‘A way to gain control’ Treating Trichotillomania, the hair pulling disorder

"It takes the edge off whatever they might be feeling."

It is thought that up to two percent of the population experience impulse control disorder, Trichotillomania. The condition, sometimes known as Trich or TTM, is characterised by hair pulling. It usually involves hair on the head but hair from the eyebrows and eyelashes can also pulled as a form of relief. Trich affects a disproportionate number of women compared to men. Up to 90 percent, in fact. However, some studies have suggested that this may be due to the fact that women are more likely to seek medical advice than men. In  early childhood, rates of Trich are similar for girls and boys. The HSE does not classify Trich as a form of mental illness itself, but the condition is often treated as a form of stress relief from other points of emotional distress such as anxiety or trauma. But it's important to note that Trich is a habit and that, like all habits, it can be broken.

Consultant Trichologist at Universal hair and scalp clinic Carol Johnson says that a lot of the patients she sees harbour guilt about their condition - even if it's not warranted.

“There’s a shame that becomes accelerated as the hair pulling continues," she says.

“There’s always going to be repetition with addiction, but that doesn't mean that support can't help.

"This is a cycle and if you change the pattern, you can change the cycle. Patients need to know this is nothing to feel guilty about. It’s simply a habit."

Universal offers scalp soothing treatments to people experiencing Trich or TTM. These treatments can help the scalp and skin where it might have become aggravated from excessive pulling, or in some cases, infected. Not everybody who contacts the clinic will feel comfortable admitting that they have been engaging in hair pulling. Rather, they simply want their new hair to grow. However, Johnson says that accepting the problem is often the first step to breaking the habit for good.

“There are a number of techniques that are proven to work," she explains. "We’ll get them to document how they’re feeling, teach them distraction techniques, and recognise their triggers.

“They can log their behaviours, look at how many hairs they pulled and what they did with them. It helps to bring a consciousness to it."

Sometimes people with Trich will examine the hair they pull. Sometimes they'll put it in their mouth, or ingest it. Other times, they'll put it under their pillow, or play with it, or bite it.

"It’s very much a way to gain control," says Johnson, "and it very much occurs when they’re alone."

"It could be uncertainty, it could be low self esteem, it could be an event that triggered it.

“Because Trich tends to begin in young teenage girls, and because it starts early, it becomes a comfort thing. It takes the edge off whatever they might be feeling."

OCD Ireland classes Trich as one of their 'Three Disorders' alongside OCD and BDD (body dysmorphic disorder). Often characterised by risk factors such as past trauma and anxiety, the three disorders can be debilitating, but they can also be managed. Where some people find it helpful to create a barrier to reduce the sensation associated with hair pulling, others may apply Vaseline or cream to make the hair harder to pull. Alternative sensory input and sources of distraction can also help reduce a person's desire to act on their hair pulling impulse. Leaving head massagers, stretch toys, and things to chew on around the house can act as alternative stress relievers. Ice chips may be worth chewing on as a distraction, or to sooth inflamed and itchy parts of the scalp. One of the most important things patients need to accept though, is that their condition can be managed and the cycle of hair pulling can be broken.

“They need empathy," says Johnson. "And hopefully then they'll feel comfortable enough to speak, to unlock what the root cause is."

You can some more tips for Trich self management here. 

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November is Mental Health Month on Her, where we'll be talking to you and the experts about some of the common - and the not so common - disorders and conditions affecting women in Ireland today.  You can follow the rest of our Mental Health Month series here.  Want to get in touch? Email me at [email protected].