Do you often pull your hair consciously or unconsciously? If you feel pleasured or relieved when you pull your hair, you may be experiencing ‘trichotillomania’ or hair-pulling disorder.
"Hair pulling can be a sign of unresolved anxiety or stress. Often, people may not realize about their condition and simply consider it as a bad habit, until they start experiencing severe psychophysical symptoms,’’ says Dr. Zeel Gandhi, Chief Ayurvedic Doctor at Vedix.
In this article, let’s discuss the symptoms, causes, and risk factors of trichotillomania. You can also explore different treatments available in Ayurveda as well as conventional medicine.
What Is Trichotillomania?
Trichotillomania , which is also known as ‘hair-pulling disorder’ is the condition in which you have an inbuilt compulsion to pull out your hair, often from your scalp. Though your hair grows back in the beginning stages, it may lead to permanent hair loss due to follicle damage over time.
Symptoms Of Trichotillomania
1. You pull off your hair repeatedly from any region in the body.
2. You frequently attempt to control your hair pulling.
3. You may have hypertension before you pull the hair or while resisting yourself to do so.
4. You feel relieved from your tension after pulling.
5. You may play with your pulled hair or rub it across your skin or face.
6. You may feel like biting or chewing your pulled hair.
7. You feel like pulling hair with selective textures.
8. You may have hair loss with small or large bald patches.
9. You often pull your hair privately and feel like hiding your disorder from others.
What Causes Trichotillomania?
Ayurveda believes that the physical, mental, and emotional well-being of an individual depends upon the harmony of three vital energies: Vata, Pitta, and Kapha doshas in the body. When any of these tridoshas are aggravated, it may cause various disorders, including trichotillomania.
1. Events like emotional abuse may lead to elevation of Vata dosha in your body which is associated with feelings of terror, fear, and anxiety. Aggravated Vata may lead to erratic eating, lethargy, sluggishness, and insomnia, which can eventually cause trichotillomania.
2. Factors such as excessive consumption of white sugar or alcohol, physical or verbal abuse, over-ambition, or overwork may lead to a spike in your Pitta levels. It may make you feel more aggressive and angry. The elevation in Pitta dosha is considered to be the most intense of all the dosha types that cause the hair-pulling disorder.
3. Feeling of mental exhaustion and worthlessness are caused by aggravated Kapha dosha in your body. It may lead to oversleeping, eating disorders, and a slower lifestyle, which can eventually result in hair-pulling disorder.
‘’In a way, hair pulling is the attempt of your body to regulate your negative emotions and the act can make you feel temporarily relieved from the emotional distress caused by imbalanced doshas,’’ says Dr. Zeel.
Trichotillomania Risk Factors
In some people, stressful events or situations such as accidents may trigger the hair-pulling disorder.
Trichotillomania can be genetic  and people who have the condition running in their first-degree relatives are most likely to get affected.
3. Other Disorders
People who have other disorders like obsessive-compulsive disorder (OCD) are more susceptible to trichotillomania.
How To Treat Trichotillomania?
1. Ayurvedic treatments
Ayurvedic treatments to cure trichotillomania focus on managing your emotional distress by pacifying the aggravated doshas in your body.
A. Ayurvedic Hair Care
1. To pacify Vata Dosha, massage your scalp and hair regularly using sesame or bhringraj oil. Also, you can start using herbal hair oils that contain Vata pacifying herbs like yashtimadhu, ashwagandha, shatavari, etc.
2. To pacify Pitta Dosha, massage your scalp and hair regularly using coconut or bhringraj oil. Also, you can start using herbal hair oils that contain Pitta pacifying herbs like nimba, yashtimadhu, brahmi, etc.
3. To pacify Kapha Dosha, massage your scalp and hair regularly using sunflower oil or bhringraj oil. Also, you can start using herbal hair oils that contain Kapha pacifying herbs like Karpoora, jyothishmathi, jatamansi, etc.
‘’Apart from bringing your elevated doshas to their balanced state, these dosha-specific Ayurvedic herbs also aid in reversing hair loss caused by trichotillomania by promoting healthy hair growth,’’ says Dr. Zeel.
B. Ayurvedic Head Massages
Head massage therapies like shiro abhyanga, shiro dhara, shiro pichu, shiro vasti, etc. have a special place in Ayurveda in healing your stress-related disorders such as trichotillomania. These head massages promote the relaxation of your scalp blood vessels and induce a deep sense of peacefulness while attaining dosha equilibrium.
Especially, shiro dhara therapies with dosha balancing medicated liquids can impart immense relaxation to your mind while it helps in the elimination of toxins in the form of urination and lymphatic drainage, thus, preventing compulsive trichotillomania.
Panchakarma is a combination of the following five purification procedures:
1. Vamana (emesis) - It eliminates excess Kapha causing mucus, while it relieves repressed emotions and imparts clear thinking.
2. Virechan (purgation) - It pacifies elevated Pitta which causes imbalanced bile secretion and improves your concentration levels.
3. Basti (enema) - It controls elevated Vata levels in the large intestine, which results in the healing of Vata disorders.
4. Nasya (errhines) - It eliminates excessive doshas accumulated in the head region along with nose, throat and sinuses while releasing the trapped emotions in the respiratory tract.
5. Rakta moksha (bloodletting) - It neutralizes the pitta-genic toxins from your blood, which are responsible for causing hyper-tension.
