Imagine harboring a secret that’s so embarrassing you can’t tell even the people closest to you. You live a normal life that’s tinged with the constant fear they’ll find out and judge you for something you cannot control. Now, imagine you’re a child  still learning how to cope with mixed emotions, trust, and peer pressure — all while struggling with a mortifying secret.

That’s what life is like every single day for people with trichotillomania.

Trichotillomania, or trich, is the compulsion to pull out one’s hair from the roots. An estimated 1 to 2% of people worldwide struggle with it, with onset most commonly occurring during late childhood or early puberty. It’s both an uncommon and silent condition; in fact, actual numbers of people with trich may be higher, but from shame and embarrassment, some struggle with the condition their entire lives without anyone knowing. On the off-chance your child develops this condition, know what to look for and how to help him or her.

UNDERSTANDING TRICH

Trichotillomania is a relatively nascent area of mental health research; there are several theories as to what causes it, but no proven conclusion. Researchers are even at odds about whether it is a psychological condition or biological one caused by a change in hormone levels.

An important aspect of trich is that the pulling of hair – from any part of the body, including head, face, arms, leg and pubic area – is often a direct response to an emotion, usually stress. A person first feels stress, then, a sense of pleasure or relief once he or she has pulled out the hair, frequently followed by guilt, embarrassment, self-loathing or shame. Some people do pull out of habit, without an emotional trigger, but the cycle of pleasure, relief, guilt and shame remains. (A related disorder is dermatillomania, or skin picking. While the action is different, the compulsion and emotional experience is the same.)

While researchers cannot identify its cause, they have been able to determine what constitutes trichotillomania. According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DMS-5), trich is characterized by:

• recurrent pulling out of one’s hair, resulting in hair loss
• repeated attempts to decrease or stop hair pulling
• a sense of shame or distress that can affect the person’s social or professional functioning
• hair pulling or hair loss that is not prompted by cosmetic care or another medical condition or mental disorder

IDENTIFYING AND RESPONDING

People of any age or gender can develop trichotillomania, though it’s more common in women, than men, and onset commonly coincides with puberty. Because people with trich may pull single strands from any part of their body, often (though not always) in private, it’s a difficult condition to identify. But over the years, the compulsion can cause bald spots on the scalp or scanty eyebrows or eyelashes. You may notice an unusual amount of hair shed around the person’s pillow, bed, desk, or bathroom. If young, she may suddenly not want you to brush or style her hair.

If your child exhibits these signs, be gentle when asking if everything is OK. He will likely deny that he pulls his hair because of the shame he feels; she may become defensive because her fear of being discovered has been realized. If she shrugs it off — but the bald spots remain or increase — assure her of your acceptance and support and help her get treatment.

TREATING TRICHOTILLOMANIA

There is no proven solution to trichotillomania. If the condition first appears when the child is young, he or she is likely to stop pulling naturally after some time. But adolescents may have a harder time curbing hair pulling, and people who start pulling in adulthood have the hardest time of all. Some may stop pulling with treatment, while some may not.

Therapy is considered the best way of helping people struggling with trich. Some psychiatrists prescribe antidepressants also, as one theory suggests trichotillomania is caused by a change in levels of dopamine and serotonin (chemicals related to depression) in the brain. But while this medication may help reduce trich symptoms in some, there is no scientific evidence – not in the form of clinical trials, research, or studies – that proves it is effective in treating trich or that trich is related to depression.

Treating trichotillomania is a long and difficult road that requires patience and willpower. And it can only begin when the person admits – to him or herself as well as to a confidante – that he or she has trichotillomania. Multiple setbacks and/or failure is common and doesn’t mean the person isn’t trying; compulsion, by definition, is a difficult thing to resist, let alone master. What matters is the attempt, because while trich poses no threat to the individual or others around them, the emotional turmoil a person experiences can make him or her anxious, depressed, or withdrawn over time.

HOW TO HELP SOMEONE WITH TRICHOTILLOMANIA

If you suspect your child or someone you know struggles with trich, here are some suggestions on how to help, from the Canadian Body-Focused Repetitive Behaviour Support Network (CBSN):

Understand, don’t blame

The most important thing you can do to help a person with trich is to understand he or she cannot control the behavior. Blaming him for not stopping or expecting her to stop at once will only add to the person’s stress and make the disorder worse. Avoid phrases like “Just stop it” or “Try harder.” Know that he or she wants to stop pulling hair but cannot do so.

Identify possible stressors

Identifying emotional triggers can help a person stop or reduce hair pulling. It could be a number of things: He could be unhappy with his job; she could have financial troubles; he could be stressed about exams, etc. Knowing what prompts the behaviour can help the person make life changes that reduce the stress, and consequently, the compulsion.

Keep hands busy

Finding an activity for him to do with his hands can help keep him from pulling hair. If she’s studying, suggest that she make notes to keep her hands active. Or get him a ball or small toy to squeeze. He may subconsciously put it down and start pulling, but if that happens, just remind him gently to keep using the ball or toy.

Get help

Therapy is the best way to manage trichotillomania. And a professional may have even more suggestions for dealing with the condition and/or supporting a loved one. Also, online support groups can be a source of comfort for people with trich, who often feel isolated and lonely from hiding their behaviour. The following organizations offer peer-to-peer support as well as broader discussion forums for people all over the world:

• CBSN
• Trich.org
• Trichotillomania.co.uk

No two people with trich are alike; while one may recover completely, one may never stop pulling. But therapy and emotional support can go a long way in helping a person in their struggle against trichotillomania.