Trichotillomania – You make the diagnosis!

Lets play “hair doctor” for a moment and figure out what is wrong with this patient; A man walks into a hair doctor’s office complaining that he is losing his hair at his right temple.  “This is just where my Dad lost it,” he says, “but at least on my Dad it looked more equal on both sides.  I just can’t figure out why this hair loss has happened to me this way.”  As you speak with him, you find out he is a hedge fund manager and he is right-handed.  He relates how this hair loss really bothers him and asks you to perform hair transplant to fill in that area.

So what does this patient have?  Does he have normal male pattern hair loss just on one side or does this strike you as a little unusual…?  Should you go ahead and offer him a hair transplant?

The Answer:

If your instincts told you something was out-of-place, go sign up for the MCAT.  This patient had trichotillomania (pronounced TRICK-o-TILL-o-MAIN-EE-A) and was literally pulling out his own hair (note that he was right-handed!) from the stress of his job at the hedge fund.  Trichotillomania is the name given to involuntary hair pulling of any kind.  The hair that is pulled out can be anywhere; brows, eyelashes, head hair, and most of the time people say they cannot stop themselves from doing it.

Now that may sound a little strange, but to those people for whom pulling hair has become a reality, the situation is more than frustrating –  it can be tragic.  Maybe you know someone like this from high school or college, or maybe you are reading this because the loss of your own hair bothers you and you are wondering what you can do about it.

As a matter of fact, this frustrating medical condition is where the expression, “pulling one’s hair out,” came from – so if you are in the latter category, you are not alone.  Trichotillomania often affects people in their youth but can start at any time.  It can also be associated with very stressful periods of a person’s life; divorce, moving, changing jobs, personal loss, school and home stressors, depression, and anxiety all can result in compulsive hair pulling.

The Tricky Diagnosis…:

First, just getting a solid diagnosis for Trichotillomania is a step in the right direction.  It allows you to rule out pattern hair loss (also known as “androgenetic alopecia”) or other diseases (like “scarring alopecias”) as a cause and avoid ineffective treatments.  Psychiatrists, hair doctors, dermatologists, and most general practitioners will be able to diagnose this condition with good accuracy.  But just asking if someone is pulling their hair out is not enough – because people sometimes do not realize (or just as often are in denial about) their own hair pulling!

…And even Trickier Treatment:

Treatment for Trichotillomania is another matter.  There are three main approaches;

– Psychotherapy is one of the mainstays of treatment because it helps people by redirecting their behavior to something less destructive.  It is wrong to think that this is a problem that can be cured by sheer will alone.  Plenty of people who suffer from “trich” are strong-willed and might not even admit they are pulling their own hair out.

– Medications like N-AcetylCysteine (also known as “NAC”) and anti-depressants have also been found to be beneficial.  Check with your doctor since there are always recent and more promising developments in the medical treatment for this condition.

– Hair replacement surgery can be life-changing for certain select patients, but it is never attempted if the condition has any potential of being active because the surgery itself can reactivate the urge to pull the hair leading to scarring and a worsened situation overall.

 …But there is Hope!

It is essential to remember that Trichotillomania CAN be treated.  Never lose hope!  The first step is to realize what you have and seek treatment.  Look for specialists in the fields of psychiatry, hair medicine or surgery, and dermatology for a targeted approach, and be prepared to work with several doctors or try several treatments for a final solution.  Your hair and your self-esteem are worth it!

Trichotillomania is the name given to involuntary hair pulling of any kind.  It often affects people in their youth but can start at any time.  Just getting a solid diagnosis for Trichotillomania is a step in the right direction, which is why patients should seek specialists in the fields of psychiatry, hair medicine or hair replacement surgery, and dermatology for a targeted approach, and be prepared to work with several doctors or try several treatments for a final solution.

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