Tasneem Abrahams

Mastering Hair Pulling

Compulsive Hair Pulling Is More Common Than You Think!

Research shows that trichotillomania is a very common disorder.

Posted May 23, 2016

If you find yourself feeling riddled with the compulsive urge to pull out your own hair to the point of balding, you might be thinking, "Why me? what is wrong with me? Am I the only person who does this?" People who compulsively pull out their own hair often hide this habit in shame, leading to increased feelings of loneliness and social isolation. What many do not know is that compulsive hair pulling is a clinically recognized disorder called Trichotillomania. It is included in the American Psychiatric Association's Diagnostic and Statistical Manual under the category Obsessive Compulsive and Related Disorders (OCD-R), and referred to in clinical circles as a body-focused repetitive behavior (BFRB). This means that although it is not OCD, it is very closely related in that it presents with similar symptoms. Despite this, Trichotillomania along with all the other BFRBs are of the most under-diagnosed and therefore untreated psychiatric conditions. The shame and embarrassment experienced by Trich sufferers are often tied to the false assumption that you are the only person who engages in this strange behavior. 

You are NOT alone! 

Source: postman85/pixabay

As a little known condition, Trichotillomania only recently started received attention from medical researchers in the field of mental health. Studies into the epidemiology of Trichotillomania has been lacking until about the last decade, when there has been a growing recognition of the need for prevalence studies to understand how often Trichotillomania occurs in different groups of people and why. This information is vital in developing prevention strategies for those groups identified as being at-risk, and management of those already challenged by the condition. A 2013 study reports that it is estimated between 0.6% and 4.0% of the overall population, and 1% in the United States will have experienced Trichotillomania in their lifetime. This means that approximately 2.5 million Americans may be affected by this condition at some point in their lives. The problem with gathering statistical data on the frequency of trichotillomania is that denial of the disorder is frequent, and many people who have the disorder do not seek professional help and are therefore not counted. There is also mounting evidence of heritability having an influence, with a 1994 study reporting that approximately 5% of first-degree relatives of the 22 study participants were reported to be hair pullers.

Who is affected by Trichotillomania?

Trichotillomania does not seem to discriminate significantly between age, gender or race. It can affect children from as young as baby to adults into their later elderly years. The average age of onset for trichotillomania is between 9 and 13 years with a peak prevalence at 12-13 years. The severity of presentation also appears to be higher in adolescence with prognosis becoming poorer as onset age approaches adulthood. This means that adolescent to young adult sufferers usually have a more long-lasting form of the disorder and do not respond as well to treatment.

Age of onset also appears to have a correlation to the prevalence of trichotillomania between the sexes. The literature suggests that there is an equal distribution of Trichotillomania incidence between the sexes among preschool-aged children, whereas a staggering 70-93% of pre-adolescents and young adults are female. A 2007 article in the American Journal of psychiatry reports that females tend to outnumber males by 3 to 1 among adults, with the Diagnostic and Statistical Manual (DSM-5) citing an overall female predominance of 10 to 1. However, it is also important to bear in mind that male sufferers are often also less likely to report or seek help for Trichotillomania because it is easier to hide. 

Currently there are no studies reporting differences in the prevalence of trichotillomania between different racial groups, although the disorder has been reported in all race groups. 

Trichotillomania and other psychiatric disorders

Mira DeShazer/ Pixabay
Source: Mira DeShazer/ Pixabay

In 2012, at an American Association of Psychiatry (APA) meeting, a panel of experts presenting the recent advances in research reported that up to 60% of individuals with Trichotillomania had another current psychiatric disorder. They further went on to list major depression, generalized anxiety disorder, social phobia, obsessive compulsive disorderimpulse control disorders, and substance use disorder as the most commonly occurring conditions co-morbid with Trichotillomania.

Why are the numbers important?

Research of this nature is fundamental to the successful development of effective prevention and management of the condition on a large scale. By understanding who it affects and what the average age of onset is we can develop a better understanding of what triggers onset so we are better able to be proactive in preventing it. 

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