Trichotillomania is an often-misunderstood mental health condition. For people who have this disorder, why does pulling hair feel good, and what types of treatment can help them end this problematic behavior?
What Is Trichotillomania?
Trichotillomania is a mental health condition that causes people to compulsively pull out their own hair. Common targets for people with trichotillomania include the hair on their head, their eyebrows, and their eyelashes.
The disorder is sometimes also referred to as hair-pulling disorder, TTM, and trich.
In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), trichotillomania is included in the “Obsessive-Compulsive and Related Disorders” chapter. Other conditions in that section include:
- Obsessive-compulsive disorder (OCD)
- Body dysmorphic disorder
- Hoarding disorder
- Excoriation (skin-picking) disorder
One common characteristic among these disorders is that they involve repetitive behaviors that a person feels forced to perform. And while engaging in these behaviors may cause fleeting moments of relief, these compulsions can be sources of significant distress.
The shame, guilt, and other effects of trichotillomania can become so severe that they undermine a person’s ability to function in social situations, at work, or in other important areas of life.
Is Trichotillomania Common?
Trichotillomania is relatively uncommon – but in a nation as large as the United States, even rare conditions can have a widespread impact:
- According to the DSM-5, the estimated past year prevalence of this disorder among adults and adolescents is 1%-2%.
- The current U.S. population includes about 25.8 million adolescents (ages 12-17) and about 267 million adults (ages 18 and above).
- Using the DSM-5’s estimate, this would mean that about 258,000-516,000 young people and 2.67-5.34 million adults struggle with compulsive hair-pulling every year.
The DSM-5 reports that the rate of trichotillomania is 10 times higher among girls and women than among boys and men. However, an April 2020 study in the journal Psychiatric Research, which was based on an analysis of a survey involving 10,169 adults, found virtually identical rates among men (1.8%) and women (1.7%).
Why Does Pulling Hair Feel Good?
For someone who doesn’t have trichotillomania, it can be difficult to understand why anyone would follow through on the urges they experience. Why does pulling hair feel good?
The first thing to remember is that for people who have this condition, pulling out their own hair isn’t an intentional, rational action. It is a compulsive behavior that is a symptom of a mental illness.
However, as alluded to earlier in today’s post, pulling out their hair can cause momentary relief for someone with trichotillomania. Below are a few reasons why that may be the case.
Release of tension
People with trichotillomania, OCD, and other disorders that involve recurrent compulsive behaviors often experience a buildup of psychological tension the longer they go without acting on their urges.
When they finally do so – which for someone with trichotillomania involves pulling out hair – the tension dissipates. Though it may not last very long, the sudden absence of emotional discomfort can be quite pleasurable.
Brain chemistry
Some experts believe that the act of pulling out hair can trigger the release of endorphins, which are naturally occurring brain chemicals that block pain sensations and increase feelings of well-being.
Other activities that can prompt endorphin release include exercising, meditating, listening to enjoyable music, spending time with loved ones, and having sex.
Coping mechanism
This is similar to tension release, only it involves a response to external stressors that are known as triggers. Examples of potential triggers can include problems at work, relationship conflicts, health worries, anxiety about an upcoming evaluation or presentation, or simply boredom.
In the same way that someone with a substance use disorder (addiction) may be compelled to use alcohol or another drug to cope with stress, someone with trichotillomania may respond by pulling out their own hair.
Physical sensation
In some cases, the answer to “why does pulling hair feel good?” may simply be because it produces a satisfying physical sensation, similar to what someone feels when they scratch an itch, stretch their back, or rub their temples.
Automatic behavior
This reason may not fit neatly in the “feel good” category, but for some people with trichotillomania, the action becomes an automatic, unconscious habit. In other words, they may pull out their own hair without even realizing what they are doing, just as other people hum, tap their fingers, or engage in other habitual behaviors.
How Is Trichotillomania Treated?
Personalization is a key component of effective treatment for trichotillomania. Thus, one person’s treatment plan can differ from another’s due to factors such as:
- Their age and gender
- The severity of their symptoms
- How long they have been living with trichotillomania
- How this disorder has affected their life
- If they have any co-occurring mental health conditions
The final factor above can be particularly important, as trichotillomania is often accompanied by concerns such as depression, anxiety, OCD, attention-deficit/hyperactivity disorder (ADHD), and posttraumatic stress disorder (PTSD).
Levels of care
When developing a comprehensive treatment plan for someone with trichotillomania, one of the first decisions often involves determining which level or levels of care are right for the individual. Options in this area include:
- Residential treatment
- Partial hospitalization (PHP)
- Intensive outpatient program (IOP)
- Outpatient therapy
Types of treatment
Depending on the patient’s needs as well as the parameters of the program they’re in, treatment for trichotillomania can involve a combination of prescription medication and therapy.
Medications that may be used to treat trichotillomania include:
- Selective serotonin reuptake inhibitors (SSRIs), a category that includes fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft)
- Clomipramine, a tricyclic antidepressant
- Olanzapine
- Lamotrigine
- Naltrexone
Therapies that may be beneficial for someone who has trichotillomania include:
- Individual, group, and family therapy
- Cognitive behavioral therapy (CBT)
- Habit reversal therapy (HRT)
- Dialectical behavior therapy (DBT)
- Acceptance and Commitment Therapy (ACT)
- EMDR and other trauma therapies
- Yoga, mindfulness, art therapy, and other holistic therapies
It’s important to remember that there is no program, medication, or type of treatment that is perfect for everyone who has trichotillomania. This underscores the importance of finding a provider that will take the time to conduct a thorough assessment, then use this information to develop a customized plan that reflects your unique needs, goals, and preferences.
Find Treatment for Trichotillomania in Atlanta
North Atlanta Behavioral Health is a trusted provider of personalized outpatient care for adults who have been living with trichotillomania and other mental health concerns.
When you choose our mental health treatment center in Atlanta, GA, you can expect to receive focused services and comprehensive support from a team of experts who are truly invested in your success. Working together, we can help learn to manage your symptoms, so that you can live the healthier and more satisfying life that you deserve.
To learn more about how we can help, or to schedule a free consultation, please visit our Admissions page or call us today.
