Articles

Hair loss or Hair Pulling ?

By Ms. Nitta Thomas : Psychologist

Diana was a smart girl with thick black curly hair in my psychology graduate class. She was a sweet girl, friendly with every one. She had a peculiar habit. She used to pull out her hair, every now and then, especially when she was stressed out. To cover up her bald patches on the scalp, she used to change the parting of her hair very often. She just thought of it as a bad habit and nothing more. Diana realized what she had, was not just a bad habit, but an Impulse Control Disorder, when our course teacher started a discussion on “Trichotillomania”. Before that she has never heard the ‘T’ word, nor did we know anything about Impulse Control Disorders.

The ‘T’ word!!

Trichotillomania is repetitive, intentional hair pulling that causes noticeable hair loss. The hair can be in any region of the body, including head, body, eyelashes etc. The hair may come out in round patches or across the scalp. This is an Impulse Control Disorder. The important feature of an Impulse Control Disorder is the failure to resist an impulse to do something even when it can be harmful to self and others

Who has this?? Why this happens??

Trichotillomania is equally common among males and females in childhood but it appears to be more common in females in adulthood. People often start compulsive hair-pulling around the ages of 12-13, but there are people who have this disorder from a much younger or older age. Frequently, a stressful event such as change of schools, abuse, family conflict or the death of a parent can be associated with the onset. The actual cause of trichotillomania is not known but many factors are associated with it. Researches have shown that genetic issues, neurochemical imbalance, problems in brain metabolism, childhood trauma and stressful life events all have an impact on the onset of disorder.

How do you know you have this?

A person with this disorder usually has….

An uneven appearance to the hair
Bare patches, or all around (diffuse) loss of hair
Bowel blockage (obstruction) if people eat the hair they pull out
Constant tugging, pulling or twisting of hair
Denying the hair pulling
Hair regrowth that feels like stubble in the bare spots
Increasing sense of tension before the hair pulling
Other self-injury behaviours
Sense of relief, pleasure or gratification after the hair pulling

What to do if my child has the problem?

Early detection is the best form of prevention - it leads to early treatment.
Decreasing stress can help, because stress may increase hair pulling.
The younger the child, the more likely he or she is, to grow beyond the pulling behaviour So stop worrying over it!
Cultivate an interest in cookery or other hands-on, active pursuits.
Keep some play dough or silly putty around and play with it yourself and kids.
Anything you are doing with your hands, your child will want to mimic.
Encourage outdoor activities, sports etc.

Different modes of treatments are there for this condition

Pharmacological Therapy

A number of medications has shown promise in reducing the severity of symptoms. Most of these fall under the category of Selective Serotonin-Reuptake Inhibitors (SSRIs), which are commonly used to treat anxiety and depression. The effectiveness of these drugs for hair pulling ranges considerably. Consult your physician about this.

Habit Reversal Training

Habit Reversal Training or HRT is a type of Cognitive Behavioural Therapy. You can ask your therapist about this. Usually therapist encourages hair pullers to develop an increased awareness of the times of day, emotional states and other factors that promote hair pulling as an important precursor to being able to control the behaviour. Then the hair puller will learn strategies like relaxation and alternative responses to pulling hair.

Behaviour modification

Again another psychological technique. You will learn to associate the problem behaviour with negative consequences rather than with relief or pleasure. Over time, when the person stops getting ‘positive' results from their behaviour (pleasure or relief from hair pulling), the behaviour occurs less and less often. He/ She also learns new and more positive ways of expressing their needs and feelings.

Counselling and Family Therapy

Counselling may be helpful to discover and cope with deeper emotional issues that may have led to the disorder. Family therapy is always helpful for children and adolescents having the problem.

What you need to know

Write a Journal, Hmm that really helps…..

Writing a journal will help you to identify the impulses and monitor the changes. Keep a journal to keep track of the impulses – when and under what circumstances it occurs, so you can monitor yourself. Mark achievements in this diary and see what you can learn from them. An ‘achievement' might consist of resisting the urge to carry out the problem behaviour Celebrate your successes and acknowledge the hard work you put into resisting the urges.

Distraction, Do something interesting!!

When urges are great, do something else. Take up enjoyable hobbies and interests to provide distraction and enhance self-esteem.

Positive self-talk, some pep up talks can really help, you know!!

Try to catch yourself when you think or say negative things about yourself and replace them with more positive and realistic things. For example, "I am a worthwhile person - I am thinking these thoughts because I have a disorder that wants me to think this way" rather than “I am a bad person because of my behaviour” Avoid punishing yourself when you have engaged in the impulsive behaviour.

Support- you are not alone, stop being miserable!!

Enlist support from family members and friends by explaining the disorder to them and what you are doing to try to overcome it.

Now, back to my friend’s story. When she learned about her problem she went to a therapist and her friends and family supported her through out the therapy. Now she is able to cope up with her impulses, she has no more bald patches in her scalp and she is on the way to become a Clinical Psychologist!!