Trichotillomania
What is Trichotillomania?
Trichotillomania (TTM) or hair-pulling, has been observed for thousands of years as an aberrant behaviour that often occurs in times in stress, boredom, or frustration. Initially characterized as a rare, untreatable disorder, TTM is now recognized as a relatively common disorder for which several treatment options exist.
TTM is classified in the Diagnostic and Statistical Manual of Mental Disorders (4th edition) (DSM-IV) as an “impulse-control disorder not elsewhere classified” (APA, 1994, p609), and is characterized by the repeated pulling out of one’s hair from any part of the body resulting in noticeable hair loss.
The most common hair-pulling sites are the scalp, eyelashes, eyebrows, pubes, face and extremities. Anxiety virtually always accompanies the illness, with many people describe the hair-pulling as relieving this anxiety.
On the other hand, complications such as fear of losing control and becoming completely bald can cause an extreme heightening of their anxiety. The hair-pulling is generally not painful and may be engaged in from minutes to hours a day and is often done when alone.
TTM has a reported prevalence of 2.0% to 2.5% in the United States. Despite increasing research and clinical focus on TTM locally, the prevalence of TTM in South Africa is not known. Nevertheless, the true prevalence of TTM worldwide may in fact be higher than the US rates indicate as many patients with TTM are very secretive about the disorder.
TTM seems to be more common in women than men: 75% to 93% of clinic patients with TTM are women. This female preponderance may be due (in part) to women’s greater willingness to seek medical care. While TTM can begin at any age, the common age of onset is puberty.
Parents or other family members rarely understand the truly compulsive nature of the problem (saying something like “why don’t you just stop?” or in fact punishing them for hair-pulling) and can add to the person’s feelings of low self-worth.
In addition to the shame and humiliation felt over the inability to control the urges to pull their hair, the sufferer may have to endure ridicule by others – often leading to their avoidance of intimate relationships for fear of having their shameful secret exposed.
As such, TTM contributes to a lifetime of significantly decreased quality of life. Furthermore, TTM appears to be commonly associated with other problematic behaviours (such as nail biting, skin picking, picking at acne, nose picking, lip biting and cheek chewing) as well as other mood, anxiety and substance use disorders.
What causes hairpulling?
There is no one certain cause of TTM. Onset of hair-pulling has been suggested to be associated with a stressful life event such as illness, injury or parental divorce. However, in many cases there is no identified traumatic event or precipitating factor. Family dynamics and modelling may also play a role in the initiation of this disorder. The role of genetic factors in the aetiology of TTM is also being investigated. More recent work suggests that there may be some disruption in the system involved with one or more of the chemical messengers (i.e. serotonin, dopamine) between the nerve cells of the brain. Involvement of the serotonergic and dopaminergic neurotransmitter systems is currently being investigated locally and internationally. This investigation of a genetic basis for TTM is further encouraged by recent findings that genetic variants play a role in disorders with significant phenomenological and neurobiological similarities with TTM, e.g. obsessive-compulsive disorder.
How is Trichotillomania treated?
At this stage, different treatments may need to be tried before finding the one that works. Treatments can be divided into three major groups: medication, behavioural techniques, and hypnotherapy.
Medication
The so-called selective serotonin reuptake inhibitors (SSRI’s) have been the most extensively studied medications in TTM, and are currently the first-line pharmacotherapy.
Unfortunately, it has been suggested that the effectiveness of SSRI’s in patients with TTM may wane with time, i.e. treatment with SSRI’s is often associated with a high relapse rate. Still, SSRI’s are a reasonable first-line agent because of their efficacy in several patients, their favourable side-effect profile, and their efficacy in treating comorbid conditions such as depression and obsessive-compulsive disorder.
Several lines of evidence suggest that the anticonvulsant topiramate might also be effective in the treatment of TTM. The efficacy of this medication is currently under investigation.
Behavioural techniques
In terms of behaviour therapy, habit reversal is the treatment of choice. This method consists of behavioural monitoring, relaxation training, and competing reaction training (substituting a competing behaviour such as clenching a fist in response to the urge to pull hair). One study has suggested that behaviour therapy may be superior to treatment with SSRI’s for reducing the symptoms of TTM.
Hypnotherapy
Hypnotherapy has been used in the treatment of TTM, either alone or in combination with another form of therapy, and it has been suggested that hypnosis can bring effective results. Hypnotherapy commonly includes regression to the age of TTM onset to uncover hidden conflicts, relaxation to relive tension, and suggestion to increase awareness and control of hair-pulling.
This treatment method may provide a useful alternative for the patient who refuses medication or is unable to comply with behavioural therapy. It is very important that the therapist implementing hypnotherapy should be adequately trained.
Importantly, even if medical or behavioural treatments are successful in stopping the hair-pulling, the psychological complications (mentioned above) often also require healing with group and/or individual psychotherapy.
