Dr Eddie Murphy Living with trichotillomania

Mary, I can hear and feel the stress in your letter. There is a lot going on for your daughter. It seems that much of her experiences stem from the emotion of fear. Too often in the medical system, when children don’t hit pre-determined clinical thresholds for the diagnosis of a particular condition, they are deemed unsuitable for CAMHS intervention. In my view, these thresholds are set too high. We need CAMHS to be a one-stop shop to support children and their families, who are obviously struggling but may not have an official diagnosis. Some quick advice first: scientific trials have not found much evidence to support the benefits of craniosacral therapy. Nevertheless, I appreciate that parents will try anything during times of stress for their children.

What is trichotillomania?

Often called ‘ Trich,’ or ‘ TTM,’ trichotillomania is often not discussed or acknowledged due to the shame and embarrassment that it causes people who have it. They pull out the hair on their scalp, eyelashes, eyebrows or other parts of the body. This often results in the individual having noticeable bald patches or they may have no eyelashes. This disorder is different from alopecia, although both often result in noticeable bald patches. The main difference is that people with alopecia lose their hair involuntarily whereas people with trich actively pull their hair out.

Current research estimates that 1-2% of the population has trichotillomania to some degree. It often develops in pre- or early adolescence. It does appear to affect women more often than men but as more research is done, this picture may change since it is possible that men are more embarrassed by the condition and and are therefore less likely to seek help.

What can be done?

It is important for people to find appropriate treatment because trich is manageable! Many people with trich lead active and fulfilling lives. Cognitive Behavioural Therapy, (CBT) with a particular focus on the behaviour part, is very useful. The presence of anxiety and self-esteem issues means cognitive strategies are important too. I would advise that anyone with trich should find how much a CBT practitioner knows about the condition before deciding to pursue a course of treatment with them. For example, I don’t offer treatment for trich to patients. The best evidence-based approach used by psychologists or behavioural therapists involves habit reversal training and stimulus control techniques. There are useful resources at ocdireland.org and I hope Mary and her daughter will find this answer useful.