The truth about trichotillomania - the hair pulling disorder

We look at what it is, who’s at risk and how to treat it.
(Photos courtesy of Julie Mason)

When Julie Mason was 15, her mom started finding hairballs around the house. When she was in university, she developed a bald spot the size of a grapefruit. 

Mason, now 27, has trichotillomania. People with this psychiatric disorder repeatedly pull hair from their scalp, eyebrows, pubic hair, or other parts of their body, to the point it leads to significant hair loss, causes them distress and interferes with their life. The disorder, belonging on the obsessive-compulsive spectrum, is thought to affect between two and five per cent of the population — with a larger chunk being women — though experts suspect more people live with milder forms of the disorder. 

"It's probably best thought of as a maladaptive grooming behaviour," said Dr. Mark Sinyor, a psychiatrist at Sunnybrook Health Sciences Centre in Toronto who has treated hundreds of patients with trichotillomania. "All of us groom… but if you're doing it for many minutes or hours a day, then you probably suffer from a body-focused repetitive behaviour."

Body-focused repetitive behaviours include hair-pulling, skin-picking, nail biting and, in children, thumb-sucking. These are self-grooming, self-stimulating and self-soothing behaviours, said Sinyor.

As for what causes trichotillomania, it appears to be linked to genetics and a person's environment, though more research is needed to determine specific causes, said Dr. Evelyn Stewart, an associate professor of psychiatry at the University of British Columbia.

"Maybe there's modelling," Stewart said, noting that people with hair-pullers in their immediate family are thought to have an increased risk of becoming hair-pullers themselves. "So if kids are watching their parents distractedly pull their hair, it might influence them."

Sinyor said trichotillomania often presents itself around pre-teen years and may involve behaviour such as pulling out hair — particularly hairs perceived to be coarse or irregular —  touching the hair to the lip and, sometimes, consuming it, which can lead to serious health issues, such as a hairball in the bowel.

The triggers for why and when people pull hair vary. Some may pull unconsciously when they're stressed or bored, while others will stand in front of a mirror intentionally pulling out hair for hours, he said.

While most people will remain predisposed to the condition their entire lives, there are effective treatments, said Sinyor.

"There's no reason to suffer in silence," said Dr. Katy Kamkar, a clinical psychologist at the Centre for Addiction and Mental Health in Toronto, who said people often experiencing shame or distress due to the condition.

Kamkar treats trichotillomania patients using cognitive behavioural therapy, an evidence-based psychological treatment that looks at interrelationship between thoughts, behaviour, physical symptoms and emotions. She helps patients self-identify their hair-pulling triggers, monitor their actions and develop strategies to mitigate or stop the behaviour. 

Some strategies may include: covering fingers in tape to heighten awareness when hands wander toward the scalp, wearing gloves, or putting hair in a ponytail. Medication is sometime prescribed to treat trichotillomania, but psychiatrists say it hasn't yet been proven to be effective.

Mason, who lives in Guelph and facilitates bi-weekly support groups for people with trichotillomania and dermatillomania, the skin-picking disorder, now shaves her head to thwart her hair-pulling attempts. She still has to steer clear of tweezers, aware she'll be tempted to pluck stubble.

But she's reached a place of acceptance.

"It's more a societal belief that a beautiful person, or a worthy or successful person, is a person with a full head of hair," she said. "I'm learning that the bald spots are a problem (only) if you really believe they are."

People who think they may have trichotillomania should speak to their family doctor and seek treatment.

Katrina Clarke is a Toronto-based journalist who writes about relationships, health, technology and social trends. Find her on Twitter at @KatrinaAClarke.