Information About Trichotillomania
Trichotillomania Frequently Asked Questions:
The following are frequently asked questions on trichotillomania. The information provided is not meant to be a substitute for the information obtained at an evaluation and by discussion with a physician but merely to encourage understanding of this condition. No questions regarding individual scenarios will be answered by the AHRS. No changes in treatment should be undertaken by a patient without discussion first with the patient's physician.
Trichotillomania can be difficult to diagnose and is often confused initially with alopecia areata, a different type of hair loss. Also, if the individual with trichotillomania is being secretive about the habit, it obviously can delay the diagnosis. Trichotillomania and alopecia areata can be confused because they both can present as patches of hair loss and both can even have short stubby hairs in the affected areas. However, there are some differences between the two conditions that a trained hair specialist can recognize. One is that the patches of hair loss in trichotillomania are often irregular, geometric patterns where in alopecia areata the patches are smooth-bare and perfectly round. If there is doubt in the mind of the hair specialist, a biopsy can be done to confirm the suspected diagnosis. The biopsy findings of trichotillomania under the microscope are quite specific.
This can be a difficult diagnosis to make if the person denies the real reason for the hair loss. Sometimes in trichotillomania, only eyelashes may be pulled out. It can be easily confused with alopecia areata in which the eyelashes may be lost as well. In trichotillomania, there is a cycle of continual regrowth and loss in an uneven pattern. There is often the stubble of hairs either regrowing or broken off. Biopsies of the eyelid to provide definitive information are generally not done.
Your daughter has a disorder characterized by the irrational compulsion to pull out her hair. It is undoubtedly confusing to her and a painful admission for her to make, even to her parents and close friends. Certainly, she doesn't want to "mutilate" herself. You can be sure, that if she could choose, she would love to have hair like her friends. People with trichotillomania are not "crazy". They simply have this irresistible urge to pull at their hair, which can be as puzzling to them as it is to you. People with trichotillomania, like people with other compulsions or obsessions, are often very successful in school and work. With gentle offers of help and support without accusations or ridicule, your daughter may eventually see the benefit of getting professional help. The teen years are difficult enough without the added burden of struggling with strange compulsions, especially one that is as visible as having patches of hair loss.
Trichotillomania is felt to be related to other disorders characterized by compulsions (such as nail biting and skin picking) or obsessions (characterized by intrusive unwelcome repetitive thoughts) that may be in part caused by alterations in brain chemistry. One thought is that there may be changes in serotonin metabolism. The group of drugs called serotonin reuptake inhibitors, of which Prozac is one type, can have a beneficial effect in treatment of these disorders. Prozac has been FDA approved for 14 years and has a good safety profile, though like all medications, it can have unwanted side effects. A health professional, experienced in use of these medications, should monitor such treatment.
In some cities, there are support groups for people with trichotillomania, dedicated to mutual emotional support and sharing successful treatment strategies. There are also specialists in various areas of the country who are especially interested in treating trichotillomania and may have group therapy session in which you could talk with others having the same issues. You can learn more about support groups and specialists in your area by contacting the Trichotillomania Learning Center, a national trichotillomania support organization, dedicated to supporting individuals with educational materials, outreach and networking. The email address is firstname.lastname@example.org. They also have two yearly national meetings, focusing on various aspects of trichotillomania. There are internet message boards and chat rooms, another way of finding and "talking" with people who are experiencing problems like yours