Trichotillomania (hair-pulling disorder)

Panorama general

Trichotillomania (trik-o-til-o-MAY-nee-uh), also called hair-pulling disorder, is a mental disorder that involves recurrent, irresistible urges to pull out hair from your scalp, eyebrows or other areas of your body, despite trying to stop.

Hair pulling from the scalp often leaves patchy bald spots, which causes significant distress and can interfere with social or work functioning. People with trichotillomania may go to great lengths to disguise the loss of hair.

For some people, trichotillomania may be mild and generally manageable. For others, the compulsive urge to pull hair is overwhelming. Some treatment options have helped many people reduce their hair pulling or stop entirely.

Síntomas

Signs and symptoms of trichotillomania often include:

• Repeatedly pulling your hair out, typically from your scalp, eyebrows or eyelashes, but sometimes from other body areas, and sites may vary over time
• An increasing sense of tension before pulling, or when you try to resist pulling
• A sense of pleasure or relief after the hair is pulled
• Noticeable hair loss, such as shortened hair or thinned or bald areas on the scalp or other areas of your body, including sparse or missing eyelashes or eyebrows
• Preference for specific types of hair, rituals that accompany hair pulling or patterns of hair pulling
• Biting, chewing or eating pulled-out hair
• Playing with pulled-out hair or rubbing it across your lips or face
• Repeatedly trying to stop pulling out your hair or trying to do it less often without success
• Significant distress or problems at work, school or in social situations related to pulling out your hair

Many people who have trichotillomania also pick their skin, bite their nails or chew their lips. Sometimes pulling hairs from pets or dolls or from materials, such as clothes or blankets, may be a sign. Most people with trichotillomania pull hair in private and generally try to hide the disorder from others.

For people with trichotillomania, hair pulling can be:

• Focused. Some people pull their hair intentionally to relieve tension or distress — for example, pulling hair out to get relief from the overwhelming urge to pull hair. Some people may develop elaborate rituals for pulling hair, such as finding just the right hair or biting pulled hairs.
• Automatic. Some people pull their hair without even realizing they're doing it, such as when they're bored, reading or watching TV.

The same person may do both focused and automatic hair pulling, depending on the situation and mood. Certain positions or rituals may trigger hair pulling, such as resting your head on your hand or brushing your hair.

Trichotillomania can be related to emotions:

• Negative emotions. For many people with trichotillomania, hair pulling is a way of dealing with negative or uncomfortable feelings, such as stress, anxiety, tension, boredom, loneliness, fatigue or frustration.
• Positive feelings. People with trichotillomania often find that pulling out hair feels satisfying and provides a measure of relief. As a result, they continue to pull their hair to maintain these positive feelings.

Trichotillomania is a long-term (chronic) disorder. Without treatment, symptoms can vary in severity over time. For example, the hormonal changes of menstruation can worsen symptoms in women. For some people, if not treated, symptoms can come and go for weeks, months or years at a time. Rarely, hair pulling ends within a few years of starting.

When to see a doctor

If you can't stop pulling out your hair or you feel embarrassed or ashamed by your appearance as a result of your hair pulling, talk to your doctor. Trichotillomania is not just a bad habit, it's a mental health disorder, and it's unlikely to get better without treatment.

When to see a doctor

If you can't stop pulling out your hair or you feel embarrassed or ashamed by your appearance as a result, talk to your health care provider. Trichotillomania is not just a bad habit, it's a mental health condition. It's not likely to get better without treatment.

Causas

The cause of trichotillomania is unclear. But like many complex disorders, trichotillomania probably results from a combination of genetic and environmental factors.

Factores de riesgo

These factors tend to increase the risk of trichotillomania:

• Family history. Genetics may play a role in the development of trichotillomania, and the disorder may occur in those who have a close relative with the disorder.
• Age. Trichotillomania usually develops just before or during the early teens — most often between the ages of 10 and 13 years — and it's often a lifelong problem. Infants also can be prone to hair pulling, but this is usually mild and goes away on its own without treatment.
• Other disorders. People who have trichotillomania may also have other disorders, such as depression, anxiety or obsessive-compulsive disorder (OCD).
• Stress. Severely stressful situations or events may trigger trichotillomania in some people.

Although far more women than men are treated for trichotillomania, this may be because women are more likely to seek medical advice. In early childhood, boys and girls appear to be equally affected.

Complicaciones

Aunque puede no parecer particularmente grave, la tricotilomanía puede tener un enorme impacto negativo en tu vida. Las complicaciones pueden incluir:

• Angustia. Muchas personas con tricotilomanía declaran sentir vergüenza y humillación. Quizás sufran de baja autoestima, depresión, ansiedad, y consuman alcohol o drogas a causa de su trastorno.
• Problemas con el trabajo y la actividad social. La vergüenza causada por la pérdida de pelo puede llevar a que evites las actividades sociales y oportunidades de trabajo. Las personas que tienen tricotilomanía quizás usen pelucas, se peinen de modo que disimule las zonas calvas o usen pestañas postizas. Algunas personas pueden evitar las relaciones íntimas por miedo de que se descubra su trastorno.
• Daño a la piel y al pelo. Arrancarse el pelo constantemente puede causar cicatrices y otros problemas, incluyendo infecciones, a la piel en tu cuero cabelludo o al área específica de donde se arranca el pelo, y puede afectar permanentemente el crecimiento del cabello.
• Bolas de pelo. Comerte el pelo puede hacer que se forme una gran bola de pelo apelmazado (tricobezoar) en tu tracto digestivo. Después de unos años, la bola de pelo puede causar pérdida de peso, vómitos, obstrucción intestinal y hasta la muerte.