How does it manifest itself?
Pulling out can be automatic - while reading, studying, watching a screen, when a person hardly notices his actions - or consciously, as a way to cope with anxiety. There is often a ritual: a person looks for the “wrong” hair, twirls it, looks at the root, and sometimes runs it over his lips. Areas with hair of different lengths and broken hair shafts form on the scalp, and the boundaries of the lesions are uneven. Many carefully disguise bald spots with hair, a scarf or eyebrow cosmetics and do not talk about the problem for years.
- Repeated hair pulling causing bald spots
- Increasing tension before pulling out and relief after
- Hair of different lengths and broken rods in the hearth
- The crown, temples, eyebrows, eyelashes are most often affected
- Attempts to hide outbreaks and denial of the problem
- Sometimes - biting or swallowing hair
Why is this happening
There is no single reason. Features of the functioning of brain systems responsible for controlling habitual actions, hereditary predisposition and emotional state play a role. Yanking becomes reinforced as a way to relieve tension, boredom, or anxiety, and over time becomes an automatic skill. Often there are other disorders nearby: anxiety, depression, obsessive-compulsive disorder, as well as the habit of biting nails or picking the skin. It is important to understand: parents and loved ones are not to blame, and accusations and prohibitions only intensify the symptom.
- Hereditary predisposition
- Anxiety, stress, boredom as trigger conditions
- Concomitant anxiety and depressive disorders
- Other repetitive behaviors: nail biting, skin picking
- Reinforcing the habit with short-term relief
How is it different from other causes of hair loss?
The main difference is its mechanical nature: the hair does not fall out on its own, but is removed. With alopecia areata, the lesions are round, the skin in them is smooth, without broken hair, and the nails often change. With diffuse hair loss after illness or childbirth, the hair thins evenly throughout the head. With a fungal infection, there is peeling, itching, and inflammation. The doctor examines the skin through a trichoscope: with trichotillomania, fragments of rods, twisted hair, and pinpoint hemorrhages are visible. In controversial cases, tests are prescribed to exclude deficiencies.
- Broken hair of varying lengths inside the hearth
- Uneven, geographical boundaries of plots
- The skin is usually without inflammation or peeling
- The side opposite the working hand is most often affected
- Ferritin and TSH tests help rule out other causes
Dangerous complication: hair ingestion
Some people not only pull out hair, but also chew or swallow it. Hair is not digested and can accumulate in the stomach, forming a dense lump - a trichobezoar. It causes heaviness, abdominal pain, nausea, vomiting, weight loss, and in severe cases it blocks the intestinal lumen and requires surgical intervention. Therefore, the doctor always asks about this habit, and if there are complaints about the stomach, he will refer you for examination. Hiding such a symptom is dangerous.
- Heaviness and pain in the upper abdomen
- Nausea, vomiting, early satiety
- Losing weight for no reason
- Examination: gastroscopy, ultrasound, tomography if necessary
- Treatment of trichobezoar is usually surgical
Treatment
The main method is cognitive behavioral therapy, primarily the training of replacement habits. A person learns to monitor in what situations the desire to pull out arises, and replace the action with an incompatible one: clench your fists, pick up an object, use gloves or a plaster on your fingers. Diary of episodes, working with anxiety and teaching loved ones the right support can help. If anxiety or depression is severe, the doctor may add drug therapy - only a psychiatrist selects it. Hair growth products are secondary: the hair grows back on its own when the pulling stops.
- Cognitive behavioral therapy and habit replacement training
- Journaling: time, place, emotions before an episode
- Mechanical barriers: gloves, patches, short haircut
- Working with anxiety and relaxation skills
- Treatment of concomitant depression as prescribed by a psychiatrist
- Family support without reproaches and punishments