As per Ayurveda, the morbidity of mind and body are co-dependent. The purification of the body attained through Panchakarma, in turn, results in mental well being.
D. Herbal Internal Medication
Trichotillomania is correlated to the Unmada (psychological disorders) of Vata-Pitta origin in Ayurveda. The following herbs are often prescribed to support healthy neurological faculties in the patients:
1. Brahmi ghrita
2. Kalyanaka ghrita
E. Meditation And Pranayama
Meditation is the key to the subtle channels of your mind. It aids you in re-patterning your most habituated responses like hair pulling. Meditation  clears your mind channels and supports the transmission of Prana (the vital breath) throughout your system. This, in turn, leads to proper metabolism of your food, thoughts as well as emotions. It subsides your negative feelings such as anxiousness, anger, stress, etc.
Also, Pranayama is highly potential in calming down your feelings of distress. Practice Ujjayi Pranayama for 41 days in conjunction with meditation for the best results.
Vedix Tip: A well-balanced diet with dosha specific foods based on your innate Prakriti contributes tremendously in maintaining your doshas in a balanced state.
2. Other Medications
Recent studies found that drugs such as clomipramine  (a tricyclic antidepressant), olanzapine (an antipsychotic), and N-acetylcysteine work significantly to control trichotillomania.
However, no drugs have been approved by the FDA and further clinical trials are required to evaluate the efficacy and safety of the drugs.
3. Habit Reversal Therapy
Habit reversal therapy  is one of the most effective treatments for trichotillomania and it involves five stages of training as follows:
A. Awareness Training
In this stage, individuals are asked to track their hair pulling patterns by documenting their emotions, time of pulling along with other important information. Thus, individuals identify different psychological and environmental factors that cause the impulse of hair-pulling.
B. Competing Response Training
In this stage, individual practices to replace the hair pulling habit with a different behavior or action. Often, stress management tools like worry beads and stress balls are used to consciously divert the mind of an individual from hair pulling.
C. Motivation And Compliance
In this stage, activities are conducted in which an individual is motivated to stick with the habit reversal training. This may include group sessions with people enduring similar challenges where they receive praise, support, and motivation from one another. Also, sessions are held with family and friends of the patient in which they learn how to respond and deal with the symptoms of trichotillomania.
D. Relaxation Training
In this stage, the individual practices meditation and deep breathing, which helps in reducing the stress that is associated with trichotillomania effectively. These relaxation techniques help individuals to calm their central nervous system against stress triggers.
E. Generalization Training
This is the stage in which the individuals practice their newly acquired competing response and relaxation techniques in different situations. This ensures that the new behavior or response of the individual becomes automatic.
4. Affirmation Therapy
This therapy involves auto-suggesting or tuning your subconscious mind during deep sleep (hypnosis). It helps the therapist bring out the root-problem or event that caused emotional distress within you. It makes you feel emotionally liberated.
5. Other Preventive Measures
A. Wear thick hand gloves, especially during nights when the urge to pull your hair out will be at a peak.
B. You can apply slippery cream or oil to your hair strands.
C. Start wearing a cotton scarf or cap over your scalp.
D. Short haircuts may help tremendously as it is difficult for you to pull it off.
Whom Does Trichotillomania Affect?
Hair-pulling disorder is most common in children, teenagers, and young adults. It may trigger as early as 10 years of age and women are more prone to the condition than men. And, derangement in your doshas occurring during puberty, pregnancy, menopause, etc. can also lead to the onset of the hair-pulling disorder.
In recent studies, it is estimated that trichotillomania affects about 3.4% of women and 1.5% of men worldwide.
How Is Trichotillomania Diagnosed?
Often, there are high chances that trichotillomania gets misdiagnosed as alopecia areata, as both the conditions look alike to the untrained eye. Also, people, especially children, and teenagers may feel fearful or ashamed to share their compulsive habits with their doctors.
However, uneven hair breakage is the distinctive feature of trichotillomania that may help doctors diagnose the condition. And, unlike alopecia areata (almost the same length of hair strands in or around a bald patch), hair strands of different lengths can be noticed during trichotillomania.
Also, if you are right-handed, then the hair loss pattern is most pronounced on the right half of your scalp, and vice versa when you are undergoing hair pulling disorder.
How Long Does Trichotillomania Last?
Trichotillomania is a chronic disorder where the severity of the symptoms can vary over time. For example, the fluctuation of hormones in women during menstruation may intensify the hair pulling due to aggravation of Pitta.
‘’Undergoing regular treatments would help you resolve the condition in a few months. In some people, the symptoms may come and go for weeks, months, or years when left untreated,’’ says Dr. Zeel.
Does Hair Grow Back After Trichotillomania?
In most cases, hair grows back after you recover from trichotillomania. When the condition persists for a longer time, you may notice less hair growth or it may grow back with a different texture. Rarely, scarring damage occurs to your follicles which leads to permanent hair loss.
Please consult with your healthcare professional or Ayurvedic consultant before you start taking any of the medications and treatments mentioned in this article to control your hair-pulling disorder.
The Last Word
Trichotillomania or hair-pulling disorder may result in negative repercussions in your social, occupational, or other areas of functioning in your day-to-day life. It is very important to seek medical help immediately if the condition doesn’t get controlled on its own within a few months.
Balancing your Ayurvedic doshas will help you restore health across your emotional and mental spheres, thus, addressing the root cause of your hair-pulling disorder.
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