Research
As mentioned previously, currently there is a research project undertaken at the MRC Research Unit on Anxiety Disorders (Dept of Psychiatry, Tygerberg), which primarily focuses on the issue of genetic factors in different psychiatric disorders (including TTM) and to the question of susceptibility to these conditions after streptococcal infection. More specifically, this study aims to identify specific genes that contribute to the development of TTM and other similar conditions.
If you need more information on TTM, or are interested in research and want to discuss the matter of participation, the Mental Health Information Centre (MHIC) can be contacted at +27 21 938 9229/9029.
OTHER RESOURCES
Resources are readily available for patients who wish to learn more about their condition and the available methods for treatment:
Books
Stein DJ, Christenson GA, Hollander E. Trichotillomania. Washington DC: American Psychiatric Press; 1999.
Keuthen NJ, Stein DJ, Christenson GA. Help for Hair pullers. Oakland, CA: New Harbinger Publications: 2001.
Goldfinger GR. The Hairpulling Habit and You: How to Solve the Trichotillomania Puzzle. Washington, DC: Writers’ Cooperative of Greater Washington; 1999.
Internet Sites
www.trich.org
Trichotillomania Learning Center
www.home.intekom.com/jly2/index.html
Amanda’s Trichotillomania Guide
Written by Christine Lochner (Clinical Psychologist), MRC Unit for Anxiety Disorders
Is there any dr, hypnotherapist or centre in Cape Town / Northern suburbs which you can recommend for a person with ongoing Trichotillomania ?
Dear Mary,
You can contact Andre van der Merwe on 021 9495198 or Jorgan Harris on 021 9822554.
Kind regards,
MHIC
Hi, I’m a Trich since 1992. I am still pulling. I’m 33. I’m currently on Depramil. But it doesn’t help my urge. Can you please help?
Good day Marli,
It would be good to combine your medication with other forms of treatment as well such as behavioural techniques, and hypnotherapy. You can have a look on https://www.mentalhealthsa.org.za for a ‘mental health professionals’ database to locate a psychologist in your area.If you are in the vicinity of Cape Town, please let me know whether you’d be interested in joining our research study?
Kind regards,
MHIC
Hello, my bald patches (scalp) were noticed when I was about 9 and I am now 43. Just come through an horrific grievance process where my supervisor victimised me. You can imagine the anxiety and as a “Trichster” how I tried to cope. I had to leave the company, but managed to find a temp job at a much much lower salary. Different kind of stress now, but I haven’t pulled in 3 months! Not on any medication, but would like to know of any support groups in Port Elizabeth?
Thank you.
Hi Samantha,
Please have a look at the following links:
http://blogs.sun.ac.za/mhic/2011/02/10/trichotillomania/
http://www.home.intekom.com/jly2/index.html
http://lifeshifts.co.za/2012/08/27/are-you-literally-pulling-your-hair-out/
Maybe with their help you can find support in P.E?
Kind regards,
MHIC
Hi, I’d like to know which therapists have had success in ‘treating’ trich in Cape Town, and what medications you have found to work. Would I need to see a psychiatrist to get this? I’ve had trich for 18 years and have only tried online therapy which hasn’t helped. Am now ready to give medication a shot. Thanks.
Hi Sabrina,
Trich is best treated with CBT (cognitive behavioural therapy). You can have a look on our website’s mental health professionals database for someone in Cape Town. Just ask specifically whether they have experience in treating Trich. You can consider using NAC (can obtain it from Dischem). Please have a look at the following link http://www.trich.org/dnld/NACarticle_InTouch55_rev.pdf
Regards,
MHIC
Good day
My daughter (8) has very recently been diagnosed with trich. Please advise who I can contact in Joburg with known success rate. Feel helpless! Thanks so much
Hi Suanet,
Please see below the contact details of Tyrone Edgar who works with trich. I hope this will be helpful?
Tyrone Edgar
M.A. Clinical Psychologist
Hurlingham Office Park (Block G) Woodlands Ave Sandton 2196
Tel: (011) 285 0080
E-mail: tyrone.edgar@cbtrsa.com
Website: http://www.cbtrsa.com
TheCBTgroup Website: http://www.thecbtgroup.com
Kind regards,
Janine Roos MHIC
For information and to help avoid embarrassment: Whatever you do don’t subscribe to TLC News on this link http://www.home.intekom.com/jly2/index.html
You are actually subscribing to a Choir Society, which has nothing to do with Trichotillomania and they get to know all about your uglies. AND info@TLC. org does not exist.
Hi Samantha,
Thank you for letting us know!
