What is Trichotillomania and how did it present in my daughter?

Trichotillomania Facts

Trichotillomania is a hair pulling disorder and is often known as Trich.

Trichotillomania is when someone can’t resist the urge to pull out their hair. They may pull out the hair on their scalp, eyelashes, eyebrows, under arms, legs, pubic regions and anywhere hair grows on their bodies.

Sufferers have an intense urge to pull their hair, the urge will grow and intensify until they pull the right kind or the right amount of hair, then the urge is replaced with relief.

Some people play with their hair after pulling it, stroking the root bulb across their lips, chewing the bulb, swallowing the hair, others just discard it and the pulling is gratifying enough.

Trichotillomania falls under the OCD category of mental health illness’s. By its very nature it is not something that someone can just stop, snap out of, control, as the category name says it is obsessive and compulsive.

It can start at any age but it is often between the ages of 5 and 7 and 11 and 14 that trichotillomania starts,

People who suffer with Trich tend to be very lonely and isolate themselves from others because of fear of judgement and their own feelings of shame.

In children males and females are equally likely to suffer but from adolescence and into adulthood more females than males suffer with trichotillomania.

There is no known cause and no known cure for trichotillomania.

Many professionals think trichotillomania is an anxiety related illness. This is because stress and anxiety can make symptoms worse and hair pulling more prolific however most people with Trich will tell you they pull whether stressed or anxious or happy and calm.

Most people are offered Cognitive Behavioural therapy (CBT) and SSRI’s antidepressants which have proven to be somewhat effective in treating OCD behaviours. There have been varying degrees of success reported with either or both combined ideas.

How Trichotillomania Presented in my Daughter?

In April 2018 I caught my daughter pulling out individual strands of hair from her scalp, discarding several strands but seemingly choosing to keep certain strands. I watched for a while as she played with the hair, stroking her lips and then biting into the root.

At first she said she had never done it before, then she said she had caught herself doing it several times a day over the last week or so. Neither of us thought it was  a big deal and for the next couple of weeks, every time I saw her I mentioned it and she stopped.

Then my daughter told me how she felt she was becoming addicted to pulling out her hair to find the perfect root, it wasn’t about the pain, it wasn’t self harm as I was suspecting. It wasn’t about the hair itself but the bulbous root on the end. She explained how she felt almost excited when the bulb burst between her teeth. This was a VERY steep learning curve for me.

Tidying out her room with a full spring clean I was horrified to find lots of hair behind her bed, she was clearly pulling a lot more than I realised and i was shocked she wasn’t bald from the amount of hair under her bed.

In May there was evidence of clear bald spots on the top and right hand side of her head and a huge amount of thinning all around. I was horrified and felt so sorry for her. She already had anxiety and struggled going to school, now she looked ill. I think it is only the fact she looked ill that stopped kids bullying her or teasing her about it. However she was aware people were talking about her and pointing and staring.

The Psychiatrist at CAMHS that she saw for anxiety and had her on 20mg of Fluoxetine (prozac) for anxiety and depression said he wanted to double her dose in an attempt to stop the OCD urges. Fluoxetine increased to30mg on 19th June 2018 Fluoxetine increased to 40 mg on 3rd July 2018. I believe it was the Fluoxetine that triggered her Trichotillomania and later went on to cause her to develop Myalgic Encephalomyelitis.

My daughter was now wearing a beanie hat most of the time/ Her psychiatrist had written a letter for school so they allowed her to wear it in class.

We both went on a huge learning curve researching Trich and finding out about options for hair transplants, weaves, extensions, wigs etc. 

The heart-breaking thing is my daughter was desperate to stop and wanted her hair to grow back but couldn’t control the urges and felt she was a failure so her self esteem was doubly hit, once by the visual and once by the emotions.

In August 2018 she decided to try a wig but she found it hot and itchy and felt everyone knew it was  a wig and the frustration of not being able to pull was making her very angry and annoyed and short tempered.

Since becoming ill in September 2018 and sleeping for over 20 hours a day some days she saw a lot of hair regrowth and had a fringe again. However the urges have not gone and it is a minute by minute battle with herself when she is awake not to pull. One she gives in and pulls one hair the search for the perfect hair starts and can mean a lot of pulling and the reoccurrence of bald spots so a few minutes pulling can set her back weeks of regrowth 😦

Elizabeth hated the wig after the first few days, it was hot and made her head itchy, made her think everyone was looking at her and knew it was a wig and would think she was undergoing chemo treatment and it also prevented her from pulling when she needed to so was increasing her anxiety and stress.

During the Covid19 pandemic lockdown periods Elizabeth went almost 2 years without having her hair cut. She was more controlled with her pulling and more selective over where and how much so her main area of thinness was her crown and along her main hair parting. However now she found a new way to meet her need. She had a lot of split ends and was fixated on further splitting them, so she would pull hairs apart into strands then pull them out exposing the root bulb and getting double the satisfaction.

So now she had thinning on top, multiple layers from re growth and shocking conditioned hair from the bottom to mid length. Time to go to the dreaded hairdresser and get the dead, split ends cut off, the layers blended and get advice on what we affectionately refer to as her pineapple (the sticking up re growth around her crown area).


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