An Inability to Resist Harming Oneself
Trichotillomania is very different from a single incident or two of pulling one’s hair. Gaffney explains that clinically significant hair-pulling “tends to occur in episodes.” It can be made worse by stress, or conversely, by relaxation. For example, he points out, some people with the condition have particular difficulty controlling their impulse to pull out their body hair when reading a book or watching television.
“Nail biting, scratching, gnawing and excoriation may be associated with trichotillomania,” Gaffney explains. “Those with the condition may also have mood disorders, such as depression, anxiety disorders or mental retardation.”
The hallmark of impulse control disorders like trichotillomania is the inability to control or resist the temptation (or impulse) to do something harmful to oneself or someone else. A sufferer sometimes experiences a sense of increasing tension before performing the behavior and can feel a sense of relief or release of tension afterwards. Sometimes people even express a degree of pleasure after having performed the act.
Features of trichotillomania that fit the description of an impulse control disorder include the inability to resist urges to pull out your hair, mounting tension before pulling and feeling of relief afterward.
Course of the Disease and Treatment
In some children, this disorder spontaneously resolves on its own, even after months or years of stereotypical, recurrent hair-pulling. In adults, it may appear and disappear spontaneously in trichotillomanic episodes, or it may be chronic and unrelenting.
Fredrick Penzel, Ph.D., a psychologist at Western Suffolk Psychological Services in Huntington, N.Y., is an expert in trichotillomania. He describes two approaches to treating the condition in adults that are considered helpful medication and behavior therapy, although, he adds, “Neither is a cure.”
Penzel explains the medications typically used include SSRIs and SNRIs such as Prozac, Paxil, Luvox, Zoloft, Celexa, Serzone, Effexor and Anafranil. Occasionally, he says, these drugs may be augmented with a second medication such as Risperdal, Zyprexa, and Seroquel to help them to work better.
The psychologist describes the behavioral therapy used to treat the condition as “Habit Reversal Training (HRT),” an approach developed more than 25 years ago by Dr. Nathan Azrin. HRT typically includes four steps:
- Awareness training keeping detailed records of all hair-pulling episodes and their surrounding circumstances.
- Relaxation training learning to calm one’s nervous system and to focus and center oneself.
- Breathing retraining learning to breathe from the diaphragm to increase relaxation and focus.
- Competing response training a method of tensing the forearms and hands that is incompatible with pulling.
For more information on trichotillomania, consult the following resources:
- The West Suffolk Psychological Services, Huntington, N.Y., Web site at http://www.homestead.com/westsuffolkpsych/index.html.
- The Trichotillomania Learning Center, Inc., Santa Cruz, Calif., Web site at http://www.trich.org.
The TLC, Inc. site also includes links to many personal pages maintained by people with trichotillomania or by family members of those with the disorder.
The value of Web-based support groups has not been evaluated, but anecdotal evidence suggests many people with “trich,” as they themselves commonly call it, have been successful in modifying their hair-pulling behaviors through regular contact online with other “trich”-sters. Such support is not recommended as a substitute for professional diagnosis and treatment, but may be a useful adjunct to such interventions.