Kind regards,
MHIC
Hi
I’m 15 years old and I’ve been struggling with TTM for about 5 years now. I haven’t had the courage to speak about it to anyone and I originally thought I was the only one until this year I looked up the condition and found it actually had a name. I’m not sure what to do.. Considering therapy but I don’t know how to ask my mom. Thanks x
Hi Caitlin,
Thank you for your enquiry. Yes, it has a name! It would be great if you could enter into therapy – maybe confide in your mom? Please have a look at the following http://www.webmd.com/anxiety-panic/guide/trichotillomania
If you are in Cape Town, we are looking for participants for our study on TTM. You can get more information on this on our website. One of our psychologists will also be seeing participants in Jo’burg between 12 – 18 October. Please email me if you need any more information? mhic@sun.ac.za
Kind regards,
Janine
I have known about Tich for a long time now, I have tried to monitor it and realize it is very stress related. I have had this since I was a young girl, this incessant urge to pull every hair on my body but now I am 27 and it really has to stop. I have an Identical twin sister and she is affected but not as severe as I am. I don’t want medication, or therapy because I had a brilliant childhood, happy and healthy and I don’t know why I am doing this. I have tried numerous home remedies, and suggestions by friends and family but this only last for a few days at a time and I am fed up. Can someone suggest a hypnotist for Hypnotism in Durbanville, Northern Suburbs? I hear this has helped people stop smoking and I am eager to try this!
Looking forward to a reply
Max
Hi Max,
Thank you for your enquiry. Please have a look at the database of mental health professionals on https://www.mentalhealthsa.org.za where you can search for someone in your area and by field of expertise. The other option is to join our research study on TTM? You can bring your twin sister along if you wish as we are also looking into the genetics part of TTM. You will be interviewed by Prof Christine Lochner who is an expert in the field. She will also be able to refer you correctly? If you are interested, please email me at mhic@sun.ac.za
Kind regards,
MHIC
Hi. I started pulling my hair when I was 13. I am now about to turn 30. I had knee length thick beautiful hair which had to be cut to 3cms when I was 16 because I couldn’t cover the bald patches anymore. My boyfriend at the time is my husband today and luckily incredibly supportive. High school and my early 20’s were not easy – most people don’t know my story but just know me as the lady with the short hair that won’t grow…. I started wearing wigs to work 6yrs ago and have now got a successful career and a job I love. My son is in pre school and doesn’t understand why mommy can’t have long hair. I would really like to get rid of this addiction. I don’t smoke but I feel like this may be worse. I’m in cape town. Please help.
Hi Roxanne,
I sent you an email.
Kind regards,
Janine
Hi there,
Who in South Africa offer the intralace systems (pull-free hair barrier) for trich sufferers?
Thanks,
Dear Rose,
Thank you for your enquiry. As far as I know this is not available in SA.
http://www.lucindaellery-hairloss.co.uk/intralace.php
http://www.trich.org/about/ab-intro.html
Kind regards,
Janine
MHIC
Hi there . I’ve had trich for about 4 years now . I’m at my worst point at the moment and I feel completely helpless. I keep asking my mom to take me to different doctors or to get some new extensions as I’ve pulled many of my old ones out already , but she just tells me I must put some effort in from my side and she can’t keep spending money if I’m not going to contribute . But she never sees how hard I try . My confidence has dropped dramatically and nobody understands. I wish my mom understood more about trich and could help me more , but she just doesn’t understand . If you know of any doctors in Pretoria please let me know . Or just any information I can give my mom . I feel completely helpless and I don’t know what to do …
Dear Kelly,
Please have a look at the following; maybe show your mom? http://www.trich.org or http://www.stoppulling.com or http://www.trich.org/about/ab-intro.html
And here are options for treatment:
tyrone.edgar@cbtrsa.com
http://www.cbtrsa.com
or mail to cbtpractice@mweb.co.za
011 285 0088
Psychiatrist Dr Annemarie Potgieter: (In Pta: +27123621581)
http://www0.sun.ac.za/mhicweb/node/1429 (Colin Franco)
Hope this will be of help?
Kind regards,
MHIC
I have had TTM for about 8 years now. I so wish this study was happening while I was in Stellenbosch. I am currently on this website because I am at my lowest point. I basically have no eyelashes left. I try put mascara on, hoping that there will be a hair there to catch it, but all I find is a bald eyelid. I have never been to a doctor / psychologist / hypnotherapist about this before, but I feel it is time. I was wondering if someone could recommend who to try first, which avenue? I don’t mind being on medication if it helps. I live in the Eastern Cape, I can travel to Port Elizabeth or East London if there are good recommendations in either of these cities? I’m also going to Cape Town next month so I can possibly go to somewhere there.
Thank you in advance.
Nicky
Dear Nicky,
Thank you for your enquiry. It would be good to get to a psychiatrist/psychologist as soon as possible. Also have a look at the following: http://www.trich.org or http://www.stoppulling.com.
Here are options in PE:
Psychiatrists: Margo De Vries tel. 041 3642790/079 456 9413 or Derick Van Der Merwe tel. 049 8460158/082 3730577
Clinical psychologists: Leanne Kay tel. 041 3743335; Lorryn Herbst te. 041 8185437; Louise Malan te. 041 3661116
If you are coming to Cape Town and are interested in seeing Prof Christine Lochner (TTM expert), please contact me on 021 9389229 or send an e-mail to mhic@sun.ac.za
She only sees research participants, but gives valuable information and do referrals as well.
Kind regards,
Janine Roos
MHIC