "The tension is relieved only by the act of pulling."

According to Gaffney, pulling can be either a symptom of a psychiatric illness or a syndrome in its own right. He notes it's important to make sure a physical illness, like a scalp infection or other skin infection, isn't causing the problem before diagnosing hair loss as trichotillomania.

Dr. Oscar Klein, a New York City psychiatrist and hair specialist, says compulsive hair pulling should never be ignored, particularly in childhood, which is when most cases originate.

In some children, the condition resolves itself and disappears, Klein says, but in others it may persist and become a lifelong burden, unless it's successfully treated.

Barnes says trichotillomania is something she's had to learn to live with, though it still occasionally interferes with her social life and feelings of self worth.

"It's a lot like smoking and other bad habits," she says. "I'd like to stop pulling my hair out, and I make all kinds of plans to stop, but any time I'm stressed, that's my first response."

Experts agree that trichotillomania can be extremely difficult to treat, but note that an important first step is securing an accurate diagnosis as soon as possible.

"A lot of children twist and twirl their hair when they're tired or anxious," Klein says, "but this isn't something to become concerned about unless it results in noticeable loss of hair. If the hair is being broken and the scalp begins to look patchy or moth-eaten, a health care professional should be consulted immediately."

Klein says that trichotillomania is easy to diagnose with a biopsy, because it results in hair shafts that are broken off, leaving the root behind, but a qualified physician can often spot the condition without a biopsy.

Once the diagnosis of trichotillomania is made, there are several treatment options, including medication and cognitive-behavioral therapy.

"The prescription drugs known as selective serotonin reuptake inhibitors, or SSRIs, are often helpful," says Klein, noting that recent research has implicated serotonin chemistry in the brain as a possible cause of the condition.

Both Klein and Gaffney point out that punishing children or adolescents who compulsively pull their hair out doesn't help and, in fact, might make the trichotillomania worse.

"Children and adults with trichotillomania already have low self-esteem because of their appearance, as well as because their behavior sets them apart from peers," Klein says. "Punishments are totally ineffective and can cause the hair-pulling to escalate in frequency and severity."

What to Do: To learn more about trichotillomania, visit the National Mental Health Association. The nonprofit Trichotillomania Learning Center in Santa Cruz, Calif., has a wealth of information on the disorder and its treatment. To link to an online support network for individuals with trichotillomania, click here.

SOURCES: Interviews with Oscar Klein, M.D., psychiatrist and hair loss expert, New York City; Gary R. Gaffney, M.D., associate professor, psychiatry department, University of Iowa College of Medicine, Iowa City; Darlene Barnes, computer programmer, diagnosed with trichotillomania in 1975, Portland, Ore.

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