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Treatment for Trichotillomania

Trichotillomania or hair-pulling disorder can be defined as the need or impulse to pull your hair. Taking notes, talking on the phone, studying… These are times when some people have fun playing with their hair. People who suffer from Trichotillomania tend to roll it, stretch it, or even get it uprooted. This last custom can lead to a serious problem or even a chronic pathology. People who suffer from hair pulling disorder cannot control the urge to tear their hair. Which can be from the head, eyebrows, arms, armpits, eyelashes or even pubes. This condition should be addressed and patients should opt for treatment for Trichotillomania.
Arriving at a time when the effects of trichotillomania will begin to become visible, appearing bald on the head and other parts of the body. Discover in this article all about this impulse control disorder: What is trichotillomania? stages, symptoms, causes, consequences, associated with this disorder. Treatment for Trichotillomania and much more.
Trichotillomania affects 4% of the population. The most affected people are children and women. This disorder of pulling hair irrationally and compulsively begins normally at an early age about 3 and 7 years. And it is common for this behavior to last approximately 12 months. And disappear over time, however, it is not always so. Trichotillomania at an early age (before age 6) has a better prognosis of treatment for Trichotillomania.
In the case of adults, the first symptoms often occur in adolescence. And the problem can be prolonged even indefinitely if it is not treated properly.
The causes of trichotillomania are varied and depend on the person. However, stress, anxiety, conflicts with other people, or concerns can act as triggers of this disorder. Keep reading!
What is trichotillomania?
Trichotillomania is a disorder of impulse control. Which is characterized, in that the sufferer has an uncontrollable urge to pull the hair/ hair-pulling disorder. Normally the scalp hair is pulled, but it may also occur on the eyebrows, eyelashes, beard and pubic hair.
People who suffer from this disorder start by pulling the hair from a unique place or you can do it from different places. The usual thing is that the hair is torn off one by one. And with time, the number of areas of the hair plucking increases. This results in alopecia in the affected area or areas.
People who suffer from this disorder are not able to stop this impulse, generating much discomfort.
The most common is that before the episode the person experiences anxiety of diffuse and generalized character. A state that drives them to pull their hair. Once he/she does, they experience tranquility and a sense of liberation. But immediately afterward they begin to feel guilty. Which increases anxiety levels and generates a vicious circle. In fact, trichotillomania is a disorder that usually worsens during periods of stress. Because, in a way, it acts as an escape valve.
Obviously, all cases are not equal. There are those who do not experience that tension. But simply pull their hair automatically, while they are immersed in other activities. Such as watching television, reading or studying. In other cases, the person experiences a tingling sensation in the area, which is what unleashes the impulse.
Stages of Trichotillomania
Within the trichotillomania different stages are observed:
  • Early start: It occurs before age eight and is usually corrected without problem. But it is advisable to pay attention to the evolution of this disorder because it can continue in adulthood.
  • Automatic: People who suffer from this specific type of trichotillomania are not aware that they are pulling their hair. While they are concentrating on other activities, such as studying or watching television.
  • Aware: in this type of trichotillomania the person is aware of what he is doing, although he still cannot avoid it. It corresponds to a part of people who suffer from this disorder. The most frequent are the types of conscious and automatic trichotillomania. And also that both coexist.
Symptoms of Trichotillomania
The main symptom of this impulse control disorder is the need to pull hair repeatedly. Mainly, they usually pull the hair from the area of ​​the head. Especially in the neck and the areas near the ears. Also, eyebrow and eyelash hair, including body hair, is also affected in some cases.
Another symptom that follows the previous one, is an increase in the perception of tension before pulling the hair. Or when trying to inhibit this behavior. Subsequently, pleasure, gratification or release is given when pulling hair. However, this symptom of release is quickly interrupted by another symptom, that of guilt. This feeling causes anxiety levels to increase. And the cycle of a need to throw your hair back on again. 
An elevated level of stress can perpetuate trichotillomania, which generates a clinically significant discomfort. Which prevents the person from normally performing his or her social or work life.
As for the symptoms, not all people experience the same. And, not all occur in situations of stress. For example, there are situations where they can  unleash this uncontrollable impulse, some of them are:
  • Moments of relaxation.
  • Boredom situations.
  • State of calm, after a pleasant activity.
In addition, trichotillomania is accompanied by certain characteristic sensations and feelings. Some of them are:
  • Lack of impulse control.
  • Absence of pain when pulling the hair.
  • Lack of criticism about the negative effects of their compulsive behavior.
It is important to keep in mind that the person suffering from trichotillomania does not suffer from another disorder. As this could delay the diagnosis and make treatment difficult.
Causes of trichotillomania
While there is no single cause, there are some factors that influence the onset of trichotillomania:
Genetic predisposition
There are studies that point to genetic mutations. More specifically in the SLITRK1 gene, as is the case in Tourette Syndrome. So there could be some genetic predisposition to suffer from this type of impulse control.
Psychological problems
You may tear your hair as a result of the stress you are experiencing in your day to day life.
In other cases, it may be related to an obsessive-compulsive disorder or obsessive personalities.
Trichotillomania may also be accompanied by other disorders such as Attention Deficit Hyperactivity Disorder, nervous tics, onychophagy, post-traumatic stress. And mood disorders (mainly depression) and anxiety disorders. The latter can predispose and maintain the disorder and also be a consequence of it.
