Health Scan: Getting a handle on hair pulling

The phenomenon of pulling out one’s own hair – known by psychiatrists and psychologists as trichotillomania – has been recognized for centuries but has not been widely studied. Thus, how common the phenomenon is, exactly what causes it and how to treat it are not well known. According to an article by researchers at the Be’er Ya’acov Mental Health Center in a recent issue of Israel Medical Association Journal (IMAJ), trichotillomania is referred to in Homer’s Iliad, in William Shakespeare’s plays and in a work by Hippocrates. The phenomenon of trichophagia – eating one’s hair – was mentioned even before trichotillomania. The name of the condition was given in 1889 by a French physician.

As bald patches can also be the result of diseases of the scalp, such as tinea capitis and alopecia areata, dermatologists may treat the loss of hair even though the cause is actually a psychological problem, Dr. Moshe Kotler and others wrote. There are three types: early-onset (which affects young children under the age of eight), automatic (hair-pulling when engaged in other activities such as watching TV or reading) and focused (thought to occupy the individual’s attention and associated with intense urges and thoughts).

The condition affects women and girls more than men and boys, probably because most females have longer hair but perhaps for other reasons as well. Sufferers commonly deny that they have a problem and try to hide it. As it has been classified by psychiatrists as an impulse-control disorder, medications used for obsessive- compulsive problems are often prescribed, but studies of patients who have taken these drugs have had mixed results.

The authors noted that the condition has similarities with addictive disorders because of the sufferers’ diminished self-control. Drugs usually given to help people stop smoking by overcoming nicotine addiction have shown promise in at least one study. Others have suggested mood stabilizers and food supplements for the condition. The Be’er Ya’acov researchers said that genetic factors appear to contribute to the development of trichotillomania, as it is more common among identical twins than in fraternal twins who don’t share the same genome.

Professionals have not been highly successful in treating hair-pulling, and the condition is apparently more common and complex than previously believed. The authors found that cognitive behavioral therapy seems to be the treatment of choice, combined with certain medications.

But more research into the disorder is clearly necessary.