Trichotillomania--"I Feel Like Ripping My Hair Out"--A Literal Concern

By: Sierra Shumate 

           The common phrases, "I'm going to rip my hair out," or, "I feel like I want to jump out of my skin," although they are typically used figuratively, can also be literal.  For some people, a common way to cope with daily stressors or to satisfy urges is by pulling his/her own hair. Hair pulling is commonly a way to change emotional state--from one of anxiety, for example, to a more hypnotic and calmed state. It can be categorized as a self-soothing behavior, but actually takes on quite an addicting quality and is now categorized as an impulse control disorder--trichotillomania.             Other forms of the disorder, such as skin picking behaviors, are difficult to understand by some therapists, as the reasoning behind the behaviors are sometimes unclear. It proves difficult to classify the disorder, as it does have some characteristics of an OC Spectrum disorder--with preoccupations or obsessive thoughts that are mediated by the said hair pulling/skin picking.
              However, not all people with trichotillomania report obsessive thoughts or tension to be the reason behind their behavior, on the other hand, most people find that the behaviors do not occur during times of stress, but rather, during times of calm or leisure activities. Many people report being in a "trance like" state when hair pulling or skin picking, and it thus cannot be categorized under a compulsive disorder, since not all people report obsessive thoughts.
              Instead, many therapists argue that hair pulling and skin picking behaviors like these should be categorized as impulsions, rather than compulsions, because they are simply behaviors triggered by an inability to control certain impulses. Therefore, trichotillomania should instead be classified as an impulse control disorder--and grouped with these types of disorders such as compulsive gambling, binge eating, and substance abuse.
              With the ongoing controversy, it still proves difficult to diagnose these types of behaviors properly, and it is important for therapists to understand that each person has a different reason for the pulling or picking behavior, and that the type of treatment needs to be specifically tailored to meet each individual's needs.