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What is Trichotillomania?
Trichotillomania is a disorder that manefests in the
compulsive urge to pull out one's own hair. It is currently defined in medical literature as an Impulse Control
Disorder. Impulse Control Disorders are characterized by the inability to control or resist the temptation (or impulse) to
do something harmful to oneself or someone else.
The American Psychiatric Association define Trichotillomania
as:
~Recurrent pulling of one's own hair resulting in noticable
hair loss
~Increasing sence of tention immidiately before pulling the
hair
~Pleasure, gratification or relief when pulling out one's
hair
The term Trichotillomania is derived from the Greek words
for hair (thrix), to pull (tillein) and insanity, frenzy (mania) and was first coined in 1889 by a French dermatologist named
Hallepeau. The phrase, however is misleading and people with Trichotillomania are not 'mad', 'psychotic' or 'crazy' as the
name suggests. They are ordinary people who use pulling as way of coping with stress or boredom. People with this condition
prefer to call it 'trich' and refere to each other affectionately as 'trichsters'.
How common is Trichotillomania?
It is difficult to get reliable statistics, since people are often ashamed
of their behaviour and are consequently reluctant to discuss it, even with their doctor. It was once thought that the condition
was rare , but now that it is better understood more people are seeking help. More recent estimates range from 3% to 10% of
the population being affected by Trich in some way.
Who is affected by Trichotillomania?
Trich affects both children and adults. The most common age for hair
pulling to start is around 13 but it can start at any age. The onset may be associted with hormonal changes at puberty, although
many people recall a significantly stressful event associated with the onset. In children distibution amongst male and female
sufferers is equally spread. From adolesence onwards it is more common amongst females but this may be a diagnostic discrepancy.
Where do people pull from?
Scalp hair is most commonly pulled, but lashes, brows, pubic area, underarm
hair, beard, and anywhere else that hair grows can be a target area. The sites pulled vary from person to person and
may be restricted to one or two sites.
Associated behaviours include searching for that hair that stands out
in some way; compulsively playing with, or splitting the hair; repetative drawing of the hair through the fingers, or over
the lips, before or after pulling and biting of the roots once the hair has been pulled.
Some people eat the roots or the whole hair. This condition is called
Trichophagia and is potentially dangerous. Hair cannot be digested and therefore remains in the stomach. This can cause a
hairball (trichobezoar) to form in the stomach or intestines which needs to be surgically removed. Medical advise should be
sought if you suspect a hairball.
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What causes Trichotillomania?
The cause, or causes of Trichotillomania are largely unknown. There are
many theories as to its causes, but more research of the subject is needed. Theories have included problems in parental bonding,
dysregulation of grooming behaviours, trauma, or a genetic predisposition.
There is debate amongst many theorists as to the connection between Trichotillomania
and Obsessive Complulsive Disorder (OCD). Whilst there are similarities between the two, there are also marked differences.
Compulsive hair pulling is commonly included in what are called ODC Spectrum disorders, which include a variety of disorders
that seem to relate to ODC but do not meet actual ODC diagnostic criteria.
Approx 80% of trichsters report an itch like urge prior to pulling. An
irritation to the natural skin yeast Malessizia has been implicated as the cause of this. John Kender, a professor of computer
science and fellow trichster, has formulated a diet based on this theory. The diet has not been scientifically tested but
many people who have tried the diet have seen a marked improvement in their urges. John himself has remained pull free for
many years as a result of dietary changes.
It is most likely that multiple factors and abnormalities of brain neochemistry
are involved, and that several different factors account for the onset and maintenance of Trichotillomania.
How are people affected by Trichotillomania?
Trich sufferers are profoundly affected by this condition. Many experience
shame, hopelessness, low self esteem and self worth, depression and embarrassement that can impact every aspect of their lives.
There are many sufferers who have worn wigs, hair pieces or false lashes for as long as they can remember. Children who are
ridiculed by their class mates. People who can't go swimming for fear of getting thier hair wet. People who can't be in relationships
for fear of exposure to their secret. People who can't go to the hairdressers or optitions for fear of people noticing bald
spots. People who are unable to work due to problems connecting to people. People who avoid any social situations due
to social anxiety. People often think they are the only ones who pull their hair out and feel isolated. Parents are often
unable to offer compassion becasue they do not understand the nature of the disorder. And many doctors fail to diagnose the
condition because they have not been trained to do so.
