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All about trichotillomania

All about trichotillomania

Medical Manager Dr. David Tanganho

12 min

November 17, 2023

Bald patches of hair on the head are not only caused by known physiological factors such as genetic predisposition, hormonal changes or autoimmune diseases. Psychological circumstances can also lead to hair loss: so-called trichotillomania (hair-pulling disorder) causes those affected to pull out their hair or pluck it with tweezers (mental health disorder). Some dismiss this behaviour as an expression of boredom or temporary inner tension, but plucking one's own hair can lead to pronounced bald spots and great suffering for those affected over a long period of time.

What is trichotillomania?

Trichotillomania, also known as hair pulling disorder, is a psychological disorder characterised by the repeated and compulsive urge to pull out one's own hair. This behaviour can lead to severe hair loss, which can be very distressing (significant distress) and emotionally debilitating for those affected (negative emotions). Trichotillomania is common in people of all ages and genders, but is more frequently diagnosed in women and typically begins in adolescence.

What is the cause of trichotillomania?

The exact cause of trichotillomania is not yet fully understood, but it is thought to be linked to a combination of genetic, environmental and psychological factors. Some studies suggest that people with trichotillomania have an imbalance of certain chemicals in the brain, such as serotonin. These affect mood and can cause impulse control disorders (related disorders). Stress, anxiety and traumatic life events can also trigger or exacerbate hair-pulling behaviour. In addition, trichotillomania is often associated with other mental illnesses such as anxiety (anxiety disorder), depression and obsessive-compulsive disorder (repetitive behaviors). Skin picking is also one of these body-focussed disorders (skin picking disorder), which is also reported by the American Psychiatric Association. Skin picking prevents hair regrowth and is a serious problem recognised by the healthcare system.

What are the symptoms of trichotillomania?

The most common signs of trichotillomania are noticeable hair loss (alopecia), bald patches and thinning or shedding hair, particularly in scalp, eyebrow or eyelash areas, although other parts of the body may also be affected. Other signs may include broken hair and a feeling of relaxation or relief after pulling out hair. Sometimes trichotillomania is accompanied by trichophagia (the so-called "Rapunzel syndrome"), which manifests itself in behaviours such as chewing or swallowing the hair that has been pulled out. This can lead to additional health complications such as gastrointestinal problems, as the hair balls formed by the swallowed hair (technically known as "trichobezoars") can result in an intestinal blockage.

Comparable obsessive-compulsive disorders or impulse control disorders include onychophagia (compulsive nail biting) and dermatillomania (compulsive scratching and squeezing of the skin).

    What are the treatment options for trichotillomania?

    Treatment for trichotillomania usually involves a combination of therapies such as cognitive behavioural therapy, habit reversal training, the use of self-help strategies and medication. Cognitive behavioral therapy aims to identify and change negative thought patterns and behaviours associated with hair pulling, while habit reversal training helps those affected to develop strategies to replace the hair pulling behavior with a more positive alternative. Self-help strategies include setting boundaries for hair pulling, finding healthy ways to cope with stress and emotions, and using physical barriers (such as wearing gloves or a hair band) to prevent hair pulling. Medications such as selective serotonin reuptake inhibitors can also come into play to manage the impulsive and obsessive symptoms associated with trichotillomania or to treat any underlying mental illness.

    It is important for people with trichotillomania to seek support and treatment from a qualified mental health professional as soon as possible, as the disorder can have a significant impact on self-esteem and life quality (low self-esteem). Although the disorder can be difficult to overcome, by receiving the right treatment, people with trichotillomania manage their OCD and improve their overall well-being.

    Overcoming trichotillomania – what now?

    After successful treatment of trichotillomania, light or bald patches may remain and understandably many former patients want to get rid of the disorder visually. In these cases, wigs, toupees, hair pigmentation or head coverings can be helpful. However, those looking for a long-term, natural solution tend to prefer a hair transplant.

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    Hair transplant

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    Hair transplantation at HAIR & SKIN

    At HAIR & SKIN, the Swiss market leader for hair transplants and PRP autologous blood treatments, hair transplants are performed exclusively using the FUE method. Follicular unit extraction (FUE) is a hair transplant technique in which individual hair follicles are extracted from the donor area (usually the back of the head) and grafted into the recipient area (usually the front, top or crown of the head).

    A hair transplant at HAIR & SKIN involves the following steps:

    • Consultation

      During consultation, the attending doctor will examine the patient's scalp to determine the hair quality. This helps to establish if the patient is suitable for a hair transplant (medical condition).

    • Preparation

      On the day of your procedure (intervention), our hair transplant team will mark the donor and recipient areas and then shave the donor area. The areas to be treated are then disinfected and anaesthetised using a local anaesthetic.

    • Harvesting

      The hair transplant team uses a small punch (usually with a diameter of 0.6 to 1.0 millimetres) to remove individual hair follicles from the donor area. The punch is rotated in a circular motion to loosen the follicle, which is then carefully pulled out with forceps.

    • Preparation of the grafts

      Once the follicles have been harvested, they are carefully dissected to separate them into individual follicular units (groups of 1-4 hairs). The hair transplant surgeon can trim the excess tissue from the follicles to prepare them for transplantation. In the meantime, the individual follicular units are placed in a saltwater solution.

    • Implantation

      The hair transplant team makes small incisions in the recipient area and carefully inserts the follicular units into the incisions. A special needle or implantation device is used to place and insert the grafts.

    After the procedure, redness, swelling and crusting may occur in the treated areas. However, the crusts dissolve on their own within about 10 days, and the redness and swelling also subside after a few days. The transplanted hair usually falls out within a few weeks and new hair growth starts after a short time. However, the final hair transplant result only becomes visible after several months to a year. It is important to follow the treating doctor's instructions for care after the procedure in order to achieve the best possible result and minimise the risk of complications (risk factors, side effects).

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