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Hair Pulling Disorder or Trichotillomania

Hair Pulling Disorder or Trichotillomania

Hair Pulling Disorder- It is not bad to pull hair out of extreme happiness and anger or pulling hair by grandchildren, there is a comfort. But it is certainly not good to pluck hair, consciously or sub-consciously, one by one making a large portion of the head empty. ‘Trichotillomania’ is a mental disease and the patients of this disease pull and pluck their hair.

Trichotillomania:
Trichotillomania (TTM), also known as hair pulling disorder, is a mental disorder characterized by a long-term urge that results in the pulling out of one’s hair. This occurs to such a degree that hair loss can be seen. This is a mental disorder where the patient or the affected person pulls his hair down. The patient makes it a habit and always does it. Therefore, he becomes bald gradually.

At first, it does not seem to be a problem. But the person becomes addicted to this habit eventually. At one stage he cannot restrain himself from doing it. He feels distressed if he abstains. He feels a little relief after pulling his hair for a short period of time but afterward, it becomes the reason for his discomfort. At present, this disease is considered a part of obsessive-compulsive disorder.

Many people say that the person suffering from this hair pulling disorder does not feel any pain. Many say that their feeling of pain has decreased. And some say that they reduce their tension or anxiety by pulling their hair.

When and whom?
Both men and women can be affected by this disease. However, it affects women relatively more than men. The most common age of onset of trichotillomania is between ages 11 to 13. In some cases, it may onset before (2-6 years) but most of them become well soon.

The incidence of this disease is seen in different people of the same family. So there is a hereditary link. It happens also because of the problems in neurotransmitters, serotonin, and dopamine. Cats, dogs or horses have similar problems.

Places:
The scalp is the most common pulling site, followed by the eyebrows, eyelashes, face, arms, and legs.
Scalp 75%, eyelashes 53%, eyebrows 42%, pubic hair 17%, beard 10%, mustache 7%, arm 10%, leg 7%, chest hair 3%, bally 2%. This is the closest figures.

Social discomfort:
Patients may be ashamed or actively attempt to disguise their symptoms. This can make diagnosis difficult as symptoms are not always immediately obvious, or have been deliberately hidden to avoid disclosure. This ‘hair pulling disorder’ disease brings social discomfort and embarrassment. Patients always try to hide their symptoms from the society. Sometimes other mental problems can be associated with this disease too.

Special group:
There is a special group who eat their hair after pulling. And it is extremely horrible. It can obstruct the intestine in the stomach. The inner tubes of the stomach can be stopped. Many have the habit of biting after pulling hair. It is really harmful for the tooth.

Treatment:
Psycho-Education:
The biggest obstacle for treatment is the patient himself. The patient hides his problems. Since he can do all the work normally without any obstacle, this matter becomes the cause of extreme discomfort. Many even do not consider it as a disease. So he, the patient, and his family have to accept this ‘hair pulling disorder’ as a disease first.

Medication and Psychotherapy:
The treatment of this ‘hair pulling disorder’ disorder is a lot like the treatment of OCD; Serotonin Reuptake Inhibitor and Cognitive Behavioral Therapy. Habit Reversal Therapy is also beneficial for the treatment of this disease.

Caution:
Many people think that this is a skin disease. Many people also visit a dermatologist. Keep in mind that pulling own hair and hair fall are not the same. As a result, it gets late to start the treatment.

Professor and Coordinator- Psychiatric Sex Clinic, Dept. of Psychiatry, Bangabandhu Sheikh Mujib Medical University- BSMMU, Dhaka, Bangladesh and Former Mental Skills Consultant, Bangladesh Cricket Board