Hair Cutting(Trichotemnomania)
Hair cutting or Trichotemnomania is a body-focused repetitive behavior that involves the compulsive act of cutting or shaving one’s hair. It falls under the category of Obsessive Compulsive and Related Disorders (OCRD). It is closely related to Trichotillomania (hair pulling), tinea capitis (ringworm of the hair), and alopecia areata (unpredictable and sudden hair loss) and is sometimes misdiagnosed as these three conditions.
Signs & Symptoms
People with trichotemnomania find themselves repeatedly cutting or shaving their hair with scissors or razors even when there is no need to. They constantly have an obsessive feeling of removing their hair with a sharp object, which they often cannot resist. This tic (uncontrolled repetitive act) results in hair loss or bald patches on the scalp or other areas of the skin with hair such as the arm, pubis, eyebrows, and eyelashes. The portion of the skin may also appear red and itchy from the cutting or shaving, especially if it occurs in the same area.
It is important to note that these impulses to cut one’s hair do not occur because of a disorder; the feeling is the disorder itself. It may, however, be triggered by situations that cause them fear, stress, and anxiety. It may also be accompanied by sudden fluctuations in mood such as happiness, ecstasy, grief, or sadness. A common trait is that hair cutting brings such person tension relief, pleasure, or satisfaction.
Obsessive cutting: The main symptom of trichotemnomania is the obsessive cutting of one’s hair. It occurs due to a compulsive sensation to use a sharp object to remove the hair, either on the scalp or skin.
Broken hairs: Individuals with this condition usually have broken hairs or hairs that appear to be cut due to the act. It may also appear shaved depending on the instrument used to cut the hair. Doctors would need a dermoscopic view of the skin or scalp to properly diagnose.
Tension relief: A feeling of relief or satisfaction accompanies the compulsive cutting of hair. They may become distressed if they are unable to cut their hair and may exhibit desperate behaviors to satisfy their impulses.
Shame or guilt: Persons with this condition may experience shame from this obsessive habit and denial. In several cases, patients have denied cutting their hair even after clinical tests and examinations.
Withdrawal from interactions: They spend time picking at their hairs because of the irresistible urges. This may cause them to withdraw from friends, family, or social interactions.
Diagnosis
If you suspect you or someone you know is experiencing trichotemnomania, here are some steps to take to diagnose the condition:
- Assessment: A good first step to diagnosis is observing the individual for the main symptom which is uncontrolled persistent hair cutting or shaving or both.
- Medical Evaluation: The individual should seek a proper medical diagnosis by getting checked by a team of practitioners including physicians, dermatologists, and psychiatrists. They would undergo dermatoscopic examinations to examine the scalp or affected skin area to diagnose and identify trichotemnomania from other disorders.
- Psychosocial Tests: Psychiatrists would usually look out for abnormal urges and sensations to cut hair. They would also conduct tests for stressors or triggers and how the patient experiences relief from the tics.
Diagnosis
If you suspect you or someone you know is experiencing trichotemnomania, here are some steps to take to diagnose the condition:
- Assessment: A good first step to diagnosis is observing the individual for the main symptom which is uncontrolled persistent hair cutting or shaving or both.
- Medical Evaluation: The individual should seek a proper medical diagnosis by getting checked by a team of practitioners including physicians, dermatologists, and psychiatrists. They would undergo dermatoscopic examinations to examine the scalp or affected skin area to diagnose and identify trichotemnomania from other disorders.
- Psychosocial Tests: Psychiatrists would usually look out for abnormal urges and sensations to cut hair. They would also conduct tests for stressors or triggers and how the patient experiences relief from the tics.
Impacts and Effects
Continuous hair cutting causes broken hair which is a direct impact of the act itself. The length of the hair may appear irregular or shabbily cut. In the case of razor use, the affected spot could have bald patches that look like alopecia. The main effect of this condition is hair loss. They may also have damaged hair follicles, itchy skin, and injuries from the act.
Individuals with trichotemnomania may have negative impacts on their social life. These include withdrawal from loved ones and social activities because of the obsessive feeling of cutting their hair. This social isolation may also be a result of anxiety, embarrassment, or guilt from the condition, and can take deliberate steps to conceal the affected parts of their body. This can largely affect their self-esteem and body image.
The excessive urge to keep cutting their hair can interfere with the overall quality of life as they are unable to participate in hobbies, school, or work normally. This can take an emotional toll on them and may result in depression.
Treatment
Trichotemnomania can be a frustrating condition, however, there are effective treatment options available. It is important to get professional help and some of them are:
- Psychotherapy: Cognitive-behavioral therapy (CBT) and Habit Reversal Therapy are forms of behavioral therapy that help people unlearn unwanted behaviors, habits, thoughts, or emotions.
- Medications: Doctors may prescribe medications such as antidepressants (selective serotonin reuptake inhibitors or SSRIs), antipsychotics, anticonvulsants, and nutraceuticals. They are effective in reducing the hair-cutting impulse and improving their overall mood and health.
- Treatment programs: Some facilities offer intensive treatment programs for depression, addiction, and neuropsychiatric disorders like trichotemnomania. They engage in exercises such as Exposure and Response Prevention.
- Support groups: Speaking with people living with similar conditions can provide them emotional support, encouragement, as well as make them feel like they are not alone.
Choosing a therapeutic provider to support your BFRB journey is a process that takes time. Patience and persistence are key to finding your own level of success.
Medications used for OCD and other anxiety disorders have been tested on subjects with BFRBs with limited success. There has not yet been any single medication or combined medications approved by the Food and Drug Administration (FDA) for the treatment of BFRBs.