Trichotillomania is sometimes accompanied by trichology. Which consists of the habit of ingesting or chewing the hair. And can lead to obstructions in the digestive system.
Self-harm
Sometimes, it is a form of self-harm. Self-harm can be a nonverbal form of communication. You express with your body what you cannot express in words.
Commonly, self-harm is used to free yourself from emotions such as anger, sadness or the feeling of loneliness. It is a form of emotional self-regulation. When you feel physical pain you cover the emotional pain.
Normally when you hurt yourself, there are feelings like:
  • Blame yourself for something you don’t forgive yourself or something you feel you’ve done wrong.
  • Self-rejection or low self-esteem.
  • Depressed mood
  • Anxiety, malaise, anguish.
Finally, on other occasions, you may self-harm as a way to cover some traumatic experiences in the past. Such as sexual, emotional or physical abuse.
Triggering event
On certain occasions, the person begins to suffer from trichotillomania as a result of living a particularly stressful event.
Consequences of Hair pulling Disorder
Hair pulling leads to other added problems. It is very common that during the first phases you try to hide the disorder. Because the person is afraid of being criticized. Later, when the problem is evident, the most common strategy is to isolate yourself from family and friends.
Trichotillomania therefore not only affects your physical appearance. But can produce the following consequences on an emotional or social level:
  • Low self-esteem. It’s like a fish that bites its tail. For low self-esteem, you get to this problem but when you cause hair loss, your self-esteem goes down even more. As you don’t look good in front of a mirror.
  • Bad relationship with the others. The others are important. Your social relationships are affected, when you have a disorder with these characteristics. You are afraid of being noticed or what they will think of you. You are no longer comfortable with others.
  • Problems in sexuality. You feel unattractive and because of that, your sexual appetite usually decreases.
  • Feeling guilty for pulling off your hair.
Treatment for Trichotillomania
In order to deal with trichotillomania, it is necessary first of all, the willpower of the person who suffers it to be able to eradicate it. However, with willpower, it is not enough so that the person can successfully solve their problem. It must be complemented with the treatment. There are some types that allow an end to this problem, these are:
Psychological treatment for Trichotillomania
The most effective psychological therapy, in this case, is cognitive-behavioral therapy. Which results in a reversal of habit. This consists of establishing a behavior incompatible with pulling of the hair. So that when the person is aware of what he is doing, he does the opposite behavior to pull the hair. 
Patients learn to identify and manage symptoms. In addition to learning strategies that allow them to improve their quality of life. This way you can anticipate the problem or redirect that “need.” On the other hand, it is also taught to identify the triggers of the urge to pull the hair. The steps that are usually followed are:
  • First, the problem behavior is analyzed and the goals of the therapy are set.
  • Second, the patient’s motivation to renounce the effects of his behavior is appealed. For this, the wishes, values ​​, and objectives of the patient that are being affected by trichotillomania are determined.
  • Thirdly, is the habit of hair-pulling disorder somewhat conscious, that much of it is automatic. In this way, it is easier to advance in therapy.
  • Fourth, behavior incompatible with the habit is elaborated, which will be applied.
  • Fifth, to detect the situations and behaviors to which the disease has been conditioned. That is, to detect the situations in which the hair-pulling disorder always occurs.
To finish it, relaxation and emotion acceptance techniques are taught. To practice it in real life, as through imagination, of everything learned.
It is important that progress is recorded throughout the process, as well as work relapses. This is an example of the therapies that are carried out today for the treatment of trichotillomania. The results multiplied over time and in some cases, it is necessary to combine it with pharmacological treatment.
Pharmacological treatment for Trichotillomania
In the most severe cases, it may be appropriate to combine psychological and pharmacological treatment. Since the combination of both has been shown to be the most effective approach in the most severe cases.
Although there is no consensus on the specific treatment that should be offered. Medications that reduce the levels of tension associated with the act of hair-pulling disorder is usually used. It should also be taken into account that the person is likely to suffer from another associated disorder. For which they should also take medication, such as depression or obsessive-compulsive disorder.
Some medications that serve to stabilize the person are usually prescribed. But it is best to go to a professional who after an exam prescribes the most appropriate for each patient.
Alternative treatments for Trichotillomania
Some of the alternative treatments that are usually performed are clinical hypnosis. This is based on providing the patient with a series of instructions that the person assumes in a non-conscious manner. So when circumstances arise where he would perform impulsive and uncontrollable behavior, he will remember those instructions and carry them out.
The number of sessions required depends on the patient himself and the evolution of the disease.
There are several ways to treat this disorder, minimize it or even eliminate it. However, it should be clarified that the course of trichotillomania is variable. And can reappear even after years of disappearance. For this very reason, address this serious problem. And do not hesitate to opt for the treatment of trichotillomania before the problem worsen.
Trichotillomania: As a family member or friend, what can you do?
Friends and family members of a person with trichotillomania often want to be useful. However, you can feel how often the effort is not enough.
That is why to start helping the person suffering from this disease you must first be well informed about trichotillomania. So, to avoid contributing to the problem or aggravating it.
In addition, it is very important to maintain a constant supportive attitude. And make efforts to communicate directly with the person who suffers from it, always in acaring way. 
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