Is Trichotillomania an Anxiety Disorder?

Reviewed on 3/26/2021
Trichotillomania, also known as hair-pulling, is an impulse control disorder.
Trichotillomania, also known as hair-pulling, is an impulse control disorder.

Trichotillomania, also known as hair-pulling, is an impulse control disorder. It could be caused by anxiety and stress. It can coexist with an anxiety disorder. However, psychiatrists consider it as a separate illness and not an anxiety disorder. Some affected persons have also been seen to pull out their hair in a relaxed mode, such as while watching a movie.

Other mental illnesses that trichotillomania is commonly found with includes:

Patients with trichotillomania have an uncontrollable impulse to pull the hair off the head, eyebrows, eyelashes, and even of beard. This can result in thinning of hair that can even progress to a patchy loss of hair (alopecia). The condition may be so distressing to the affected people that they may avoid social and professional interactions.

Some affected people with trichotillomania can also chew or swallow the pulled-out hair. The condition is known as trichophagia and can result in the trapping of hair in the digestive system. if not identified and treated early, the trapped hair called “hairballs” or “trichobezoar” can lead to life-threatening complications.

What causes trichotillomania and what triggers it?

Scientists are yet to find out what exactly causes trichotillomania. Research has helped to identify certain factors that may play a role:

  • Genes: Genetic transmission can be one of the causes. Someone who has a family member with trichotillomania is more likely to get the condition.
  • Structural changes in the brain: There may be problems in those areas of the brain that are involved in the formation of habits, behavior, and the control of impulses.
  • Functional problems in the brain: Some scientists believe that trichotillomania is a subset of OCD, which is caused by chemical changes in the brain.
  • Childhood trauma: Early research suggests emotionally painful events during childhood to be one of the causes. However, there is a lack of evidence.

How is trichotillomania diagnosed?

Patients of trichotillomania most often approach their primary physicians for their problems of hair thinning or alopecia. Primary physicians usually rule out all the causes of hair loss before referring such patients suspected of trichotillomania to a psychiatrist or a psychologist. The psychiatrist or psychologist takes a proper medical history of the patient and looks for signs that point toward the diagnosis of trichotillomania. Blood tests may only be done to cancel out diseases that may cause hair loss.

Can trichotillomania go away?

Yes, trichotillomania is likely to go away but only with proper treatment. It usually lasts for several months to as long as 20 years before disappearing. The condition is known to have relapses and recurrences. This means it goes away and then again returns after a certain period.

Psychiatrists treat trichotillomania by any or combination of the therapies:

Psychotherapy involves biofeedback training or therapy, in which the patient is trained to identify the triggers or thoughts that propel them toward hair pulling. Eventually, they are thought to change their thinking pattern and ultimately, the habit. There is also something known as the “habit reversal” technique. With this technique, the patient is asked to concentrate on other activities, such as clenching of fists, whenever the impulse to pull the hair comes.

The United States Food and Drug Administration (US FDA) has not approved any medication for treating trichotillomania. However, doctors have seen patients getting benefitted from medications that are used to treat depression and other psychiatric disorders. N-acetyl cysteine, an amino acid supplement, has also been used in the treatment of trichotillomania.

Research is yet to establish the efficacy of a single therapy or combination of the two therapies in the treatment of trichotillomania.

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References
Elston DM. Trichotillomania. Medscape. https://emedicine.medscape.com/article/1071854-overview

National Organization for Rare Disorders. Trichotillomania. https://rarediseases.org/rare-diseases/trichotillomania/#

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