Alice,

Ever since I was in junior high, I have been pulling out my hair. I can remember not being able to pull my hair into a ponytail because the hair at the nape of my neck wouldn't reach. I still have this awful and shameful habit. I don't see it so much as just a habit, like the way one might bite one's nails, it's more like an obsession. I'll just sit and stare into space and pull clumps of hair out of my head. I remember having seen a program on T.V. which dealt with this habit as a medical problem that is curable with medication. Unlike the men and women represented on this program, I am not stripping myself bald — yet. I tend to consider it a form of self-punishment, perhaps. Just to give you some background information, I have a tendency towards bulimia (cycles of bulimia occur when my depression is at its worst) and am in general not a happy camper. What can you tell me about this?

Signed,

Me

Dear Me,

It takes strength to change behaviors, particularly when you believe them to be awful and shameful ones. So, you may not be a happy camper, but you certainly are a strong one. Hair pulling and bulimia commonly coexist, and researchers have found a relationship between the two. There is plenty more to tell about hair pulling, bulimia, and depression, as well the relationship between these behaviors and conditions, so keep on reading!

Recurrent, irresistible urges to pull out hair from your scalp, eyebrows, or other areas of your body, despite trying to stop, are symptoms of a mental disorder called trichotillomania, which is categorized as a body-focused repetitive disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). People with trichotillomania describe experiencing mounting tension before pulling out their hair, and gratification or relief after pulling it out. Trichotillomania is a chronic condition that spans genders and ages. However, research indicates that those assigned female at birth seek treatment more often than those assigned male at birth and tend to experience onset during childhood or adolescence.

Your line of inquiry sheds light on the finding that trichotillomania commonly coexists with other illnesses, such as eating disorders and other psychiatric conditions, and psychiatrists have found evidence to support a relationship between trichotillomania, obsessive-compulsive disorder, and eating disorders. Between 2 and 14 percent of those living with trichotillomania also have a bulimia nervosa diagnosis, which suggests higher rates of eating disorders among those with trichotillomania than in the general public.

Given the intersections of these (and other) diagnoses, patients are encouraged to be thorough when explaining symptoms to health care providers so that they receive the most appropriate treatment recommendations. Contrary to what you saw on television, no specific medications have been approved by the Food and Drug Administration to cure trichotillomania (although medications do treat symptoms of some coexisting disorders). There has been evidence to suggest that certain therapies can be helpful in treating this condition:

  • Habit reversal training: This therapy involves learning how to recognize situations where you're likely to pull your hair and how to substitute other behaviors instead.
  • Cognitive therapy: This therapy can help you identify and examine distorted beliefs you may have in relation to hair pulling.
  • Acceptance and commitment therapy: This therapy can help you learn to accept your hair-pulling urges without acting on them.

Other treatment methods include awareness training and social support. Like habit reversal training, awareness training assists patients in becoming aware of the circumstances that trigger hair pulling. It also involves training for employing therapeutic techniques to discourage patients from performing the behavior. Social support takes a different approach – this method focuses on creating a sense of community by involving the patient’s love ones in the therapy process.

Even though there is plenty to read online about trichotillomania and bulimia, a health care provider or mental health professional is still the best person with whom to discuss your symptoms and experiences. To prepare for a conversation with a professional, consider the following questions: When did the hair pulling and bulimia start? What do you believe are the triggers these behaviors? What has happened or does happen when you tried to stop? Thinking about these questions can help you inform your health care provider, who can then make the most appropriate recommendations for you.

Alice!

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