Can permanent damage occur?
In a word Yes. For trichsters hair re-growth is
a big concern and many people ask if the hair will always grow back again. This is one of the most difficult
questions to answer. Re-growth will largely depend on the duration and intensity of the pulling. There have been cases where
people who have pulled for 30 years have achieved full coverage once they have become pull free, whilst other have permanent
damage after 5 years of pulling.
To understand fully the implications of pulling out hair it is helpful to first look
at the structure of the hair.
KERATIN, the same strong protein that makes fur and
feathers in animals, and the outermost layer of skin and nails in humans, is the main protein composition of our hair.
Each
strand of hair consists of three layers.
MEDULLA – This is the innermost layer which
is only present in larger, thicker hairs.
CORTEX – This is the middle layer and is
responsible for the texture and color of hair
CUTICLE – This is a thin, colorless
protective layer.
Below the surface of the skin is the hair root, which is enclosed within the hair follicle At the
base of the hair follicle is the DERMAL PAPILLA The dermal papilla is fed by the bloodstream, which
carries nourishment to produce new hair. The dermal papilla is very important to hair growth because it contains receptors
for ANDROGENS, which regulates hair growth.
To understand
how hair grows lets take a look at the normal hair growth cycle.
Hair follicles follow a genetically programmed cycle
that can be broken down into 3 stages.
ANAGEN – GROWTH PHASE
About 85% of
hair follicles are in the growth stage at any one time. This stage varies from 2-5 years with hair growing approx 10cm per
year. Eyelash, arm and leg follicles have a shorter growth stage lasting only a few months so the resulting hairs are shorter.
CATAGEN – TRANSITIONAL PHASE
This stage lasts about two weeks. During this
stage the follicle shrinks to 1/6 its normal size. The lower part of the follicle is absorbed by the body and hair growth
ceases.
TELOGEN – RESTING PHASE
About 15% of hair follicles are in this stage
at any one time. The resting phase normally lasts about 2 months. During this stage the bulb of the hair shaft moves closer
to the surface of the skin. This causes the hair to loosen and then it is shed. At the end of the telogen phase the hair follicle
re-enters the anagen phase. The follicle enlarges again and a new growth cycle starts.
Hair is continually shed and
renewed by the alternating cycle of growth, rest, fallout, and renewed growth. Each follicle follows this cycle independently
of others, so the total number of hairs normally remains consistent. On average 50 – 100 hairs are shed per day. This
does sound a lot but when you consider the total number of follicles on your scalp is around 150,000, it is a very small amount.
FOLLICLE DAMAGE
When you pull a hair the hair follicle will try and repair any
damage that has occurred. The human body has a remarkable way of repairing itself but this can take some time. If you pull
a hair and the root is not pulled out this means that the hair is in its resting phase, however if you pull a hair with the
root attached the hair is in the active phase which means it is actively growing. If you pull part of the root out this can
damage the hair follicle.
The BLACK tip you see on some hairs is the area responsible for
color pigment. While the hair follicle is repairing the hair will grow but the MELANIN (which gives
hair its color) will not have ‘fused’ with the protein cells that are our hair, causing the hair to grow in grey
or white. In time your normal hair color may re-establish itself, but this is not always the case. The follicle may be repaired
enough to grow but the formation of melanin can cease which causes the hair to stay gray or while. Hair can also grow in different
eg- if you have straight hair it may grow in curly.
If you pull the hair and the whole follicle comes out with a RED tip, you have just detached the blood supply and muscle. This is permanent damage. This means that
the hair will NOT grow back.
RECOVERY TIME FRAME
Different
areas have different chances for recovery speed. This is just an estimate of how long FULL recovery will take. You will see
new growth fairly quickly in most cases.
LASHES – Some people can get FULL recovery
in 6 months but if you have been pulling for many, many years it could be 2-4 years.
EYEBROWS
– FULL recovery can be slower than lashes because this area is more easily damaged and for some people it does not totally
grow back.
SCALP – FULL recovery for normal hair can take 2-6 years. This sounds
like a long time but you have to remember that your hair only grows about ½ an inch a month. You have to wait for each hair
pulled to start its growth cycle again and if it is growing in ‘funny’ you have to give you body time to repair
itself, then you have to wait to grow length again.
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